Acromial Morphology Does Not Correlate with Age at Time of Rotator Cuff Tear: A Cross-Sectional Study.

Background: The purpose of this study was to determine if scapular anatomy differs between younger and older patients with atraumatic full-thickness supraspinatus tears.

Methods: The critical shoulder angle, acromial index and lateral acromial angle were measured on standardized radiographs of two groups of patients who underwent arthroscopic repair of full-thickness degenerative supraspinatus tears. Group 1 included 61 patients under the age of 50 years while Group 2 included 45 patients over the age of 70 years.

Arthroscopic Evaluation of the Long Head of the Biceps Tendon: Traditional Versus Allis Clamp Techniques.

Using a probe to retract the long head of the biceps tendon (LHBT) into the joint is common practice for visualizing the extra-articular portions during arthroscopy. However, extra-articular lesions may be missed in up to half of cases. Greater excursion of the LHBT may be achieved with an Allis clamp grasper.

Editorial Commentary: Wrist Ulnar Impaction Syndrome: When I Use the Wafer Procedure and When I Do Not.

Ulnar impaction syndrome is fundamentally a clinical diagnosis, which can be confirmed by magnetic resonance imaging. All palmer stages are amenable to surgical treatment with either arthroscopic wafer procedure (AWP) or ulnar shortening osteotomy, and neither the absence of a triangular fibrocartilage complex perforation nor neutral or negative variance contraindicate either. Because of its minimally invasive value proposition and likely success, there are few clinical scenarios for which I do not perform AWP preferentially.

In the Grip of Expertise.

Effective, collaborative leadership is one of the most credible and important predictors of team performance. This is relevant to us as surgeons because teamwork is now a common part of the vernacular in health care, we do not operate in a vacuum without a team, and we are well positioned to assume a leadership role on our teams. However, our standing as experts, our training and the way we were mentored, an insufficient concept of leadership as a process as opposed to a position, and inadequate nontechnical skills may disadvantage us as surgeons as collaborative members of teams.

Basal metacarpal osteotomy for osteoarthritis of the thumb.

Thumb metacarpal extension osteotomy provides effective treatment for the hypermobile trapeziometacarpal joint consistent with Eaton stage 1 disease. This procedure is a useful alternative to Eaton ligament reconstruction. Clinical outcomes are favorable and, should symptoms persist, the procedure does not jeopardize satisfactory execution of trapezial resection arthroplasty in the future.

Arthritis of the thumb basal joint: old and new treatments for a common condition.

Arthritis of the basal joint of the thumb is a condition that is becoming even more common as longevity increases and more people have active lifestyles in later life. The role of new hyaluronase-based injectable agents is evolving. A number of surgical procedures are effective in treating early-stage arthritis; the commonly performed trapezium resection and ligament reconstruction procedures have been modified by using limited-incision approaches, arthroscopic assistance, and bioengineered materials, as well as metacarpal repositioning osteotomy.

The emerging role for Uni-Elbow arthroplasty.

Uni-Elbow arthroplasty is an innovative alternative to radial head resection or implant removal in addressing painful radiocapitellar joint arthrosis. As an "arthroplasty" solution, it retains the biomechanical function of the elbow and obviates the potential complications of not having a radial head. Although its role is likely to evolve as clinical experience accumulates and reported outcomes increase in number, it may have a role in the setting of acute and chronic Essex-Lopresti lesions, and when previous radial head arthroplasty has resulted in capitellar arthrosis but when removal of the implant alone is felt to be contraindicated.

Distal interphalangeal joint arthrodesis with screw fixation: why and how.

Though DIP joint fusion can be successfully achieved with K-wires in both the osteoarthritic and rheumatoid patient, their use is often some-what of an inconvenience to the patient. They prohibit showering, may become infected, may back out and catch on clothing, and surely slowdown mobilization of the rest of the finger [1]. For optimal prehension, a modest amount of DIP joint flexion is required, however.

Finger metacarpophalangeal joint disease: the role of resection arthroplasty and arthrodesis.

When finger MP joint arthrosis exists, it is indeed infrequent that implant arthroplasty is not the most optimal treatment alternative. When post-traumatic bone loss or postinfectious dysfunction require surgical intervention, however, the hand surgeon may need to consider the options of resection arthroplasty and arthrodesis. So long as the MP joint is pain-free and relatively stable, most patterns of functional prehension can be maintained.

Suspensionplasty for basal joint arthritis: why and how.

