La Chirurgia degli organi di movimento最新文献

{"title":"Posterior shoulder pain and anterior instability: a preliminary clinical study.","authors":"Alessandro Castagna,&nbsp;Marco Conti,&nbsp;Mario Borroni,&nbsp;Giuseppe Massazza,&nbsp;Enzo Vinci,&nbsp;Giorgio Franceschi,&nbsp;Raffaele Garofalo","doi":"10.1007/s12306-007-0013-4","DOIUrl":"https://doi.org/10.1007/s12306-007-0013-4","url":null,"abstract":"<p><p>Different clinical tests have been suggested in the literature as significant indicators of anterior shoulder instability. Sometimes patients with recurrent anterior shoulder instability may show some muscular guarding thus making the evaluation of specific clinical tests very difficult. These patients may also report a medical history with posterior shoulder pain that can be also elicited during some clinical manoeuvres. From September 2005 to September 2006 we prospectively studied patients who underwent an arthroscopic anterior capsuloplasty. Shoulder clinical examination was performed including anterior shoulder instability tests (drawer, apprehension and relocation tests). Furthermore the exam was focused on the presence of scapular dyskinesia and posterior shoulder pain. The patients were also evaluated with ASES, Rowe, SST (Simple Shoulder Test), Constant and UCLA (University of California at Los Angeles) scoring system preoperatively and at the latest follow-up time. In the period of this study we observed 16 patients treated for anterior gleno-humeral arthroscopic stabilisation, who preoperatively complained also of a posterior scapular pain. The pain was referred at the level of lower trapezium and upper rhomboids tendon insertion on the medial border of the scapula. It was also reproducible upon local palpation by the examiner. Four of these patients also referred pain in the region of the insertion of the infraspinatus and teres minor. After arthroscopic stabilisation the shoulder was immobilised in a sling with the arm in the neutral rotation for a period of 4 weeks. A single physician supervised shoulder rehabilitation. After a mean time of 6.8 months of follow-up, all the shoulder scores were significantly improved and, moreover, at the same time the patients referred the disappearance of the posterior pain. Posterior scapular shoulder pain seems to be another complaint and sign that can be found in patients affected by anterior shoulder instability. It can also be related to eccentric work of posterior stabilising muscles of scapula during the altered biomechanics observed in case of anterior shoulder instability. This pain responds positively to surgical intervention showing that re-centring the humeral head probably also re-establishes the periscapular muscle-firing pattern with a mechanism mediated by the proprioceptive system.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"79-83"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0013-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plates with angular stability: our personal experience in surgical treatment of fractures of the proximal extremity of the humerus.","authors":"Rosario Lupo,&nbsp;Santo Alberto Rapisarda,&nbsp;Salvatore Lauria,&nbsp;Giovanni Palmisciano","doi":"10.1007/s12306-007-0017-0","DOIUrl":"https://doi.org/10.1007/s12306-007-0017-0","url":null,"abstract":"<p><p>We here report our experience in the use of locking proximal humerus plates that, compared to the old-generation ones, have shown a reduced incidence of complications, more manageability and higher preservation of soft tissues. Thirty-two patients underwent surgical treatment with plates with angular stability: 20 women and 12 men, with an average age of 52 years; in 6 cases they were fractures with 2 fragments, in 20 cases they were with 3 fragments and in 6 cases with 4 fragments. Results, evaluated according to the Constant Score, with a minimum follow-up of 6 months and the longest of 2 years, have revealed a 79-point Constant Score one year after surgery (min 42, max 94). In 2 cases we have observed necrosis of the epiphysis while there have not been any cases of secondary mobilisation of the synthesis equipment. Our findings, if we consider the low necrosis percentage, show the good adaptability and the preservation of the soft tissues as guaranteed by the synthesis equipment and by the surgery performed.