Function of the long head of the biceps at the shoulder: electromyographic analysis.

The purpose of this study was to delineate, through electromyographic analysis, the function of the long head of the biceps at the shoulder. Ten shoulders were examined with dynamic electromyography. The long head of the biceps was instrumented with thin wire electrodes. The supraspinatus, infraspinatus, deltoid, brachialis, and brachioradialis were instrumented as controls. Because the biceps functions primarily as a forearm supinator and elbow flexor, a long arm brace was used to lock the elbow in extension with the forearm in neutral pronation/supination. Each motion was tested in a full arc at fast (170 degrees per second) and slow (36 degrees per second) speeds and repeated with and without a 5-pound weight attached to the distal end of the brace. No electrical activity was identified in the long head of the biceps muscle in response to isolated shoulder motion with the elbow and forearm position controlled. The data demonstrate that the long head of the biceps is not active in isolated shoulder motion when the elbow and forearm are controlled. Thus, any hypothesis on bicipital function at the shoulder must be based on either a passive role of the tendon or tension in association with elbow and forearm activity.

Intra- and interobserver reproducibility of the shoulder laxity examination.

The present study evaluates the inter- and intraobserver reproducibility of clinical examination of glenohumeral laxity in the unanesthetized shoulder. Forty-three asymptomatic Division I collegiate athletes underwent bilateral shoulder laxity examination initially and again after 3 months. Translation of the humeral head on the glenoid fossa in the anterior, posterior, and inferior directions was graded by four physicians who were blinded to their own previous grading and that of the other examiners. Overall intraobserver reproducibility of examination was 46%. When grades 0 and 1 were equalized, overall intraobserver reproducibility improved to 74%. For both the equalized and non-equalized reproducibility values reported by all examiners, the kappa values for intraobserver correlation were less than 0.5, which suggests that correlations were not better than those achieved by chance alone. Overall interobserver reproducibility was 47%. When grades 0 and 1 were equalized, interobserver reproducibility improved to 78%. Kappa values were greater than 0.5 only in equalized posterior and inferior laxity. The data demonstrate that the laxity examination of the unanesthetized shoulder is not easily reproducible in either intra- or interobserver comparison. Equalization of grade 0 and grade 1 laxity improves both intra- and interobserver reproducibility. We recommend caution when determining diagnosis and treatment based on this examination.

Penetration of cryotherapy in treatment after shoulder arthroscopy.

Fifteen patients undergoing shoulder arthroscopy had indwelling temperature probes placed in the glenohumeral and subacromial spaces. All shoulders underwent diagnostic arthroscopy and debridement of the subacromial space. Cryotherapy was delivered to the shoulder via a Cryo/Cuff (AirCast, Summit, NJ) and temperatures were monitored for 90 minutes. Ten shoulders received cryotherapy and 5 were used as controls. Before cryotherapy, temperature averaged 34 degrees C in the glenohumeral joint and 31 degrees C in the subacromial space. No significant difference was seen between the temperatures recorded in the cold therapy and control groups for either the glenohumeral or subacromial space. In all cases, the subacromial space averaged 1 degree cooler than the glenohumeral joint at the conclusions of arthroscopy. These slowly equalized to an average of 35 degrees postoperatively. The present study shows that surface-applied cryotherapy does not penetrate either the glenohumeral joint or the subacromial space. Attention must be turned elsewhere to delineate how cryotherapy works.

Glenohumeral translation in the asymptomatic athlete's shoulder and its relationship to other clinically measurable anthropometric variables.

To determine the degree of shoulder translation in uninjured athletes, we examined 76 Division I collegiate athletes (44 women and 32 men) for passive range of motion in both shoulders and for knee and elbow hyperextension. Translation was based on a scale of 0 to 3+. Shoulders with symptoms of pain or a history of instability or dislocation were excluded from this study. Forty-six shoulders had 0 anterior translation, 75 had 1+, and 31 had 2+. Thirteen shoulders had 0 posterior translation, 56 had 1+, and 83 had 2+. Thirty-eight shoulders had 0 inferior translation, 105 had 1+, and 9 had 2+. No shoulder had translation of 3+ in any direction. Twenty-four athletes, 12 men and 12 women, had translational asymmetry of a minimum of one grade in at least one direction. No shoulder was asymmetric in all three directions. There was a significant correlation between dominant hand and increased translation; 19 of 24 athletes with asymmetric shoulders had greater translation in the nondominant extremity. There was no relationship between translation and range of motion, knee or elbow hyperextension, thumb-to-forearm distance, or years spent in sports participation. Asymmetry of shoulder translation may exist in the normal shoulder. This review shows that up to 2+ translation in any direction cannot be considered abnormal.

