What's New in Shoulder and Elbow Surgery

The Leni and Peter W. May Department of Orthopaedic Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 4.31). 07/2012; 94(14):1338-42. DOI: 10.2106/JBJS.L.00469
Source: PubMed
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    ABSTRACT: The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends on the procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.
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    ABSTRACT: BACKGROUND: The anterior inferior iliac spine (AIIS) contributes to hip dysfunction in patients with symptomatic impingement and resection of a prominent AIIS can reportedly improve function. However, the variability of the AIIS morphology and whether that variability correlates with risk of associated symptomatic impingement are unclear. QUESTIONS/PURPOSES: We characterized AIIS morphology in patients with hip impingement and tested the association between specific AIIS variants and hip range of motion. METHODS: We evaluated three-dimensional CT reconstructions of 53 hips (53 patients) with impingement and defined three morphological AIIS variants: Type I when there was a smooth ilium wall between the AIIS and the acetabular rim, Type II when the AIIS extended to the level of the rim, and Type III when the AIIS extended distally to the acetabular rim. A separate cohort of 78 hips (78 patients) with impingement was used to compare hip range of motion among the three AIIS types. RESULTS: Mean hip flexion was limited to 120°, 107°, and 93° in hips with Type I, Type II, and Type III AIIS, respectively. Mean internal rotation was limited to 21°, 11°, and 8° in hips with Type I, Type II, and Type III AIIS, respectively. CONCLUSIONS: When the AIIS is classified into three variants based on the relationship between the AIIS and the acetabular rim in patients with impingement, Type II and III variants are associated with a decrease in hip flexion and internal rotation, supporting the rationale for considering AIIS decompression for variants that extend to and below the rim. LEVEL OF EVIDENCE: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 02/2013; 471(8). DOI:10.1007/s11999-013-2847-4 · 2.79 Impact Factor
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    ABSTRACT: Die Arthroskopie des Ellenbogengelenkes gewinnt zunehmend an Bedeutung. Eine umfassende Untersuchung und präoperative Diagnostik sind für eine korrekte Indikationsstellung entscheidend. Neben den häufigen Eingriffen an Gelenkhaut und Knorpel können bei zunehmender Expertise auch Instabilitäten sowie Bewegungseinschränkungen arthroskopisch therapiert werden. Eine Ausweitung der Indikationsstellung auf die Frakturversorgung des Ellenbogengelenkes stellt aktuell noch eine Ausnahme dar.
    Trauma und Berufskrankheit 12/2011; 13(4). DOI:10.1007/s10039-011-1810-4

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