Suzanne L Miller

Mount Sinai School of Medicine, Manhattan, NY, United States

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Publications (7)14.01 Total impact

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    ABSTRACT: The humeral heads of whole body cadaveric shoulders underwent fluoroscopic evaluation with the head divided into three zones on both anteroposterior (AP) and axillary views creating nine zones. Five AP and three axillary fluoroscopic images in different rotational positions were assessed for pin penetration. All images were evaluated for pin penetration and the AP view was evaluated for lesser tuberosity location. Pins placed appropriately below the subchondral bone did not appear to penetrate the joint on any fluoroscopic image. Pins placed 2 mm beyond the articular surface were appropriately viewed exiting the head on most views (64%) but falsely appeared within the head on several others (36%). Pins perforating the posterior head were problematic for accurate detection on AP views (missed in 87%), but this was avoided by externally rotating the humerus to 60 degrees. Articular penetration cannot always be appreciated radiographically and special efforts are necessary to avoid this problem including the use of various rotational views as well as the use of appropriate landmarks for orientation such as the lesser tuberosity position.
    Orthopedics 09/2007; 30(8):636-41. · 1.05 Impact Factor
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    ABSTRACT: Release of the posterior rotator interval between the supraspinatus and infraspinatus tendons may be necessary to obtain appropriate mobilization for an anatomic rotator cuff repair. Ten cadaver shoulders were dissected to expose the region between the infraspinatus and supraspinatus from the spinoglenoid notch to the greater tuberosity. Measurements were made from the spinoglenoid notch to the glenoid rim, the glenoid rim to the confluence of the supraspinatus and infraspinatus musculotendinous junction, and from the confluence of the tendons to the insertion on the humerus. The histologic features of the posterior rotator interval were examined. The posterior rotator interval is a clear structure, consisting of the glenohumeral capsule medially, which fuses with the supraspinatus and infraspinatus tendons laterally. The average length of the posterior rotator interval was 77.8 mm which includes the distance from the spinoglenoid notch to the glenoid rim (25 mm; standard deviation, 2.89 mm; range, 21-28 mm), from the glenoid to the tendon confluence (25 mm; standard deviation, 1.95 mm; range, 21-28 mm), and from the tendon confluence to insertion (28 mm; standard deviation, 2.36 mm; range, 24-31 mm). Release of the posterior rotator interval can be important to realign the supraspinatus tendon if it is retracted and scarred at its posterior edge.
    Clinical Orthopaedics and Related Research 04/2003; · 2.79 Impact Factor
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    ABSTRACT: Little attention has focused on subscapularis integrity after total shoulder replacement (TSR). We have noted that several patients have loss of internal rotation and subscapularis function on follow-up, leading to our review of success in restoring subscapularis function after TSR. A retrospective review was done of the records of 41 patients after TSR performed between 1995 and 2000. Mean follow-up was 1.9 years. Terminal internal rotation was evaluated by the lift-off and belly-press examinations. Subscapularis function was assessed by the patients' ability to tuck in a shirt. The subscapularis was repaired anatomically in 9 cases and through bone tunnels in 32 patients. Abnormal results were found for 25 of 37 lift-off examinations (67.5%) and 24 of 36 belly-press examinations (66.6%). Of 25 patients with an abnormal lift-off finding, 92% reported reduced subscapularis function (Fisher exact test, P <.01). Despite meticulous attention to subscapularis repair, suboptimal return of function was found on clinical examination and assessment of activities of daily living.
    Journal of Shoulder and Elbow Surgery 01/2003; 12(1):29-34. · 2.32 Impact Factor
  • Journal of Shoulder and Elbow Surgery 01/2003; 12(1):94-6. · 2.32 Impact Factor
