RESUMO
Pectoralis major tendon ruptures are rare injuries. We present a case of a pectoralis major tendon rupture incurred while bouldering that required surgical repair. The diagnosis of pectoralis major tendon rupture relies predominantly on clinical examination. Among athletes, outcomes after surgical repair are superior to those after nonoperative therapy in most cases of complete tendon rupture. Although infrequent, pectoralis major tendon ruptures can occur while climbing, and early recognition and expedited surgical treatment are paramount to maximize functional recovery.
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Músculos Peitorais , Traumatismos dos Tendões , Humanos , Músculos Peitorais/cirurgia , Músculos Peitorais/lesões , Tendões , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Ruptura/cirurgiaRESUMO
Shoulder instability is common in the National Football League athlete. Nonoperative versus operative treatment of shoulder labrum injury without bone loss depends on many factors, including type and direction of instability, presence or absence of pain and recurrent instability that limits function, and player and season situational issues. Prophylactic surgical treatment in an effort to enhance future player performance and increase the number of future games played should be discouraged. Management of shoulder instability should be based on clinical indication and surgical stabilization should not be done prophylactically in the hope of increasing the number of future games played or enhancing performance.
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Futebol Americano , Instabilidade Articular , Articulação do Ombro , Atletas , Humanos , Instabilidade Articular/terapia , Longevidade , Ombro/cirurgia , Articulação do Ombro/cirurgiaRESUMO
Delayed union or nonunion are relatively rare complications after fracture surgery, but when they do occur, they can result in substantial morbidity for the patient. In many cases, the etiology of impaired fracture healing is uncertain and attempts to determine the molecular basis for delayed union and nonunion formation have been limited. Prospectively isolating skeletal stem cells (SSCs) from fracture tissue samples at the time of surgical intervention represent a feasible methodology to determine a patient's biologic risk for compromised fracture healing. This report details a case in which functional in vitro readouts of SSCs derived from human fracture tissue at time of injury predicted a poor fracture healing outcome. This case suggests that it may be feasible to stratify a patient's fracture healing capacity and predict compromised fracture healing by prospectively isolating and analyzing SSCs during the index fracture surgery. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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BACKGROUND: Hamstring injuries can present in numerous forms, some of which can lead to persistent pain, loss of function, and delay in return to sport. Although most are treated conservatively, proximal and distal tendon avulsion injuries have become more commonly treated with surgery. Distal semitendinosus avulsion injuries have been largely reported in the elite athlete population. While conservative management has been utilized, failure in this group can significantly impact a future career. PURPOSE: The purpose of the manuscript is to describe our approach of surgical tendon excision for distal semitendinosus injury in an elite athlete. METHODS: We highlight a two-incision technique to isolate the avulsed tendon, followed by exteriorization and tendon excision. In addition, we provide insight on clinical and imaging findings to help guide management. RESULTS: This technique provides a reliable and effective surgical option for managing these rare injuries of the distal semitendinosus, along with outlining rehabilitation goals in the postoperative period. CONCLUSION: In this setting, we present a detailed surgical technique to excise the injured distal semitendinosus tendon to promote recovery and potentially allow for earlier return to play.
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Abnormal patellofemoral joint alignment has been discussed as a potential risk factor for patellofemoral disorders and can impact the longevity of any elite athlete's career. The prevalence of abnormal patellofemoral congruence in elite American football athletes is similar to the general population and does not have a relationship with quadriceps isokinetic testing. A total of 125 athletes (220 knees) from the 2011 National Football League (NFL) Combine database who had radiographic and isokinetic studies were reviewed. Congruence angles (CA) and lateral patellofemoral angles (LPA) were calculated on a Merchant radiographic view. Isokinetic testing was used to determine quadriceps-to-hamstring strength (Q/H) ratio and side-to-side deficits. The relationships between abnormal CA and LPA with Q/H ratios, side-to-side deficits, and body mass index (BMI) were examined in separate logistic regression models. A Chi-square test was used to examine the association between CA and player position. Of all, 26.8% of the knees (95% CI: 21.1-33.2%) had an abnormal CA. Knees with normal CA (n = 161) did not significantly differ from those with an abnormal CA (n = 59) in Q/H ratios (mean: 0.699 vs. 0.728, p = 0.19) or side-to-side quadriceps deficits (mean: 4.0 vs. 1.24, p = 0.45). For each point increase in BMI, the odds ratio (OR) of abnormal congruence increased by 11.4% (p = 0.002). Of all the knees, 4.1% (95% CI: 1.9-7.6%) had an abnormal LPA, and this was not associated with Q/H ratios (p = 0.13). For each point increase in BMI, the odds of abnormal LPA increased by 16% (p = 0.036). CA abnormality had much higher odds of having an abnormal LPA (OR: 5.96, p = 0.014). We found that abnormal patellofemoral radiographic alignment in elite American football players is relatively common and there was no association with isokinetic testing.
