Comparison of magnetic resonance imaging and arthroscopy in the evaluation of shoulder pathology

Fifty-seven subjects with shoulder pain, the cause of which was not clear on clinical examination, underwent magnetic resonance imaging (MRI) and arthroscopy. With arthroscopy as the standard of reference, the accuracy of MRI for diagnosing shoulder disease was assessed. Pathologic conditions were organized into 3 groups: (1) labral tears, (2) rotator cuff disease, and (3) other pathologic conditions. At arthroscopic evaluation there were 15 labral tears, 24 rotator cuff tears, and 27 other abnormalities. MRI identified 11 of the labral injuries, with accuracy of 62%, sensitivity 73%, and specificity 58%. Rotator cuff tears were identified by MRI with accuracy of 68%, sensitivity 96%, and specificity 49%. When partial rotator cuff tears were differentiated from complete tears, only 16 of 24 injuries were identified by MRI. Nonrotator cuff, nonlabral disease was identified with accuracy of 75%, sensitivity 63%, and specificity 87%. In our center MRI does not appear to be an accurate effective tool for assessing shoulder pathologic conditions in patients in whom the clinical picture is not clear and therefore may not be of assistance in surgical planning for patients with these difficult conditions.     

Computerized arthrotomography in recurring shoulder dislocations and subluxations

A prospective study of 14 patients demonstrated the value of computerized arthrotomography in the unstable shoulder. This technique allows the visualization of soft-tissue and bone anomalies that cannot be detected otherwise.     

Dynamic assessment of shoulder and patellofemoral pathology using limited-volume gas arthroscopy

Subtle instability problems of the glenohumeral joint and patellofemoral joint are difficult to assess and accurately diagnose with current methods of preoperative imaging and physical examination. A simple technique is described that provides objective information for diagnosing dynamic problems of the shoulder and patellofemoral joint. Limited-volume gas arthroscopy avoids many of the potential risks and complications of pressure-based gas arthroscopy. In addition to assessing joint dynamics, it allows for initial arthroscopic inspection of joints during open surgical cases, eliminating the additional morbidity and expense of fluid arthroscopy. Objective intraoperative assessments of completed reconstructions can also be made to insure that stabilizing procedures are adequate but not overzealous. The technique requires no special equipment, adds little time to an arthroscopic procedure, and requires only basic arthroscopic skills.Arthroscopy 1998 Jul-Aug;14(5):546-50     

Possibilities of computerized arthrotomography in the diagnosis of shoulder instabilities

Shoulder instability can usually be diagnosed by examination of the history and a careful physical examination. Additional diagnostic studies include radiographic investigations and arthroscopy as a functional and very comprehensive diagnostic procedure for shoulder lesions. Conventional radiographic investigations with special projections have proven to be reliable in revealing bony changes of the glenoid and of the humeral head, whereas CT arthrography is very helpful in evaluating capsulolabral lesions associated with shoulder instability. This kind of investigation is a highly sensitive and less invasive technique. Combined with intraarticular application of contrast medium the extent of pathologic changes associated with instability can be imaged and differentiated from other intraarticular causes of dysfunction. During a 1-year period, 42 patients were studied by double contrast arthrography followed by CT examination, and 33 were found to have a shoulder instability. The intention of this report is to describe a few CT arthrographic findings in the presence of pathologic anatomy of unstable shoulders.     

Computerised arthrotomography of primary anterior dislocation of the shoulder

Computerised arthrotomography was performed on 33 patients four to six weeks after acute primary anterior dislocation of the shoulder. Seventeen patients were under, and 16 over 50 years of age. Damage to the anterior glenoidal labrum was seen in all the younger patients and in 75% of the older ones. A large redundant capsular pouch, seen in the older patients, was present in 35% of the younger ones, and a posterior humeral head defect was seen in 82% of the younger patients and only 50% of the older. Associated fractures were more common in the older patients, and a tear of the rotator cuff was demonstrated in 63% of the older patients and in none of the younger ones.     

The diagnostic value of double contrast CT in shoulder dislocation]

The article reports of the indication, technique and results of the shoulder joint double-contrast-computertomography. It discuss its diagnostic value in comparison to other examining methods. As alternative preoperative diagnostic procedures only arthroscopy, arthrography and MRI can be considered. Also discussed are the therapeutic consequences resulting from the nature of the pathological lesions (rupture of the limbus glenoidalis, Hill-Sachs-defect, reversed Hill-Sachs-defect). Especially for the first traumatic dislocations of the shoulder joint, we consider this investigational method an eminent enlargement of the diagnostic spectrum. Therefore, we are generous with its indication, attempting to prevent reluxations by primary diagnostic and therapeutic procedure.     

