Trifurcated radial nerve in the spiral groove of the humerus.

A 62-year-old man presented with a nonunion of the humerus shaft. Using a standard triceps splitting approach, a longitudinal incision along the posterior aspect of the arm was created. Three independent radial nerves coursed posteriorly and inferolaterally around the humerus were identified in spiral groove.

Mattress suture-bridge technique for bursal-side partial-thickness rotator cuff tears.

The standard procedure used to repair partial-thickness tears involves initial progression of the lesion to a full-thickness tear prior to tendon repair. However, the option for a bursal-side partial-thickness rotator cuff tear includes the preservation of as much of the remaining intact fibers as possible. Instead of inserting suture anchors in the medial row, as in the conventional suture-bridge technique, two mattress sutures are inserted into the rotator cuff.

Displaced fracture of the coracoid process associated with acromioclavicular dislocation: a two-bird-one-stone solution.

We describe a surgical treatment for a displaced fracture of the coracoid process associated with acromioclavicular dislocation. This treatment involves fixing the coracoid process using a cannulated screw without acromioclavicular fixation under fluoroscopic guidance. The benefits of this treatment are that fixation with a cannulated screw simultaneously reduces both the displaced fracture of the coracoid process and the acromioclavicular joint via the intact coracoclavicular ligament, thus reducing the complications associated with transacromial pin fixation.

Arthroscopic transtendon suture-bridge technique for concurrent articular- and bursal-side partial-thickness rotator cuff tears.

The transtendon suture-bridge technique is primarily indicated in concurrent articular- and bursal-side partial-thickness rotator cuff tears. The articular aspect of the footprint is restored using the transtendon technique while maintaining the remaining lateral footprint of the rotator cuff. The bursal aspect of the footprint is restored via the suture-bridge technique using the tied suture stands, after applying the transtendon technique while maintaining the remaining medial footprint of the rotator cuff.

Revision of a pull-out suture anchor in the lateral row during the suture-bridge technique: technical note.

The repeated pulling-out of a suture anchor in the lateral row despite repeated attempts at insertion during a rotator cuff repair is not uncommon with the suture-bridge technique, especially in patients with osteoporosis. We describe a simple procedure for dealing with the pull-out of a PushLock anchor in the lateral row using a suture anchor with a suture eyelet during rotator cuff repair applying the suture-bridge technique.

Arthroscopic footprint reconstruction of bursal-side delaminated rotator cuff tears using the suture-bridge technique.

For a bursal-side retracted laminated rotator cuff tear, simple repair of the retracted bursal-side rotator cuff might be insufficient because the repaired tendon could remain as an intratendinous tear of the rotator cuff. We present a repair method for intratendinous rotator cuff tears using the suture-bridge technique. We believe that this method helps to preserve the remnant rotator cuff tendon without tissue damage and restores the normal rotator cuff footprint in bursal-side delaminated rotator cuff tears.

Adhesive capsulitis of the shoulder: dimensions of the rotator interval measured with magnetic resonance arthrography.

Background: This study was performed to define the dimensions of the rotator interval (RI) in adhesive capsulitis using magnetic resonance (MR) arthrography preoperatively to clarify and evaluate pathology.

Methods: We performed a retrospective review of a series of 73 shoulders that underwent MR arthrography. The shoulders were grouped according to their diagnosis: group I comprised 47 shoulders without adhesive capsulitis; group II comprised 26 shoulders with adhesive capsulitis.

Arthroscopic three-point double-row repair for acute bony Bankart lesions.

After mobilizing anteroinferior osseous Bankart lesion from the glenoid neck, a suture anchor loaded with differently colored non-absorbable braided sutures is placed on the medial edge in the glenoid neck along the rim fracture through the anterior-inferior trans-subscapularis tendon portal. Two same-colored suture limbs on the anchor are then pulled through the labrum using PDS suture shuttling simultaneously. These steps are repeated for the others suture limbs.

Deformities associated with the suture-bridge technique for full-thickness rotator cuff tears.

Purpose: This study was performed to evaluate the incidence and cause of deformities associated with the suture-bridge technique in rotator cuff tears.

Methods: We performed a prospective review of a consecutive series of 100 shoulders with full-thickness tears (50 with medium tears, 43 with large tears, and 7 with massive tears) treated by use of the suture-bridge technique in 2007. The surgical technique was classified according to the number of suture anchors inserted in the medial and lateral rows (2 x 2 suture bridges in 82 cases, 3 x 2 in 12, and 3 x 3 in 6).