Assuntos
Atletas/estatística & dados numéricos , Futebol Americano/fisiologia , Articulação Patelofemoral/anormalidades , Músculo Quadríceps/fisiologia , Variação Anatômica , Humanos , Masculino , Articulação Patelofemoral/diagnóstico por imagem , RadiografiaRESUMO
BACKGROUND: Treatment of the anterior cruciate ligament (ACL)-deficient knee in older patients remains a core debate. PURPOSE: To perform a systematic review of studies that assessed outcomes in patients aged 40 years and older treated with ACL reconstruction and to provide a new methodological scoring system that is directed at critical assessment of studies evaluating ACL surgical outcomes: the ACL Methodology Score (AMS). STUDY DESIGN: Systematic review. METHODS: A comprehensive literature search was performed from 1995 to 2012 using MEDLINE, EMBASE, and Scopus. Inclusion criteria for studies were primary ACL injury, patient age of 40 years and older, and mean follow-up of at least 21 months after reconstruction. Nineteen studies met the inclusion criteria from the 371 abstracts from MEDLINE and 880 abstracts from Scopus. Clinical outcomes (International Knee Documentation Committee [IKDC], Lysholm, and Tegner activity scores), joint stability measures (Lachman test, pivot-shift test, and instrumented knee arthrometer assessment), graft type, complications, and reported chondral or meniscal injury were evaluated in this review. A new methodology scoring system was developed to be specific at critically analyzing ACL outcome studies and used to examine each study design. RESULTS: Nineteen studies describing 627 patients (632 knees; mean age, 49.0 years; range, 42.6-60.0 years) were included in the review. The mean time to surgery was 32.0 months (range, 2.9-88.0 months), with a mean follow-up of 40.2 months (range, 21.0-114.0 months). The IKDC, Lysholm, and Tegner scores and knee laxity assessment indicated favorable results in the studies that reported these outcomes. Patients did not demonstrate a significant difference between graft types and functional outcome scores or stability assessment. The mean AMS was 43.9 ± 7.2 (range, 33.5-57.5). The level of evidence rating did not positively correlate with the AMS, which suggests that the new AMS system may be able to detect errors in methodology or reporting that may not be taken into account by the classic level of evidence rating. CONCLUSION: Patients aged 40 years and older with an ACL injury can have satisfactory outcomes after reconstruction. However, the quality of currently available data is still limited, such that further well-designed studies are needed to determine long-term efficacy and to better inform our patients with regard to expected outcomes.
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Reconstrução do Ligamento Cruzado Anterior , Adulto , Humanos , Instabilidade Articular/cirurgia , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-OperatóriasRESUMO
Rupture of the insertion of the pectoralis major muscle to the proximal humerus is becoming a common injury. Repair of these ruptures increases patient satisfaction, strength, and cosmesis, and shortens return to competitive sports. Several repair techniques have been described, but recently many surgeons are using suture anchors. The traditional repair technique uses transosseous sutures, but no study has biomechanically compared the strength of these two repair techniques in human cadavers. Twelve fresh-frozen human shoulder specimens were dissected. The pectoralis major tendon insertion was cut from the bone and repaired using one of the two repair techniques: specimens were randomly assigned to transosseous trough with suture tied over bone versus four suture anchors. The fixation constructs were pulled to failure at 4 mm/s on a materials testing system. The mean ultimate failure load of the transosseous repairs was 611 N and the mean ultimate failure load of the suture anchor repair was 620 N. The mean stiffness of the transosseous repair was 32 and 28 N/mm for the suture anchor group. We found no statistically significant difference between these two repair techniques.
