We report the case of an 80-year-old man who suffered an anteroinferior shoulder dislocation with rupture of the rotator cuff following a fall. An attempt at closed reduction under analgosedation resulted in extensive skin laceration on the elbow and forearm. The wound treatment was complex and resulted in numerous complications.
View Article and Find Full Text PDFOrthopadie (Heidelb)
March 2024
The question of whether a fall directly onto the shoulder can cause a rotator cuff tear has occupied doctors (and courts) for many years. Experts who rely on the medical insurance literature usually reject the causality of the incident. There are no scientific studies on this.
View Article and Find Full Text PDFA 36-year-old man was treated with two intraarticular corticoid injections for intense pain and severely decreased range of motion of his left shoulder. After the second injection, he came back with fulminant arthritis. Microbiological examination revealed streptococcus pneumoniae.
View Article and Find Full Text PDFPurpose: A simple fall on the shoulder is often referred to as minor trauma that cannot cause a tendon tear but at best reveal a pre-existing rotator cuff pathology. We wanted to know whether this statement was true. The purpose of our study was therefore to summarize the causes of acute rotator cuff tears reported in the literature and provide a biomechanical explanation for tendon tears diagnosed after a fall.
View Article and Find Full Text PDFPurpose: Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures.
View Article and Find Full Text PDFGiven the high prevalence of rotator cuff tears and their socioeconomic impact, surgeons and researchers have tried to understand their etiology and pathomechanism for almost hundred years. Articles about tendon degeneration with increasing age dominate the literature, and numerous factors contributing to tendon degeneration have been identified. One of them, the lateral extension of the acromion, as quantitated using the acromion index or the critical shoulder angle, has become very popular in the last few years.
View Article and Find Full Text PDFPurpose: Greater tuberosity fractures are challenging lesions concerning decision-making. In order to improve our treatment algorithm, we developed a new method, which allows predicting a possible subacromial conflict on standard anteroposterior radiographs, considering not only the displacement of the fragment but also the width of the subacromial space.
Methods: The measurement technique consisted of drawing three concentric circles on true anteroposterior radiographs.
The shape of the acromion differs between patients with degenerative rotator cuff tears and individuals without rotator cuff pathology.It can be assessed in the sagittal plane (acromion type, acromion slope) and in the coronal plane (lateral acromion angle, acromion index, critical shoulder angle).The inter-observer reliability is better for the measurements in the coronal plane.
View Article and Find Full Text PDFMinimally invasive plate osteosynthesis is a widely used procedure for the treatment of fractures of the femur and the tibia. For a short time it is also used for the treatment of humeral shaft fractures. Among other advantages, the ambassadors of this technique emphasize the lower risk of nerve injuries when compared to open reduction and internal fixation.
View Article and Find Full Text PDFSurgical repair of the rotator cuff repair is one of the most common procedures in orthopedic surgery. Despite it being the focus of much research, the physiological tendon-bone insertion is not recreated following repair and there is an anatomic non-healing rate of up to 94%. During the healing phase, several growth factors are upregulated that induce cellular proliferation and matrix deposition.
View Article and Find Full Text PDFThe radical changes in prosthetic design made in the mid 1980s transformed the historically poorly performing reverse ball-and-socket total shoulder prosthesis into a highly successful salvage implant for pseudoparalytic, severely rotator cuff-deficient shoulders. Moving the center of rotation more medial and distal as well as implanting a large glenoid hemisphere that articulates with a humeral cup in 155 degrees of valgus are the biomechanical keys to sometimes spectacular short- to mid-term results. Use of the reverse total shoulder arthroplasty device allows salvage of injuries that previously were beyond surgical treatment.
View Article and Find Full Text PDFThe purpose of this study was to determine whether changes in glenoid version are associated with humeral head displacement and changes in the joint reaction forces, as these might contribute to instability or loosening in total shoulder replacement. A total shoulder prosthesis was implanted in neutral version in 6 cadaveric shoulders. Glenoid version was then changed in steps of 4 degrees toward more anteversion and retroversion.
View Article and Find Full Text PDFBackground: Factors predisposing to tearing of the rotator cuff are poorly understood. We have observed that the acromion of patients with a rotator cuff tear very often appears large on anteroposterior radiographs or during surgery. The purpose of this study was to quantify the lateral extension of the acromion in patients with a full-thickness rotator cuff tear and in patients with an intact rotator cuff.
View Article and Find Full Text PDFAlthough loosening of cemented glenoid components is one of the major complications of total shoulder arthroplasty, there is little information about factors affecting initial fixation of these components in the scapular neck. This study was performed to assess the characteristics of structural fixation of pegged glenoid components, if inserted with two different recommended cementing techniques. Six fresh-frozen shoulder specimens and two types of glenoid components were used.
View Article and Find Full Text PDFThe presence of a notch at the inferior part of the scapular neck is a common radiographic finding in patients treated with a reverse Delta III shoulder prosthesis. It is thought that this notch is a result of mechanical contact between the polyethylene cup of the humeral implant and the inferior glenoid pole during adduction of the arm. This in vitro study assessed the effect of glenoid component positioning on glenohumeral range of motion in 8 shoulder specimens.
View Article and Find Full Text PDFBackground: Glenoid loosening continues to be the primary reason for failure of total shoulder arthroplasty. The purpose of this study was to evaluate, with use of a sensitive and reproducible imaging method, the radiographic and clinical results of total shoulder replacement with a pegged, cemented polyethylene glenoid implant.
Methods: Forty-three patients (forty-seven shoulders) underwent a total shoulder replacement with a cemented polyethylene glenoid component with four threaded pegs.
Background: During shoulder replacement surgery, the normal height of the proximal part of the humerus relative to the tuberosities frequently is not restored because of differences in prosthetic geometry or problems with surgical technique. The purpose of the present study was to determine the effect of humeral prosthesis height on range of motion and on the moment arms of the rotator cuff muscles during glenohumeral abduction.
Methods: Tendon excursions and abduction angles were recorded simultaneously in six cadaveric specimens during passive glenohumeral abduction in the scapular plane.
Unlabelled: Idiopathic or surgical tightening of the glenohumeral joint capsule may cause displacement of the humeral head relative to the glenoid fossa and favor the development of instability and/or osteoarthritis. In the present investigation the relative position of the humerus to the glenoid fossa was determined at the end of the ranges of eight different passive movements before and after selective capsular plication in eight cadaveric shoulders to study the effects of selective capsular plications on the kinematics of the shoulder. While the capsule was in its unaltered state, translation of the humeral head was 3.
View Article and Find Full Text PDFGlenoid version seems to play an important role in the stability and loading of the glenohumeral joint. The purpose of this study was to compare measurements of glenoid version on axillary views and computed tomography (CT) scans. Radiographs and CT scans of 25 patients evaluated predominantly for glenohumeral joint instability and 25 patients after implantation of a total shoulder prosthesis were analyzed by 3 independent observers.
View Article and Find Full Text PDFPurpose: In the repair of soft tissue to bone using suture anchors, failure of the suture material can occur at the anchor eyelet. This study examines the load strength at which suture material fails with different metallic suture anchor eyelets.
Type Of Study: Biomechanical study.
Shoulder instabilities have been classified according to the etiology, the direction of instability, or on combinations thereof. The current authors describe a classification system, which distinguishes between static instabilities, dynamic instabilities, and voluntary dislocation. Static instabilities are defined by the absence of classic symptoms of instability and are associated with rotator cuff or degenerative joint disease.
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