Tension band sutures using a washer for a proximal humerus fracture.

To prevent distraction and varus deformity between the humeral head and shaft, tension band sutures placed between the head of the interlocking screw and the rotator cuff, and we recommend using nonabsorbable sutures. We describe our simple procedure to overcome these difficulties in tension band suturing after reducing a proximal humerus fracture to maintain the reduction.

A long head of the biceps tendon confluent with the intra-articular rotator cuff: arthroscopic and MR arthrographic findings.

Many anomalous origins of the long head of the biceps tendon (LHBT) have been reported. However, developmental anomalies of the LHBT are rarely encountered in daily practice. We report a patient with an anomalous LHBT that was adherent to and confluent with the rotator cuff throughout its intra-articular course and present the clinical, magnetic resonance arthrography, and arthroscopic findings.

Can the glenopolar angle be used to predict outcome and treatment of the floating shoulder?

Objective: Displaced ipsilateral fractures of the clavicle and the glenoid neck are usually the result of high-energy trauma. The objective of this study is to evaluate the association of the glenopolar angle (GPA) with the clinical outcome of the floating shoulders.

Methods: Seven patients treated conservatively and nine patients with clavicular fracture treated operatively were evaluated retrospectively.

Arthroscopic fixation for displaced greater tuberosity fracture using the suture-bridge technique.

With the described technique, two bioabsorbable suture anchors are inserted to create a medial row through the intact cuff for fixation of the fragment of the greater tuberosity. The medial row is repaired with a sliding knot. After confirmation of the fracture site, pilot holes for a PushLock anchor (Arthrex, Naples, FL) are prepared directly in line with the medial anchors and approximately 5 to 10 mm distal to the lateral edge of the fragment of the greater tuberosity.

Arthroscopic double-pulley suture-bridge technique for rotator cuff repair.

After preparation of the bone bed, two doubly loaded suture anchors with suture eyelets are inserted at the articular margin of the greater tuberosity. A retrograde suture-passing instrument penetrates the rotator cuff to retrieve the sutures through the modified Neviaser or subclavian portal. An ipsilateral pair of suture eyelets in the suture anchor is passed through the margins of the rotator cuff tear.

Estimating the dimensions of the rotator interval with use of magnetic resonance arthrography.

Background: The goal of the present study was to define the dimensions of the normal rotator interval with magnetic resonance arthrography and to compare these dimensions with those in shoulders with known chronic anterior instability in order to determine if abnormalities of the rotator interval might be better understood and estimated preoperatively.

Methods: We retrospectively reviewed a consecutive series of 202 shoulders that had undergone magnetic resonance arthrography between 2004 and 2005. Of these, 120 shoulders were included in the present study.

Modified single-portal type II SLAP repair.

We present a simplified, cost-effective method for repairing a type II SLAP lesion that requires only one working portal in the rotator interval. The rotator cuff tendon or muscle is not violated when using this portal. The biceps root can be firmly reattached anteriorly and posteriorly using one double-loaded absorbable bone anchor with a suture eyelet.

Arthroscopic separate labral repair and capsular plication with a suture anchor.

Capsular volume reduction is becoming a more popular procedure for treating the unstable shoulder. We present a novel technique of arthroscopic labral repair and capsular plication using a single suture anchor with two nonabsorbable braided sutures that repairs the involved labrum and capsule separately. It is a simple technique from the standpoint of simultaneous labral repair and capsular plication, making it easily reproducible and cost-effective.

Biceps long head tendon revisited: a case report of split tendon arising from single origin.

A 27-year-old, right-hand-dominant woman with a posttraumatic anterior shoulder dislocation 3 months earlier after traffic accident presented because of pain and limited range of motion in the right shoulder. On physical examination, the patient had negative instability tests and a sulcus sign. On arthroscopic examination, a bifurcate long biceps tendon with two limbs was observed about 1 cm distal to the origin in the supraglenoid tubercle.

Partially ruptured posterior cruciate ligament causing medial tibiofemoral joint impingement.

Impingement syndrome resulting from a partially torn posterior cruciate ligament (PCL) stump has not been reported in the English-language literature. We present 2 cases of impingement caused by the torn stump of a partially ruptured PCL. Both patients suffered from severe knee joint pain during knee flexion over 70 degrees to 90 degrees and medial joint-line tenderness after the injury.