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Procedimentos Ortopédicos/métodos , Músculos Peitorais/fisiologia , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgia , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos/fisiologia , Cadáver , Feminino , Humanos , Úmero/fisiologia , Úmero/cirurgia , Masculino , Músculos Peitorais/lesões , Músculos Peitorais/cirurgia , Ruptura , Técnicas de Sutura , Suporte de Carga/fisiologiaRESUMO
INTRODUCTION: The Latarjet and Bristow procedures address recurrent anterior shoulder instability in the context of a significant bony defect. However, the bony and soft tissue anatomy of the coracoid as they relate to coracoid transfer procedures has not yet been defined. The purpose of this study was to describe the soft tissue attachments of the coracoid as they relate to the bony anatomy and to define the average amount of bone available for use in coracoid transfer. METHODS: Ten paired fresh frozen shoulders from deceased donors were dissected, exposing the coracoid, lateral clavicle, and acromion, along with the coracoid soft tissue attachments. The bony dimensions of the coracoid and the locations and sizes of the soft tissue footprints of the coracoid were measured. RESULTS: The mean maximum length of the coracoid available for transfer (ie, distance from the coracoid tip to the anterior border of the coracoclavicular ligament) was 28.5 mm. The mean distance from the coracoid tip to the anterior pectoralis minor was 4.6 mm, to the posterior pectoralis minor was 17.7 mm, to the anterior coracoacromial ligament was 7.8 mm, and to the posterior coracoacromial ligament was 25.7 mm. CONCLUSION: Average dimensions of the bony coracoid and average locations and sizes of coracoid soft tissue footprints are provided. This anatomic description of the coracoid bony anatomy and its soft tissue insertions allows surgeons to correlate the location of their coracoid osteotomy with the soft tissue implications of the coracoid transfer as the native anatomy is manipulated in these nonanatomic procedures.
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Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Transferência Tendinosa , Tendões/anatomia & histologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Músculo Esquelético/anatomia & histologia , Transferência Tendinosa/métodosRESUMO
Scapholunate injuries are the most frequent of the intercarpal ligament injuries in the wrist. Current repair methods generally involve an open approach the dorsal capsule of the wrist. Arthroscopic repair of the dorsal portion of the scapholunate interosseus ligament would carry the advantages of less stiffness and would preserve the important dorsal capsular stabilizers. In the development of this technique, we first sought to determine the anatomic location and accessibility of the dorsal scapholunate ligament and the site in which a suture anchor would be placed. Ten fresh-frozen cadaver limbs were used. With the arthroscope in the 4 to 5 portal, the most dorsal portion of the SLIL was visualized in each specimen. K-wires were inserted through the 3 to 4 portal into the scaphoid adjacent to most distal portion of the dSLIL visualized. All limbs were dissected and the location of the wires relative to the prominence on the scaphoid directly adjacent to the central portion of the dSLIL was measured. The location of the prominence relative to the dSLIL was studied through magnified photography of a stained section of a cadaveric scaphoid. The mean distance of these wires distal to the center of the dSLIL is presented. Then the technique of arthroscopic repair of the dSLIL was developed using additional cadaveric wrist specimens. The technique is described.
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Artroscopia , Ligamentos Articulares/cirurgia , Osso Semilunar , Osso Escafoide , Idoso , Idoso de 80 Anos ou mais , Fios Ortopédicos , Cadáver , Humanos , Ligamentos Articulares/anatomia & histologia , Osso Semilunar/cirurgia , Pessoa de Meia-Idade , Osso Escafoide/cirurgiaRESUMO
The ulnar, radial, median, medial antebrachial cutaneous, and lateral antebrachial cutaneous nerves are subject to traction and compression in athletes who place forceful, repetitive stresses across their elbow joint. Throwing athletes are at greatest risk, and cubital tunnel syndrome (involving the ulnar nerve) is clearly the most common neuropathy about the elbow. The anatomy and innervation pattern of the nerve involved determines the characteristic of the neuropathy syndrome. The most important parts of the work-up are the history and physical examination as electrodiagnostic testing and imaging are often not reliable. In general, active rest is the first line of treatment. Tailoring the surgery and rehabilitation protocol according to the functional requirements of that athlete's sport(s) can help optimize the operative outcomes for recalcitrant cases.