Abductor pollicis longus suspensionplasty is a simple, effective treatment alternative forbasal joint arthritis. Use of a suspensionplasty technique acknowledges our current understanding of forces involved during pinch and grip, as well as the role of normal ligamentous anatomy. The primary rationale for performing suspensionplasty revolves around resisting the sagittal plane collapse that will occur when the thumb is loaded during pinch.

Thumb by metacarpal extension osteotomy: rationale and efficacy for Eaton Stage I disease.

This article describes the rationale and results of a "biomechanical" strategy to restore trapeziometacarpal (TM) stability when symptomatic Eaton Stage I disease exists. Though the author has performed TM arthroscopy, synovectomy, and capsular shrinkage for such cases in 10 patients, the author has been dissatisfied with the outcomes, particularly pain relief. The author currently relies exclusively on extension osteotomy as treatment for this subset of patients.

Reconstruction of the interosseous ligament unloads metallic radial head arthroplasty and the distal ulna in cadavers.

Purpose: Longitudinal radioulnar dissociation may result when a compressive load to the hand results in excessive proximal migration of the radius with interosseous ligament (IOL) disruption and radial head fracture. Interosseous ligament reconstruction has been proposed to restore more normal forearm mechanics. The objective of this study was to evaluate the effect of IOL reconstruction on compressive load transfer through the forearm after excision and metallic replacement of the radial head in cadavers.

Ulnar impaction syndrome.

Although Palmer's classification of TFCC lesions differentiates post-traumatic central perforations (IA tears) from degenerative tears secondary to ulnocarpal impaction (IIC) [3], the distinction is not always clear clinically. In the final analysis, the literature suggests that as many as 25% of wrists with TFCC tears have residual symptoms following arthroscopic debridement alone [23], and it is likely that static or dynamic ul-nar positive variance plays a role [2,5,17,25]. The authors' results suggest that combined arthroscopic TFCC debridement and wafer resection are feasible and efficacious as treatment for all stages of ulnar impaction syndrome.

Gene transfer to human joints: progress toward a gene therapy of arthritis.

This article describes the clinical application of gene therapy to a nonlethal disease, rheumatoid arthritis (RA). Intraarticular transfer of IL-1 receptor antagonist (IL-1Ra) cDNA reduces disease in animal models of RA. Whether this procedure is safe and feasible in humans was addressed in a phase I clinical study involving nine postmenopausal women with advanced RA who required unilateral sialastic implant arthroplasty of the 2nd-5th metacarpophalangeal (MCP) joints.

Reconstruction of the interosseous ligament restores normal forearm compressive load transfer in cadavers.

Purpose: Longitudinal radioulnar dissociation may result when compressive load to the hand causes excessive proximal migration of the radius with interosseous ligament (IOL) disruption and radial head fracture. Although radial head salvage or arthroplasty and temporary distal radioulnar joint pinning constitute the current treatment for this injury IOL reconstruction has been proposed to restore normal forearm mechanics. To help provide a biomechanical basis for IOL reconstruction we measured load transfer and proximal migration of the radius with the IOL intact, cut, and reconstructed while leaving the radial head intact.

Structural properties of reconstruction constructs for the interosseous ligament of the forearm.

Purpose: The Essex-Lopresti fracture-dislocation, also termed longitudinal radioulnar dissociation (LRUD), results in major functional impairment from pain and limitation of motion at the wrist and elbow. Interosseous ligament (IOL) reconstruction has been proposed to help treat LRUD and restore forearm stability. The objective of this study was to evaluate the biomechanical structural properties of 3 different IOL reconstruction constructs and of the intact IOL for comparison.

Principles of limb salvage surgery of the upper extremity.

The goals of limb salvage surgery in the upper extremity are to achieve resection of the tumor and preserve hand function without the risk for local recurrence. Historically, amputation was the treatment of choice for a neoplasm of the hand, wrist, and forearm, but limb-sparing procedures have become feasible largely because of advances in diagnostic imaging, reconstructive microsurgery, and adjuvant radiotherapy and chemotherapy. Because preservation of hand function, even modest levels thereof, is clearly superior to amputation from a functional standpoint, the authors review the principles of limb salvage in this article.

Patient-reported outcome after carpal tunnel release for advanced disease: a prospective and longitudinal assessment in patients older than age 70.

Purpose: Advanced stages of nerve compression are likely to result in irreversible intraneural changes including intrinsic fibrosis and axon loss, and advanced age is expected to compromise nerve regeneration and recovery. Although satisfactory outcomes have been reported we hypothesized that carpal tunnel release in an elderly population with advanced carpal tunnel disease might not significantly improve symptom severity, functional status, or grip strength compared with before surgery. Our purpose was to evaluate these 3 parameters both before and after surgery to assess the efficacy of surgical intervention.