Injuries of Upper Limbs

Injuries of Upper Limbs
     

• SJ O’Brien, MJ Pagnani, S Fealy,
  et al (Hosp for Special Surgery, New York)
  The Active Compression Test: A
  New and Effective Test for Diagnosing Labral Tears and
  Acromioclavicular Joint Abnormality.
  Am  J Sports Med 
  26: 610-613, 1998.
     
  Superior labral tears are
  difficult to diagnose. A new test for detection
  of labral abnormality and acromioclavicular joint
  abnormality is presented which is both specific and
  sensitive.
      
  Technique :
  The physician stands behind the
  patient, who flexes the affected arm forward at 90^o with the elbow at full
  extension, adducts the arm 10-15 medial to the
  sagittal plane and internally rotates it till the
  thumb points downward. The physician applies
  downward pressure on the arm.
  The maneuver is repeated with the palm fully
  supinated. The test is positive if
  there is pain with the first maneuver that is reduced
  or eliminated with the second maneuver. 
  Pain on the shoulder in the acromioclavicular
  joint is indicative or acromioclavicular joint
  abnormality, whereas pain or painful clicking is
  diagnosed as labral abnormality.
      
  Results : Of 56 patients who had
  positive active compression tests, 53 were found to
  have labral tears. The remaining 3 patients
  had a reverse Hills-Sach’s lesion, a hypermobile
  biceps tendon and multidirectional laxity and biceps
  tendinitis and anterior instability without a discrete
  labral tear. The specificity was 100%
  and the specificity 98.5%, the positive predictive
  value was 94.5% and the negative predictive value was
  100%.
          

• Gartsman GM, Khan M, Hammerman
  SM  (Texas Orthopedic
  Hosp, Houston)
  Arthroscopic Repair of
  Full-Thickness Tears of the Rotator Cuff
  J Bone Joint Surg Am 80-A:
  832-840, 1998.
      
  This is a study of 73
  patients (mean age 60.7 years) who underwent
  arthroscopic repair of full thickness rotator cuff
  tears. 69 patients had an
  anatomical repair and 4 were repaired a mean 3mm
  medial to the insertion of the tendon.
  The scope could also detect that 63
  glenohumeral joints were normal and 10 had an
  intra-articular lesion. 90% rated the result as
  good to excellent.
      
  This technique should be used
  only by experienced surgeons.
  The open operation is relatively easy, but the
  advantage of arthroscopy includes smaller incision,
  access to the glenohumeral joints and treatment of
  intra-articular lesions, no need to detach the deltoid
  and less soft tissue desection.