Local anesthesia in outpatient knee arthroscopy: a comparison of efficacy and cost.

This study was performed to compare the efficacy, cost-effectiveness, and safety of general, regional, and local anesthesia when performing outpatient knee arthroscopy. The study consisted of two portions. A retrospective review of 256 outpatient knee arthroscopies was performed. The types of anesthesia used were general endotracheal, regional (epidural or spinal), and local. Comparisons were made between operative procedure, anesthesia procedure time, need for supplemental anesthesia, recovery room time and cost, pharmaceutical cost, and complications. A prospective study consisted of 100 consecutive outpatient knee arthroscopies performed using local anesthesia. Data identical to the retrospective portion were obtained. Visual analog scales were used in a patient questionnaire completed at the first postoperative visit to assess patient satisfaction with local anesthesia. The retrospective data showed similar demographics and operative procedures performed in the three study groups. The difference between operative time and total anesthetic time for the local group was 35 minutes less than for regional, and 23 minutes less than for the general group. These differences were statistically significant (P < or = .05). Total pharmaceutical cost was significantly less for the local group (P < or = .05). Recovery room cost for the local anesthesia group averaged $134 compared with $450 for regional and $527 for general. This difference was significant (P < or = .05). There were 19 complications with general anesthesia, 16 with regional anesthesia, and 2 with local. There were two regional and two local cases that needed subsequent general anesthesia. The prospective data showed nearly identical time and cost data. The patient questionnaire showed nearly universal acceptance and satisfaction with the use of local anesthesia. The use of local anesthesia for outpatient knee arthroscopy is safe, effective, and well accepted. The use of local anesthesia was shown to save a minimum of $400 per case compared with the other anesthetic methods studied.

Repair of the distal biceps tendon using suture anchors and an anterior approach.

The authors describe a technique for repair of the biceps tendon rupture from the radial tuberosity. A single anterior incision, limited volar dissection, and implantable bone anchors were used. With this technique, the authors have repaired the distal biceps tendon in 5 men (mean age, 39 years). Four patients were laborers and 1 was an athlete. Mechanism of injury was a single traumatic event with an unanticipated large load being applied to the flexed arm. Four patients were treated acutely and 1 was treated 6 months after injury. All patients returned to preinjury activity levels by 5 months after repair of the tendon. Clinically, all repairs remained intact (mean followup, 2.5 years). Range of motion was symmetric. No evidence of associated nerve injuries, heterotopic bone formation, or olecranon tenderness occurred. Subjective, as well as objective, results were excellent in those 5 patients whose distal biceps tendon was repaired by the single volar incision and implantable anchors.

Isolated volar carpometacarpal dislocation of the fifth digit.

McWharter first described volar carpometacarpal dislocations of the fifth digit in 1918. Since then, 14 cases have been reported in the medical literature. Berg and Murphy were first to report a case of ulnopalmar dislocation that was successfully treated with closed reduction and immobilization. Previously reported cases required internal fixation with or without open reduction. We report a fifth carpometacarpal ulnopalmar dislocation, treated with closed reduction and casting.

Kyphotic deformity in patients who have a myelomeningocele. Operative treatment and long-term follow-up.

The results of resection of the lordotic segment cephalad to the apical vertebra of a kyphotic deformity in thirty-nine patients who had had a myelomeningocele were reviewed retrospectively. The operations were performed between 1973 and 1984, when the patients were an average of six years and ten months old (range, one year and five months to twenty years old). The average duration of follow-up was eleven years and one month (range, five years and one month to seventeen years and four months). The average preoperative kyphosis was 111 degrees (range, 77 to 151 degrees) and the average postoperative kyphosis was 40 degrees (range, 2 to 88 degrees). The preoperative deformity was reduced an average of 64 per cent (range, 0 to 98 per cent). At the latest follow-up evaluation, the average kyphosis was 62 degrees (range, -25 to 100 degrees). The measurements were obtained from lateral radiographs that were made with the patient sitting preoperatively, immediately postoperatively, at one year, and yearly until the time of the latest follow-up evaluation. At the most recent examination, thirty-four patients had a partial loss of correction, with twenty-five of them having maintained at least 50 per cent of the correction. The five remaining patients had an improvement in the alignment by an average of 26 degrees. Only two patients had an increase in kyphosis compared with the preoperative deformity. Thirty-seven patients had an average increase of 3.2 centimeters (range, 0.2 to 8.2 centimeters) in the height of the lumbar spine; the two remaining patients, who had a decrease in height, had operative intervention after reaching skeletal maturity.