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    ABSTRACT: Acute anterior glenohumeral dislocations have been commonly treated with closed reduction and the use of intravenous sedation. Recently, the use of intra-articular lidocaine has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. The purpose of this study was to evaluate the value of local anesthesia compared with that of the commonly used intravenous sedation during the performance of a standardized reduction technique. In a prospective, randomized study, skeletally mature patients with an isolated glenohumeral joint dislocation and no associated fracture were randomized to receive either intravenous sedation or intra-articular lidocaine to facilitate reduction of the dislocation. Reduction was performed with the modified Stimson method. The two groups were compared with regard to the rate of successful reduction, pain as rated on a visual analog scale, time required for the reduction, time from the reduction until discharge from the emergency department, and cost. Thirty patients were enrolled in the study. Five (two in the lidocaine group and three in the sedation group) required scapular manipulation in addition to the Stimson technique to reduce the dislocation. The lidocaine group spent significantly less time in the emergency department (average time, seventy-five minutes compared with 185 minutes in the sedation group, p < 0.01). There was no significant difference between the two groups with regard to pain (p = 0.37), success of the Stimson technique (p = 1.00), or time required to reduce the shoulder (p = 0.42). The cost of the intravenous sedation was $97.64 per patient compared with $0.52 for use of the intra-articular lidocaine. Use of intra-articular lidocaine to facilitate reduction with the Stimson technique is a safe and effective method for treating acute shoulder dislocations in an emergency room setting. Intra-articular lidocaine requires less money, time, and nursing resources than does intravenous sedation to facilitate reduction with the Stimson technique.
    The Journal of Bone and Joint Surgery 12/2002; 84-A(12):2135-9. · 3.23 Impact Factor
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    ABSTRACT: Some authors have recommended that rotator cuff tears <50% of tendon thickness be debrided and those involving >50% of the tendon be treated with miniopen repair. We hypothesize that if indications for selecting between simple debridement and tendon repair were appropriate, then both groups should have comparable outcomes. Thirty-nine patients with partial rotator cuff tears met inclusion criteria and were available for retrospective analysis. Twenty-six percent of patients who underwent debridement and 12.5% of patients who had mini-open repair had unsatisfactory results according to Neer's criteria.
    Orthopedics 12/2002; 25(11):1255-7. · 1.05 Impact Factor
  • Suzanne L Miller, James N Gladstone
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    ABSTRACT: Selecting the appropriate graft for ACL reconstruction depends on numerous factors including surgeon philosophy and experience, tissue availability (affected by anatomical anomalies or prior injury or surgery), and patient activity level and desires. Although the patella tendon autograft has the widest experience in the literature, and is probably the most commonly used graft source, this must be tempered with the higher reported incidences of potential morbidity and pitfalls associated with its use. The hamstring tendons are gaining increasing popularity, mostly due to reduced harvest morbidity and improved soft tissue fixation techniques, and many recent studies in the literature report equal results to BTB ACL reconstruction with respect to functional outcome and patient satisfaction. On the other hand, many of these studies report higher degrees of instrument (KT-100) tested laxity for hamstring reconstruction, and some have reported lower returns to preinjury levels of activity. One question that remains to be addressed is how closely objectively measured laxity tests correlate with subjectively assessed outcomes and ability to return to high levels of competitive sports. Allograft use, which decreased in popularity during the 1990s, appears to be undergoing a resurgence, with better sterilization processes and new graft sources (tibialis tendons), leading to increased availability and improved fixation techniques. The benefits of decreased surgical morbidity and easier rehabilitation must be weighed against the potential for greater failure of biologic incorporation, infection, and possibly slower return to activities. In our practice, for high-demand individuals (those playing cutting, pivoting, or jumping sports and skiing) BTB tends to be the graft of choice. For lower demand or older individuals, hamstring reconstructions will be performed. Allograft tissue will be used in older individuals (generally over 45 years old), those with signs of arthritis (and compelling evidence of instability), or those individuals who understand the pros and cons of allograft use fully and do not want their own tissue used.
    Orthopedic Clinics of North America 11/2002; 33(4):675-83. · 1.25 Impact Factor

Publication Stats

211 Citations
14.01 Total Impact Points

Institutions

  • 2002–2003
    • Mount Sinai School of Medicine
      • Department of Orthopaedics
      Manhattan, NY, United States
    • Mount Sinai Hospital
      New York City, New York, United States