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"97-101"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0017-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informed consent in shoulder surgery.","authors":"Giuseppe Porcellini,&nbsp;Fabrizio Campi,&nbsp;Paolo Paladini,&nbsp;Paolo Rossi,&nbsp;Nicola Lollino","doi":"10.1007/s12306-007-0018-z","DOIUrl":"https://doi.org/10.1007/s12306-007-0018-z","url":null,"abstract":"<p><p>Informed consent is an essential tool for diagnosis and therapy in medicine, and is of fundamental importance in surgery, where it underpins the operation itself. Its origins can be traced back to US forensic medicine but is now incorporated into the Italian legal system, with different consequences depending on the context in which it is applied. This article describes our experiences in shoulder surgery, with suitable references to legislation and analysis of the literature studies in this area.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"103-7"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0018-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of risk in shoulder surgery : medical-legal repercussions.","authors":"Mario Randelli,&nbsp;Leonardo Maradei,&nbsp;Nikolaos Markopoulos,&nbsp;Alessandro Castagna","doi":"10.1007/s12306-007-0021-4","DOIUrl":"https://doi.org/10.1007/s12306-007-0021-4","url":null,"abstract":"<p><p>It is generally recognised that any medical-surgical activity entails the risk of failure, placing the physician at risk of malpractice claims. In order to protect both the physician and the patient, it is important to identify the risk factors relating to the various pathological situations and assess both the incidence and significance of such risks. Hence, a \"Potential Failure Rating\" could be devised already during the preliminary stages for every type of medical process. Such a rating would be useful both in clinical and medicolegal settings. This article considers the most common and important risk factors involved in typical diseases of the shoulder, from which a relative failure rating is formulated.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"125-31"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0021-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New perspectives in rotator cuff tendon regeneration: review of tissue engineered therapies.","authors":"Roberto Rotini,&nbsp;Milena Fini,&nbsp;Gianluca Giavaresi,&nbsp;Alessandro Marinelli,&nbsp;Enrico Guerra,&nbsp;Diego Antonioli,&nbsp;Alessandro Castagna,&nbsp;Roberto Giardino","doi":"10.1007/s12306-007-0015-2","DOIUrl":"https://doi.org/10.1007/s12306-007-0015-2","url":null,"abstract":"<p><p>Tissue engineering may play a major role in the treatment of rotator cuff tendon lesions through replacement of an injured tendon segment. Tendons have very poor spontaneous regenerative capabilities, and despite intensive remodelling, complete regeneration is never achieved and the strength of tendon and ligaments remains as much as 30% lower than normal even months or years following an acute injury. Tendons seem to be the least complex of the connective tissues with respect to their composition and architecture and this leads to the expectation that they would be more amenable to tissue engineered approaches than other tissues. An accurate literature revision was done in order to know the state of the art of tissue engineering therapies in the field of rotator cuff regeneration. The following techniques of tissue engineering were considered: local injection of stem cells or growth factors, gene transfer, in situ tissue engineering and in vitro production of bioengineered tendons to be further transplanted in the lesion site. So far, few experimental or clinical studies have been done on tendon tissue engineering compared to the extensive work on other tissues of orthopaedic interest, such as bone and cartilage. The existing studies are related to the following tissue engineering methodologies: gene transfer, in situ tissue engineering and in vitro production of bioengineered tendons. In our opinion the previously described literature revision showed the necessity for future studies in this area also because of recent advances in biological and bioactive scaffolds.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"87-92"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0015-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial reconstruction technique in the treatment of complex fractures of humeral proximal epiphysis with SMR prosthetic modular system.","authors":"Raffele Russo,&nbsp;Luigi Vernaglia Lombardi,&nbsp;Fabio Cautiero,&nbsp;Gerardo Giudice,&nbsp;Michele Ciccarelli","doi":"10.1007/s12306-007-0020-5","DOIUrl":"https://doi.org/10.1007/s12306-007-0020-5","url":null,"abstract":"<p><p>Prosthetic treatment of complex fractures of humeral proximal meta-epiphysis is a very complex surgery that often does not lead to satisfactory results. Indeed, although in the last 35 years since Neer's studies some progress has been made in the knowledge of the anatomy of humeral meta-epiphysis proximal portion, surgical technique and prosthetic design, in the literature we find non-homogeneous experiences regarding the clinical-functional