Speciality
Spotlight

 




 

Sports
Medicine


 

 





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 90o 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
    sensitivity 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.

       

  • Steinbeck J, Jerosch J (Westphalian Wilhelms Univ, Muenster, Germany)


    Arthroscopic Transglenoid Stabilization versus Open anchor Suturing in Traumatic Anterior Instability of the Shoulder.


    Am J Sports Med 26: 373-378, 1998.

       


    Till recently, the traumatic anterior instability of the shoulder was treated by the open Bankart operation. Now the same procedure can be performed arthroscopically. The two procedures have been compared with a minimum follow up to 36 months. The results of arthroscopic surgery were found to be inferior to the open surgery.

       

  • Berjano P, Gonzalez BG, et al (Cirugia Ortopedica y Rehabilitacion ASEPEYO, Madrid)


    Complications in Arthroscopic Shoulder Surgery


    Arthroscopy 14: 785-788, 1998

       


    Arthroscopic surgery is considered safe. Yet a variety of complications have been associated with this procedure. This is a retrospective study of 179 cases. 171 were arthroscopy alone and 8 had open surgery in addition. Overall the complication rate was 9.5%. The combined procedures had a complication rate of 5.3% whereas arthroscopy alone had 10.6%. However, few of the complications adversely affected the clinical outcome.

        


    The complications include respiratory distress, capsular tear, haematoma, excessive bleeding, infection, postoperative oedema and ulnar nerve
    neurapraxia.

       

  • Ferretti A, De Carli A, Calderaro M, et al (Univ of Rome “La Sapienza”)


    Open Capsulorrhaphy with Suture Anchors for Recurrent Anterior Dislocation of the Shoulder.


    Am J Sports Med 26: 625-629, 1998.

       


    Recurrent anterior shoulder dislocation has been treated by various procedures including staple capsulorrhaphy. The authors have evaluated the results of non-absorbable suture anchors with a 2-4 years follow up.

       


    95% of patients had a satisfactory surgical outcome. 18 of 22 patients could go back to active competitive sports (overhead or collision sports). 2 operations were unsuccessful – one had deep seated infection and the other had recurrent dislocation.

       

  • Ferretti A, De Carli A, Fontana M (Univ of Rome, La Sapienza)


    Injury of the Suprascapular Nerve at the Spinoglenoid Notch: the Natural History of Infraspinatus Atrophy in Volleyball Players.


    Am J Sports Med 26: 759-763, 1998

       


    Supraspinatus nerve injury at the spinoglenoid notch results in isolated paralysis of the infraspinatus muscle, loss of strength in the external rotators and inconstant pain.

       


    The authors have recorded their experience of such injuries in 38 volleyball players.

       


    35 of 38 patients were treated non-surgically with strengthening exercises. At the end of 5.5 years, 14 patients still played volleyball and 3 had retired symptom free. The atrophy was unchanged. 3 patients were operated (those who had pain at the posterior aspect of the shoulder). All of them could play volleyball and the atrophy had notably reduced.

       

  • Ogawa K Yoshida (Keio Univ, Tokyo)


    Throwing Fracture of the Humeral Shaft: An Analysis of 90 Patients.


    Am J Sports Med 26: 242-246, 1998.

       


    The authors have published possibly the largest series of this entity. These fractures occur most frequently during pitching. 91% occurred during overhand or three quarters overhand throwing. There was no evidence of stress fracture earlier. The fractures are spiral, and occur below the insertion of deltoid at the junction of middle and lower 1/3rd of humerus. There was no comminution. 14 patients had associated radial palsy, which recovered spontaneously. The main fracture force is an external rotation occurring during the acceleration phase of the throw. Patients who practice irregularly are at greater
    risk

        

  • Brukner P (Olympic Park Sports Medicine Centre, Melbourne, Australia)


    Stress Fractures of the Upper Limb


    Sports Med 26: 415-424, 1998.

       


    Stress fractures of the upper limb are rare and occur mainly in upper limbs dominated sports.

       


    Gradual onset bone pain and tenderness are the prominent findings. Such fractures have been seen in the clavicle, scapula, humerus, olecranon, ulna, radius and metacarpal.

       


    The diagnosis may be confirmed by a radiograph but an isotope scan is more diagnostic.

       


    The majority of patients recover after a few weeks of rest and rehabilitation helps them to return to active sports.

       

  • D’Arco , Stiler M, Kelly J, et al (Temple Univ, Philadelphia)


    Clinical, Functional and Radiographic Assessments of the Conventional and Modified Boyd-Anderson Surgical Procedures for Repair of Distal Biceps Tendon Ruptures.


    Am J Sports Med 26: 254-261, 1998.

       


    The conventional Boyd-Anderson procedure for distal biceps tendon rupture is associated with several complications. Several modifications have been developed. The clinical, functional and radiographic outcomes of the conventional and modified procedures
    have been studied.

       


    The results were almost equally effective from the point of view of return of premorbid activity levels, patient’s satisfaction and overall clinical results. 

       

 



 

 

Speciality Spotlight

 

 

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 90o 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 sensitivity 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.
       

