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Publications (5)19.05 Total impact

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    ABSTRACT: The purpose of this study was to evaluate the clinical results of latissimus dorsi tendon transfer in patients with an irreparable posterosuperior rotator cuff tear to help determine which patient and anatomic factors affect clinical outcome. Fourteen patients with a latissimus dorsi tendon transfer were clinically evaluated with use of the PENN (University of Pennsylvania) shoulder score as well as with quantitative measurement of isometric muscle strength and the range of motion of both shoulders at a minimum of twenty-four months postoperatively. The anatomic results were evaluated with postoperative magnetic resonance imaging and electromyography. Nine patients were satisfied with the outcome, had significant clinical improvement, and reported that they would have the operation again under similar circumstances. The other five patients were dissatisfied with the result and had significantly worse PENN scores, active elevation, and objective measures of strength. Eight of the nine patients with a good clinical result were male, and four of the five with a poor result were female. Patients with a good clinical result had had significantly better preoperative function in active forward flexion and active external rotation compared with the patients with a poor result. The magnetic resonance imaging demonstrated healing of the tendon to the greater tuberosity in twelve patients and equivocal healing in two. There was no significant atrophy of any of the transferred muscles. Electromyography demonstrated clear activity in the transferred latissimus muscle during humeral adduction in all fourteen patients, some electrical activity with active forward elevation in only one patient, and some electrical activity with active external rotation in six of the nine patients with a good clinical result. None of the patients with a poor clinical result demonstrated electrical activity of the transferred muscle with active forward flexion or external rotation. Synchronous in-phase contraction of the transferred latissimus dorsi is a variable finding following the surgical treatment of irreparable posterosuperior rotator cuff tears, but when it is present it is associated with a better clinical result. Preoperative shoulder function and general strength influence the clinical result. Female patients with poor shoulder function and generalized muscle weakness prior to surgery have a greater likelihood of having a poor clinical result.
    The Journal of Bone and Joint Surgery 04/2007; 89 Suppl 2 Pt.1:1-9. DOI:10.2106/JBJS.F.01160 · 4.31 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the clinical results of latissimus dorsi tendon transfer in patients with an irreparable posterosuperior rotator cuff tear to help determine which patient and anatomic factors affect clinical outcome. Fourteen patients with a latissimus dorsi tendon transfer were clinically evaluated with use of the PENN (University of Pennsylvania) shoulder score as well as with quantitative measurement of isometric muscle strength and the range of motion of both shoulders at a minimum of twenty-four months postoperatively. The anatomic results were evaluated with postoperative magnetic resonance imaging and electromyography. Nine patients were satisfied with the outcome, had significant clinical improvement, and reported that they would have the operation again under similar circumstances. The other five patients were dissatisfied with the result and had significantly worse PENN scores, active elevation, and objective measures of strength. Eight of the nine patients with a good clinical result were male, and four of the five with a poor result were female. Patients with a good clinical result had had significantly better preoperative function in active forward flexion and active external rotation compared with the patients with a poor result. The magnetic resonance imaging demonstrated healing of the tendon to the greater tuberosity in twelve patients and equivocal healing in two. There was no significant atrophy of any of the transferred muscles. Electromyography demonstrated clear activity in the transferred latissimus muscle during humeral adduction in all fourteen patients, some electrical activity with active forward elevation in only one patient, and some electrical activity with active external rotation in six of the nine patients with a good clinical result. None of the patients with a poor clinical result demonstrated electrical activity of the transferred muscle with active forward flexion or external rotation. Synchronous in-phase contraction of the transferred latissimus dorsi is a variable finding following the surgical treatment of irreparable posterosuperior rotator cuff tears, but when it is present it is associated with a better clinical result. Preoperative shoulder function and general strength influence the clinical result. Female patients with poor shoulder function and generalized muscle weakness prior to surgery have a greater likelihood of having a poor clinical result.
    The Journal of Bone and Joint Surgery 03/2006; 88(2):342-8. DOI:10.2106/JBJS.D.02996 · 4.31 Impact Factor
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    ABSTRACT: One hundred cases were prospectively evaluated to determine the impact of magnetic resonance imaging on clinical decision making in an orthopaedic practice devoted to the treatment of disorders about the shoulder. Each was analyzed for changes in the clinical diagnosis or treatment. A change that either changed the primary diagnosis or type of treatment (operative versus nonoperative) was classified as category one. If additional clinically relevant findings were noted on the imaging studies without altering the primary diagnosis, or if the form of treatment was modified but not changed from operative or nonoperative, it was considered category two. Among the 100 imaging studies reviewed, category one and two changes were observed in 11 and 7 cases, respectively. Magnetic resonance imaging was particularly helpful in diagnosing ganglion cysts about the shoulder, a category one change in three out of three cases. For specific diagnoses a category one or two change was observed in 17% (10 of 59), 29% (4 of 14), 8% (1 of 13),and 100% (2 of 2) for rotator cuff disease, glenohumeral instability, adhesive capsulitis, and biceps disease, respectively. In 35 cases magnetic resonance imaging was considered to be unnecessary for the diagnosis or treatment of the patient. For the 65 patients who underwent magnetic resonance imaging, category one and two changes were noted in 10 and 5 patients, respectively. Statistical significance was demonstrated for category one changes in the entire group (100 cases) and the in subgroup recommended for magnetic resonance imaging (65 cases) (p < 0.05), indicating that the judicious use of magnetic resonance imaging can have a significant increase its impact on clinical decision making. Magnetic resonance imaging was found to be of limited diagnostic value in patients with an isolated primary clinical diagnosis of adhesive capsulitis, glenohumeral or acromioclavicular arthritis, brachial plexopathy, and cervical degenerative disk disease.
    Journal of Shoulder and Elbow Surgery 05/1998; 7(3):205-9. DOI:10.1016/S1058-2746(98)90045-3 · 2.37 Impact Factor
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    Ross E. Andersen, Thomas A. Wadden, Richard J. Herzog
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    ABSTRACT: Significant reductions in total-body bone mineral density (BMD) have been reported in obese women who consume very-low-calorie diets. A reduction in bone mass is highly correlated with an increased risk of osteoporosis. The present study investigated whether strength training would prevent such reductions in dieters. Twenty-one healthy obese women weighing (mean +/- SD) 91.1 +/- 9 kg and aged 38 +/- 9 years were randomly assigned to receive either diet alone or diet plus resistance training. Both groups consumed a 925-kcal/d portion-controlled diet for the first 16 of 17 weeks and a 1,000 to 1,500-kcal/d balanced deficit diet thereafter. Bone mineral content (BMC), BMD, fat-free mass (FFM), and fat mass were measured with dual-energy x-ray absorptiometry (DEXA) before and after 24 weeks of dieting. No significant changes in total-body or lumbar spine BMC and BMD were observed in either condition at the end of treatment. However, both groups demonstrated a significant loss of both BMC and BMD in the femoral neck and greater trochanter. Diet plus resistance training was not associated with a significantly better outcome on either of these measures versus diet alone. The results suggest that increasing the energy content of very-low-calorie diets to 925 kcal/d may prevent the loss of total BMD, but not the loss from the femoral neck and greater trochanter. These findings raise a concern in light of the high frequency of dieting in American women.
    Metabolism 09/1997; 46(8):857-61. DOI:10.1016/S0026-0495(97)90070-6 · 3.61 Impact Factor
  • Medicine &amp Science in Sports &amp Exercise 01/1995; 27(Supplement):S139. DOI:10.1249/00005768-199505001-00782 · 4.46 Impact Factor