results. At the same time, such experiences agree as far as pain relief is concerned. We report our experience in the treatment of complex fractures of humeral proximal epiphysis with SMR (Lima Lto, San Daniele, Italy) prosthetic system, using our surgical technique of anatomical reconstruction, starting from the medial neck. The case histories, 35 patients, 30 women and 5 men, aged between 56 and 79, were reported in the observation period between April 2000 and February 2005. In 20 cases the right shoulder was treated and in 15 the left one. At the follow-up the patients were assessed clinically by the average Constant Score and also by X-rays and CT scan in order to measure the prosthesis height, its off-set and retroversion.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"117-23"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0020-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of proximal ulna nonunion.","authors":"Roberto Rotini,&nbsp;Diego Antonioli,&nbsp;Alessandro Marinelli,&nbsp;Dragana Katusić","doi":"10.1007/s12306-007-0011-6","DOIUrl":"https://doi.org/10.1007/s12306-007-0011-6","url":null,"abstract":"<p><p>We reviewed our experience in the surgical treatment of 12 cases of proximal ulna nonunion. The primary injuries were 2 fracture-dislocations of the olecranon, 6 Monteggia lesions and 3 isolated fractures of the proximal ulna. According to the type of primary injury and its anatomical site, the nonunions were classified into 2 groups, considering that the nonunions nearest to the humerus-ulna joint present a more disabling clinical profile and are more difficult to treat: group A (6 patients - nonunion within 5 cm from the olecranon tip of the olecranon) and group B (6 patients - nonunion between 5 and 10 cm from the olecranon tip of the olecranon). In all cases, after fibrous callus debridement and bone surface remodelling, fixation was performed with plate and screws and homoplastic cortical bone graft (orthogonal or parallel to the plate) and an intercalary bone cylinder when the bone defect was severe. In 3 patients (group A), where the defect was smaller than 1 cm, fixation of the ulna was combined with a resection of the radial neck. Clinical-radiographic healing was achieved in all patients followed for a mean of 27 months. Complications included a case of nonunion due to failure of the intercalary graft with plate breakage. The patient healed after a new surgery performed with same technique. The score, according to the Broberg-Morrey scoring system, was 78 in group A patients and 93 in group B patients. The use of homoplastic cortical bone graft represents an effective technique to improve the mechanical properties of the fixation and supports biological union, even when the bone defect is severe.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0011-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of anatomical prostheses in primary glenohumeral osteoarthritis.","authors":"Giovanni Merolla,&nbsp;Paolo Paladini,&nbsp;Fabrizio Campi,&nbsp;Giuseppe Porcellini","doi":"10.1007/s12306-007-0019-y","DOIUrl":"https://doi.org/10.1007/s12306-007-0019-y","url":null,"abstract":"<p><p>More than 32.8% of the over-60s suffer from shoulder osteoarthritis. For advanced osteoarthritis, arthroplasty is the treatment of choice. Current systems have moved on from the first shoulder prosthesis implanted by Neer in 1974, thanks to the use of adaptable modular systems. The aim of this study was to investigate the effectiveness of anatomical shoulder replacements in 30 cases of primary glenohumeral osteoarthritis through clinical and radiographic follow-up for a mean of 5 years. All implants were total cemented prostheses. Preoperative investigations included a clinical examination, conventional X-rays and CT. The Constant-Murley scale was used to evaluate the results; the mean score increased from 21.4 preoperative to 69.8 postoperative (p<0.05). In patients aged under 50, the increase in the mean postoperative Constant Score and ROM was greater than for the sample as a whole. The following complications were encountered: 2 postoperative radial nerve paralyses, resolving in 3 months, 2 cases of glenoid loosening, 1 periprosthetic fracture and 3 cases of pain and stiffness. The results led us to conclude that anatomical prostheses are effective in the treatment of severe primary glenohumeral arthropathy.