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Traumatismos em Atletas/terapia , Transtornos Traumáticos Cumulativos/terapia , Lesões no Cotovelo , Cotovelo/inervação , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/terapia , Síndrome do Túnel Ulnar/diagnóstico , Síndrome do Túnel Ulnar/etiologia , Síndrome do Túnel Ulnar/terapia , Transtornos Traumáticos Cumulativos/diagnóstico , Transtornos Traumáticos Cumulativos/etiologia , Humanos , Neuropatia Mediana/diagnóstico , Neuropatia Mediana/etiologia , Neuropatia Mediana/terapia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/terapia , Neuropatia Radial/diagnóstico , Neuropatia Radial/etiologia , Neuropatia Radial/terapiaRESUMO
Articular cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant joint stress associated particularly with high-impact sports. The lack of spontaneous healing of these joint surface defects leads to progressive joint pain and mechanical symptoms with resulting functional impairment and limitation of athletic participation. Left untreated, articular cartilage defects can lead to chronic joint degeneration and athletic disability. Articular cartilage repair in athletes requires effective and durable joint surface restoration that can withstand the significant joint stresses generated during athletic activity. Several techniques for articular cartilage repair have been developed recently, which can successfully restore articular cartilage surfaces and allow for return to high-impact athletics after articular cartilage injury. Besides these existing techniques, new promising scientific concepts and techniques are emerging that incorporate modern tissue engineering technologies and promise further improvement for the treatment of these challenging injuries in the demanding athletic population.
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Traumatismos em Atletas/cirurgia , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Condrócitos/transplante , Doenças das Cartilagens/fisiopatologia , Doenças das Cartilagens/reabilitação , Cartilagem Articular/lesões , Cartilagem Articular/fisiopatologia , Terapia Genética , Humanos , Incidência , Osteocondrite/cirurgia , Engenharia Tecidual , Transplante AutólogoRESUMO
BACKGROUND: Triangular fibrocartilage (TFC) injuries are an increasingly recognized cause of ulnar-sided wrist pain and can be particularly disabling in the competitive athlete. Previous studies show that arthroscopic debridement or repair can improve symptoms, but the results of arthroscopic treatment of TFC injuries in high-level athletes have not yet been reported. HYPOTHESIS: Arthroscopic debridement or repair of wrist TFC injury will allow a high rate of return to full function in the elite athlete. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 2001 and 2005, 16 competitive athletes (mean age, 23.4 years) with wrist TFC injuries underwent arthroscopic surgery. Repair was performed in unstable tears, and all others underwent debridement alone. Presurgery and post-surgery mini-DASH (Disabilities of the Arm, Shoulder, and Hand) scores were recorded for each athlete through medical record review and clinical evaluation. The mean duration of follow-up was 32.8 months (range, 24-51 months). RESULTS: The TFC was repaired in 11 (68.8%) and debrided in 5 (31.3%) patients. The tear was ulnar-sided in 12 (75%), radial-sided in 2 (12.5%), combined radial-ulnar in 1, and central-sided in 1 patient. Mean mini-DASH scores improved from 47.3 (range, 25-65.9) to 0 (all patients) (P = .002), and the mean mini-DASH sports module improved from 79.7 (range, 68.8-100) to 1.95 (range, 0-18.8) (P = .002). Return to play averaged 3.3 months (range, 3-7 months). Associated conditions in the 2 patients unable to return to play at 3 months were distal radioulnar joint (DRUJ) instability with ulnar-carpal abutment (n = 1) and extensor carpi ulnaris (ECU) tendinosis (n = 1). CONCLUSION: Arthroscopic debridement or repair of wrist TFC injury provides predictable pain relief and return to play in competitive athletes. Return to play may be delayed in athletes with concomitant ulnar-sided wrist injuries.
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Artroscopia , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/cirurgia , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Desbridamento , Feminino , Humanos , Masculino , Recuperação de Função Fisiológica , Articulação do Punho/cirurgia , Adulto JovemRESUMO
We describe a new transolecranon fossa ulnar (TOFU) collateral ligament reconstruction technique and compare its response to cyclic valgus loading with the Jobe, Docking, and DANE procedures. TOFU is an arthroscopically assisted, modified all-interference screw technique. A cyclic valgus moment was applied to 32 intact and reconstructed, unembalmed elbows. Valgus angles were measured at 1, 10, 100, and 1000 cycles. At all cycles, there was no difference between intact and TOFU-treated elbows. TOFU resulted in significantly smaller angles than DANE at cycles 10, 100, and 1000; Docking at cycle 1000; and Jobe at cycles 10, 100, and 1000. The TOFU procedure shows superior resistance to valgus loading than DANE and Jobe by cycle 10, and Docking by cycle 1000. Further study is needed to evaluate the clinical value of the TOFU procedure as an arthroscopically assisted technique.