  • Steinbeck J, Jerosch J (Westphalian Wilhelms Univ, Muenster, Germany)
    Arthroscopic Transglenoid Stabilization versus Open anchor Suturing in Traumatic Anterior Instability of the Shoulder.
    Am J Sports Med 26: 373-378, 1998.
       
    Till recently, the traumatic anterior instability of the shoulder was treated by the open Bankart operation. Now the same procedure can be performed arthroscopically. The two procedures have been compared with a minimum follow up to 36 months. The results of arthroscopic surgery were found to be inferior to the open surgery.
       

  • Berjano P, Gonzalez BG, et al (Cirugia Ortopedica y Rehabilitacion ASEPEYO, Madrid)
    Complications in Arthroscopic Shoulder Surgery
    Arthroscopy 14: 785-788, 1998
       
    Arthroscopic surgery is considered safe. Yet a variety of complications have been associated with this procedure. This is a retrospective study of 179 cases. 171 were arthroscopy alone and 8 had open surgery in addition. Overall the complication rate was 9.5%. The combined procedures had a complication rate of 5.3% whereas arthroscopy alone had 10.6%. However, few of the complications adversely affected the clinical outcome.
        
    The complications include respiratory distress, capsular tear, haematoma, excessive bleeding, infection, postoperative oedema and ulnar nerve neurapraxia.
       

  • Ferretti A, De Carli A, Calderaro M, et al (Univ of Rome “La Sapienza”)
    Open Capsulorrhaphy with Suture Anchors for Recurrent Anterior Dislocation of the Shoulder.
    Am J Sports Med 26: 625-629, 1998.
       
    Recurrent anterior shoulder dislocation has been treated by various procedures including staple capsulorrhaphy. The authors have evaluated the results of non-absorbable suture anchors with a 2-4 years follow up.
       
    95% of patients had a satisfactory surgical outcome. 18 of 22 patients could go back to active competitive sports (overhead or collision sports). 2 operations were unsuccessful – one had deep seated infection and the other had recurrent dislocation.
       

  • Ferretti A, De Carli A, Fontana M (Univ of Rome, La Sapienza)
    Injury of the Suprascapular Nerve at the Spinoglenoid Notch: the Natural History of Infraspinatus Atrophy in Volleyball Players.
    Am J Sports Med 26: 759-763, 1998
       
    Supraspinatus nerve injury at the spinoglenoid notch results in isolated paralysis of the infraspinatus muscle, loss of strength in the external rotators and inconstant pain.
       
    The authors have recorded their experience of such injuries in 38 volleyball players.
       
    35 of 38 patients were treated non-surgically with strengthening exercises. At the end of 5.5 years, 14 patients still played volleyball and 3 had retired symptom free. The atrophy was unchanged. 3 patients were operated (those who had pain at the posterior aspect of the shoulder). All of them could play volleyball and the atrophy had notably reduced.
       

  • Ogawa K Yoshida (Keio Univ, Tokyo)
    Throwing Fracture of the Humeral Shaft: An Analysis of 90 Patients.
    Am J Sports Med 26: 242-246, 1998.
       
    The authors have published possibly the largest series of this entity. These fractures occur most frequently during pitching. 91% occurred during overhand or three quarters overhand throwing. There was no evidence of stress fracture earlier. The fractures are spiral, and occur below the insertion of deltoid at the junction of middle and lower 1/3rd of humerus. There was no comminution. 14 patients had associated radial palsy, which recovered spontaneously. The main fracture force is an external rotation occurring during the acceleration phase of the throw. Patients who practice irregularly are at greater risk
        

  • Brukner P (Olympic Park Sports Medicine Centre, Melbourne, Australia)
    Stress Fractures of the Upper Limb
    Sports Med 26: 415-424, 1998.
       
    Stress fractures of the upper limb are rare and occur mainly in upper limbs dominated sports.
       
    Gradual onset bone pain and tenderness are the prominent findings. Such fractures have been seen in the clavicle, scapula, humerus, olecranon, ulna, radius and metacarpal.
       
    The diagnosis may be confirmed by a radiograph but an isotope scan is more diagnostic.
       
    The majority of patients recover after a few weeks of rest and rehabilitation helps them to return to active sports.
       

  • D’Arco , Stiler M, Kelly J, et al (Temple Univ, Philadelphia)
    Clinical, Functional and Radiographic Assessments of the Conventional and Modified Boyd-Anderson Surgical Procedures for Repair of Distal Biceps Tendon Ruptures.
    Am J Sports Med 26: 254-261, 1998.
       
    The conventional Boyd-Anderson procedure for distal biceps tendon rupture is associated with several complications. Several modifications have been developed. The clinical, functional and radiographic outcomes of the conventional and modified procedures have been studied.
       
    The results were almost equally effective from the point of view of return of premorbid activity levels, patient’s satisfaction and overall clinical results. 
       

 

 

By |2022-07-20T16:41:15+00:00July 20, 2022|Uncategorized|Comments Off on Injuries of Upper Limbs

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