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"109-15"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0019-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new test of resistance in the diagnosis of postero-superior rotator cuff tears.","authors":"Stefano Gumina,&nbsp;Antonio Bertino,&nbsp;Giantony Di Giorgio,&nbsp;Franco Postacchini","doi":"10.1007/s12306-007-0014-3","DOIUrl":"https://doi.org/10.1007/s12306-007-0014-3","url":null,"abstract":"<p><p>The aim of this study was to assess the diagnostic accuracy of a new clinical test for the diagnosis of subacromial impingement and full thickness postero-superior rotator cuff tears. One hundred and twenty patients who underwent arthroscopic treatment for acromioplasty or cuff repair were previously submitted to a new test of resistance. The test is performed in the standing position with the involved arm in 90 degrees abduction, 20 degrees -30 degrees anteposition and in external rotation (as for full-can test). Thus, the patient was invited to follow the way of a spiral drawn on a drawing sheet for 20 turns; 1 turn = from the centre to the end of the spiral and vice versa (spiral width = 20 cm). The test was considered positive when the patient was not able to conclude it due to strength decrease or to shoulder pain. Sensitivity, specificity, positive and negative predictive values as well as diagnostic accuracy were calculated for our test of resistance. The test resulted scarcely reliable as detector of subacromial impingement and not very reliable as detector of small tear. When the test is positive there is a high probability that a subacromial disease exists; instead, when it is negative there is a high probability that the patient has not a large or massive cuff tear. The resistance test (Gum-Turn test) adds to our armamentarium of physical examination signs in patients with painful shoulder and furnishes further information on possible dimensions of tendinous tear.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"85-6"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0014-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the subscapularis contracture during shoulder arthroplasty for primary glenohumeral arthritis.","authors":"Giuseppe Fama,&nbsp;Pasquale Nava,&nbsp;Silvia Pini,&nbsp;Marina Mary Cossettini,&nbsp;Assunta Pozzuoli","doi":"10.1007/s12306-007-0012-5","DOIUrl":"https://doi.org/10.1007/s12306-007-0012-5","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the safety and effectiveness of a particular subscapularis release in shoulder arthroplasty for primary glenohumeral arthritis.</p><p><strong>Materials and methods: </strong>Twenty-eight patients (19F, 9M) underwent shoulder arthroplasty for primary glenohumeral arthritis. Preoperative average Constant Score (CS) was 31.2 points (range 14-52), active anterior elevation (AAE) 92 degrees (30-100 degrees ) and active external rotation (AER) 11 degrees (-40 to 20 degrees ). During arthroplasty for subscapularis contracture, patients underwent subscapularis release freeing the superior tubular tendon (STT) with a section of the coracohumeral ligament (CHL) and the superior glenohumeral ligament (SGHL) and a deep release consisting of a section of the middle glenohumeral ligament (MGHL), very close to the glenoid labrum, and the inferior glenohumeral ligament (IGHL). An anatomic study was performed on 13 cadavers, verifying the structure of subscapularis tendon and its relationship with the capsule, the surrounding ligaments and the axillary nerve. Moreover, after having placed traction sutures on the subscapularis tendon, its lengthening was measured after STT release alone and after STT and deep release. The complete absence of neurological and vascular lesions was also verified.</p><p><strong>Results: </strong>Average follow-up: 2.9 years. Postoperative mean CS was 70.5 (p[Symbol: see text]0.005), with an absolute gain of 39.1. AAE increased from 92 degrees to 142 degrees (p=0.001) while AER increased from 8 degrees to 48 degrees (p=0.002). At the last follow-up, 19 patients (67.8%) were very satisfied, 5 patients (17.8%) were satisfied, 3 patients (10.7%) partially satisfied and 1 patient (3.5%) unsatisfied. In the anatomic control, the average lengthening of subscapularis tendon was 0.9 cm after STT release alone and 2.5 cm after STT and deep release. No vascular and neurological lesions were observed.</p><p><strong>Conclusions: </strong>The subscapularis release during shoulder arthroplasty is extremely important to obtain the proper balance between anterior and posterior soft tissues and to achieve an optimal range of motion and joint stability. An adequate anatomical dissection could give good tendon mobilisation and lengthening, necessary for a good repair, and lead to a recovery of the range of motion, particularly for external rotation.</p>","PeriodicalId":76085,"journal":{"name":"La Chirurgia degli organi di movimento","volume":"91 2","pages":"71-7"},"PeriodicalIF":0.0,"publicationDate":"2008-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12306-007-0012-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27303927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}