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Ligamentos Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Ulna/cirurgia , Idoso , Cadáver , Feminino , Humanos , Masculino , Gravação em VídeoRESUMO
The purpose of this study is to compare the local microfracture effects of antegrade versus retrograde drilling of the tibial tunnel in ACL reconstruction. Arthroscopic ACL excision was performed on eight matched cadaveric knees. Arthroscopic guided tibial tunnel reaming was performed in either an antegrade (four) or retrograde (four) direction. A 3 x 3 cm section of proximal tibial surrounding the tibial aperture was removed with open dissection, and each section underwent micro-computed tomography analysis. Three musculoskeletal radiologists graded the specimens for bone aperture disruption and discrete fracture lines. Tibial aperture irregularity was seen in all four of the antegrade specimens (mean, Grade 1.5), and in none of the retrograde specimens. Discrete fracture lines were present in all four antegrade specimens (mean 10.13 mm depth; 8.95 mm length). No fracture lines were seen in the retrograde group. Retrograde drilling of the tibial tunnel in ACL reconstruction results in less microfracture trauma to the surrounding aperture bone. The use of retrograde drilling in ACL reconstruction may decrease synovialization of the graft-tissue interface when compared to antegrade drilling.
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Ligamento Cruzado Anterior/cirurgia , Artroscopia/efeitos adversos , Artroscopia/métodos , Tíbia/cirurgia , Fraturas da Tíbia/etiologia , Idoso , Cadáver , Dissecação , Humanos , Pessoa de Meia-Idade , Tíbia/diagnóstico por imagem , Tíbia/patologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Quadrilateral space syndrome is an uncommon condition that can disable the overhead athlete. The authors describe 4 cases of quadrilateral space syndrome that may assist clinicians in recognition of this problem in patients with posterior shoulder pain. HYPOTHESIS: Quadrilateral space syndrome can present as posterior shoulder pain in the overhead athlete, and surgical decompression can relieve symptoms and allow full return to activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 2004 and 2006, the authors performed surgical decompression of the quadrilateral space in 4 overhead athletes (4 shoulders; mean age, 24 years). They evaluated the clinical presentations, diagnostic tests, surgical procedures, and results of treatment. Mean follow-up was 24.5 months. RESULTS: All 4 patients underwent surgical decompression of the quadrilateral space. Fibrous bands entrapped the axillary nerve in 3 shoulders, and venous dilation was found in the fourth shoulder. All patients returned to full activity without pain or limitation of overhead function 12 weeks after surgery. CONCLUSION: Quadrilateral space syndrome is an uncommon cause of posterior shoulder pain that is easily overlooked and can severely limit overhead function in the athlete. Surgical decompression can predictably relieve pain and improve function in patients who do not respond to nonoperative regimens.
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Descompressão Cirúrgica/métodos , Síndromes de Compressão Nervosa/cirurgia , Articulação do Ombro/inervação , Dor de Ombro/cirurgia , Adolescente , Adulto , Feminino , Humanos , Síndromes de Compressão Nervosa/patologia , Recuperação de Função Fisiológica , Articulação do Ombro/patologia , Articulação do Ombro/cirurgia , Dor de Ombro/patologiaAssuntos
Cistos Glanglionares/cirurgia , Ossificação Heterotópica/cirurgia , Punho/cirurgia , Adulto , Feminino , Cistos Glanglionares/complicações , Humanos , Ossificação Heterotópica/complicações , Radiografia , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/cirurgia , Punho/diagnóstico por imagemRESUMO
The purpose of this study was to compare the histological characteristics of an autogenous fascia lata graft alone and a fascia lata graft combined with a deltoid flap in the reconstruction of rotator cuff tears. Ten New Zealand white rabbits were divided into two groups. Infraspinatus tendon defects (1 x 1 cm) were created in each animal. Reconstruction consisted of either a fascia lata graft alone or a fascia lata graft combined with a distally based deltoid flap. At 3 months, tissue harvest and histological analysis was performed. Compared to the fascia lata graft alone, there was significantly increased remodeling activity and neovascularization in the group that included a deltoid flap. Also, there was pronounced interdigitation at the graft/flap interface in the latter group. A mutually beneficial relationship may exist when an autogenous fascial graft is combined with a functional deltoid flap for reconstructing large rotator cuff defects.