肩关节镜术后糖皮质激素注射时间和剂量与术后感染的相关性

目的探讨肩关节镜术后糖皮质激素注射时间与剂量对术后感染的影响,为防治肩关节镜术后并发症提供新思路。 方法选取2014年2月至2018年3月普宁市人民医院收治的行肩关节镜手术94例患者为研究对象,根据术后是否发生感染将患者分为感染组（21例）和未感染组（73例）。分析两组术后感染发病率和病原菌分布。探讨患者的年龄、性别、住院时间、手术时间、糖皮质激素使用等与术后感染发生率的相关性。通过ROC曲线预测糖皮质激素注射时间与剂量对肩关节镜术后感染的影响。 结果肩关节镜术后感染者共21例,感染率为22.3%,其中革兰阴性菌8株（38.0%）,革兰阳性菌12株（57.2%）,真菌1株（4.8%）。与未感染组相比,感染组患者年龄、住院时间、手术时间、合并糖尿病、抗菌药物使用时间、糖皮质激素治疗日均剂量和使用时间差异均有统计学意义（P均< 0.05）;多因素Logistic回归分析显示,手术时间（OR = 1.238、P = 0.026）、糖皮质激素治疗日均剂量（OR = 1.485、P = 0.019）和使用时间（OR = 0.968、P = 0.018）均为肩关节镜术后感染的独立危险因素。ROC曲线分析显示,肩关节镜术后糖皮质激素的累计治疗时间ROC曲线下面积为0.805,95%CI：0.685～0.924,临界值为5.16;肩关节镜术后糖皮质激素日均剂量ROC曲线下面积为0.909,95%CI：0.830～0.988,临界值为12.67,差异均有统计学意义（P均< 0.001）。 结论肩关节镜术后感染以革兰阳性菌为主,长时间与高剂量糖皮质激素注射可能会导致术后感染的风险增高。肩关节镜术后合理应用糖皮质激素是避免感染发生的重要措施。     

Anterior portals in shoulder arthroscopy

The anterior portal has been the major operative portal through which hand and motorized instrumentation have been introduced into the glenohumeral joint. This portal has been limited with respect to its access to structures in the anteroinferior aspect of the joint. Anatomical and clinical studies were undertaken to evaluate the safety and effectiveness of the use of an anterior inferior, as well as an anterior superior portal. Seventy-eight unembalmed cadaver specimens and 34 operative cases were used in the studies. Only an "inside out" technique using blunt instrumentation is recommended in creating the anterior inferior portal. The margin of safety with respect to the musculocutaneous nerve is increased with adduction. The use of these two anterior portals greatly enhanced our ability to visualize and work directly on lesions of the glenohumeral ligament labral complex. These anterior portals can be safely created if guidelines are carefully followed by surgeons with considerable experience in shoulder arthroscopy.     

Peri-operative complications in pediatric and adolescent shoulder arthroscopy

Background

Shoulder arthroscopy is not common in the pediatric and adolescent population, but the frequency may be on the rise. The purpose of the study was to determine the incidence of acute complications of arthroscopic shoulder surgery in children and adolescents.

Methods

A retrospective, cross-sectional review was performed identifying patients aged 18 years or less who underwent an arthroscopic shoulder procedure from 1997 to 2009 at Institution 1 and 2007 to 2010 at Institution 2. Exclusion criteria included open procedures and missing records. Demographic and surgical data were collected, including intra-operative and post-operative complications during the first 6 months. The complications were divided into minor (no secondary treatment) and major (secondary treatment rendered).

Results

Two hundred children, mean age 15.9 years, met criteria and 73 % were boys. All procedures were performed under general anesthesia, but 51 % included inter-scalene regional anesthesia. There were 16 (8.0 %) total complications recorded. Major complications occurred in five (2.5 %) patients, including two tendinitis/bursitis requiring injections, one broken pain pump catheter requiring an accessory incision to retrieve, one pain control readmission, and one laceration of the cephalic vein requiring ligation. Minor complications occurred in 11 (5.5 %) patients, including allergic reactions, transient dysesthesias, headaches, bronchitis, syncope, transient hypotension, and uvula swelling.

Conclusion

Although we found no seriously deleterious outcomes, it is important to recognize that an additional service was rendered for 2.5 % of children undergoing shoulder arthroscopy. The events that did occur may be preventable and this study should serve as a baseline to improve quality and safety of shoulder arthroscopy in the pediatric population.     

Anatomy of the supraclavicular fossa portal in shoulder arthroscopy

Because of the need for a third portal for operative procedures during glenohumeral joint arthroscopy, we studied the anatomy of the supraclavicular fossa portal with the humerus in various degrees of abduction and the trochar placed at various angles. Our purpose was to establish a "safe zone" of introduction that would avoid damage to the tendinou portion of the rotator cuff. Eight shoulder specimens were studied. Sharp- and blunt-tipped 4-mm trocars were used to enter the joint. The trapezius was penetrated at all angles of humeral abduction and trocar angulation. The trocar penetrated the tendinous portion of the rotator cuff in all specimens at 90 degrees of abduction, seven of eight specimens at 70 degrees, six of eight specimens at 60 degrees, and three of eight specimens at 45 degrees of abduction. No penetration of the musculotendinous portion occurred when the arm was in 30 degrees of abduction or at the side. When it is necessary to use the supraclavicular portal, traction should be released and the humerus should be brought down to at least 45 degrees. The trocar should be introduced laterally at 30 degrees and angled slightly posteriorly to avoid the tendinous portion of the rotator cuff.     

Debris observed by arthroscopy of the knee.

In examination of 732 knee joints through the arthroscope since 1961, various types of debris were observed in 47. The debris was classified into four groups: precipitation of fibrin, degeneration and necrosis of villi, desquamation of articular cartilage, and metaplasia of villi. Diseases of the knee joint and their pathogenesis are discussed in the light of these findings.     

Comparison between arthroscopy and arthrotomy in the treatment of shoulder instability

Anterior post-traumatic shoulder instability represents a common finding in orthopaedic surgery. The surgical treatment of this lesion is often indispensable for the normal social life of the patient and for the sports activity of the young. The Bankart procedure with capsular retensioning by arthrotomic access has for years been the gold standard. In the last 10 years arthroscopic accesses have gained more and more consent for the surgical treatment of such lesions, with results that have considerably improved in time. It is the purpose of this study to compare the results obtained in patients affected with anterior-inferior post-traumatic shoulder instability treated by Bankart surgery, arthrotomic and arthroscopic, with a minimum follow-up of 4 years.