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Fascia Lata/transplante , Procedimentos Ortopédicos , Lesões do Manguito Rotador , Retalhos Cirúrgicos , Animais , Fascia Lata/patologia , Masculino , Coelhos , Manguito Rotador/patologia , Ruptura , Retalhos Cirúrgicos/patologia , Coleta de Tecidos e Órgãos , Transplante AutólogoRESUMO
We compared the effects of cyclic valgus loading on 2 techniques for reconstruction of the elbow ulnar collateral ligament (UCL): the docking procedure and the bioabsorbable interference screw procedure. A cyclic valgus load was applied to the 16 unembalmed elbows, and the valgus angle was measured at 1, 10, 100, and 1000 cycles. Testing was repeated after UCL palmaris tendon reconstruction via either the docking technique or bioabsorbable interference screw fixation. At cycle 1, the valgus angle was not different between treated and intact cases. At cycles 10 and 100, the valgus angle for the docking technique was significantly greater than that for both the intact cases and the interference screw technique. By the 1000th cycle, no difference was measured between the 2 techniques. In this study, bioabsorbable interference screw fixation resulted in less valgus angle widening in response to early cyclic valgus load as compared with the docking technique.
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Implantes Absorvíveis , Parafusos Ósseos , Ligamentos Colaterais/cirurgia , Articulação do Cotovelo/cirurgia , Ulna , Idoso , Fenômenos Biomecânicos , Cadáver , Humanos , Procedimentos Ortopédicos/métodos , Suporte de CargaRESUMO
The Neer and Hawkins impingement signs are commonly used to diagnose subacromial pathology, but the anatomy of these maneuvers has not been well elucidated in vivo. This 3-dimensional open magnetic resonance imaging study characterized shoulder anatomy and rotator cuff impingement in 8 normal volunteers placed in the Neer and Hawkins positions. Subacromial and intraarticular contact of the rotator cuff was graded, and minimum distances were computed between the tendon insertion sites and the glenoid, acromion, and coracoid. Both the Neer and Hawkins maneuvers significantly decreased the distance from the supraspinatus insertion to the acromion and posterior glenoid and from the subscapularis insertion to the anterior glenoid. However, the Hawkins position resulted in significantly greater subacromial space narrowing and subacromial rotator cuff contact than the Neer position. In the Hawkins position, subacromial contact of the supraspinatus and infraspinatus was observed in 7 of 8 and 5 of 8 subjects, respectively. In contrast, rotator cuff contact with the acromion did not occur in any subject in the Neer position. Intraarticular contact of the supraspinatus with the posterosuperior glenoid was observed in all subjects in both positions. Subscapularis contact with the anterior glenoid was also seen in 7 of 8 subjects in the Neer position and in all subjects in the Hawkins position. This extensive intraarticular contact suggests that internal impingement may play a role in the Neer and Hawkins signs.
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Imageamento por Ressonância Magnética , Manguito Rotador/patologia , Síndrome de Colisão do Ombro/patologia , Articulação do Ombro/patologia , Adulto , Simulação por Computador , Humanos , Masculino , Lesões do Manguito Rotador , RupturaRESUMO
This study evaluates the relative roles of the radial collateral ligament, the lateral ulnar collateral ligament, and the overlying musculature in posterolateral rotatory instability of the elbow. Fourteen cadaveric upper limbs underwent sequential arthroscopic sectioning of the lateral collateral ligament complex. After sectioning, arthroscopic and fluoroscopic evaluation of a lateral pivot shift test was done. Minimal instability was noted after the first section, but no difference between radial collateral or lateral ulnar collateral ligament sectioning was found. A greater degree of instability was seen between the first and second cut ( P = .0001), but no significant difference was seen between sectioning the 2 groups ( P = .61). Complete instability occurred only after sectioning the overlying musculature. On the basis of this study, injury to both the radial collateral and lateral ulnar collateral ligaments is necessary to cause significant posterolateral rotatory instability of the elbow. Furthermore, the overlying musculature plays an important role in overall stability.