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Surgical treatment of the acromioclavicular dislocations using the vukov technique
J. Shoulder Elbow Surg. January/February 1995
$96 Abstracts
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ROTATOR CUFF LESIONS: DO ULTRASSONOGRAPHY AND PNEUMOARTHROGRAPHY IMPROVE THE CLINICAL SUPRASPINATUS TEST RELIABILITY. Nicoletti, S. J.,MD & Moura, L. MD. Escola Paulista de Medicina. S~o Paulo, Brazil. Forty-eigth consecutives patients with painful shoulder and no improvement of pain with a specific rehabilitation program were sequencially submited to Supraspinatus Clinical Test (SCT), Ultrassonograpy (US) and Pneumoarthrography (PA) prior to Arthros-copic examination (Gold Standard). Sensitivity and Specificity were calculated for each isolated examination, for SCT associated with PA and finally for SCT associated with US and PA. Results: When SCT was positive the use of either one or the other imagenologic test improved diagnostic sensitivity in 7%. When SCT plus US and PA was used the diagnostic sensitivity improved only 10% in relation to the clinical test alone. Specificity on the other hand was found to improve from 43% for SCT to 60% for SCT+ PA and to 80% for SCT+US. Conclusions: US and PA did not significantly improve the reliability of the positive Supraspinatus Test but it did improve the chances to detect a supraspinatus lesion in a patient with negative clinical test.
SURGICAL TREATMENT OF ACROMIOCLAVICULAR DISLOCATIONS THE VUKOV TECHNIQUE.
cont.
3) M.U.A. and s u r g e r y (15,7%) ; 4 ) s u p r a s e a p u l a r nerve b l o c k and P.T. (3,5%). The f i n a l r e s u l t s show t h a t o n l y 19 p a t i e n t s (33,3%) were c o n s i d e r e d e x c e l e n t ; 38 p a t i e n t s (67,7%) remain w i t h some type o f d i s a b i l i t y .
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CORACO-ACROMIAL AND CORACO-HUMERAL LIGAMENTS. MICRO AND MACROSCOPIC ASPECTS. O.Lech, MD, A.Kuhn, MD, P.Siqueira, MD., & P.Schmidt, MD. Passo F~ido, RS, and Curitiba, PR, Brazil. The C-A and C-H ligaments of 20 shoulders (12 fresh cadavers) were analysed. The C-A ligament has an average width of 24,70~m in its origin, 14,55nm in the insertion and 36,25 nm in lenght. The average distance between the top of coraeoid process to the anterior acromion was 42,55nm. The C-A ligament is a pa~-t of the acromial arch, m~d its microscopic structure is formed by a dense, well-defined cormective tissue, similar to a normal ligament. The C-H ligament has its origin about 10,10ram rom the top of the coracoid process, with sn average width of 15,60n~n in the origin mld 23,95mm in the insertion, and 19,60ram of lenght. The C-H ligament is the main restrain of the external rotation. Its microscopic structure is formed by an irregular type of cor~ective tissue. It is considered a continuum of the G-H capsule, rather than a typicai ligament.
THE USING
Rui J. Fernandes, M.D., Marcos R. Fernandes, M.D• Hospital Ortop~dico de Goiania - Goias - Brazil
Twenty-seven cases of acromioclavicular dislocations, classified by Rockwood system, are presented by the authors. All the cases were treated by the Vukov technique ( n° 5 suture o f the clavicle to the coracoacromial ligament, and the resection of 0.8 cm. of the distal clavicle to prevent an articular degeneration). This operation have been used in the past four years, and the results are encouraging.
22 ADHESIVE CAPSULITIS - MULTIDISCIPLINAR APPROACH O.iech, MD, G.Sudbrack, MD, & C.Valenzuela,PT. Passo Fundo and Porto Alegre, RS, Brazil. 61 cases of adhesive capsulitis in 57 patier~s were evaluated after a multidisciplinar form of treatment (shoulder surgeon, algologist, physiotherapist). In average, the treatment was iniciated 7 months after the symptoms have started. 8 2 , 4 % o f the patients had a prior treatment without any improvement. The patients were evaluated in two groups, according to the etiology: i~) with systemic diseases associated, where the incidence of bad results was higher; 2~) with shoulder pathology associated. The treatment consiste of: l)medication and P.T. (66,6% of the cases); 2)M.U.A. and hidraulic capsular distention (22,8%); conL
24
LATISSIMUS DORSI TRANSFER TREATMENT OF MASSIVE ROTATOR
FOR THE CUFF T E A R S
S e r g i o A. R o d x i g u e s / H o s p i t a l de T r a u m a to-Ortopedia/Rio de J a n e i r o / B r a s i l E i g h t y - s i x r o t a t o r s cuff tears conf i r m e d by p n e u m o a r t h r o g r a p h y were t r e a t e d f r o m 1989 to 1994. S i x t y p a c i ents w e r e s u b m i t t e d to surgery. Seventeen tears were small, 23 large and 20 massive tears. From the massive ones, four, could be r e p a i r e d with local tissue, i n c l u d i n g teres m i n o r and s u b s c a p u l a r i s t r a n s f e r , three were d e b r i d e d and t h i r t e e n were treated with l a t i s s i m u s d o r s i t r a n s f e r . The p a t i e n t s w e r e o p e r a t e d on between 1993 a n d 1994, m e a n f o l l o w - u p of 14 months. E i g h t men and five women, w i t h an a v e r a g e of 56 yea~s (range 37-76)A The a v e r a g e galn in ant.flex, was 90~, abd. 60, ext.rot. 25 ° , int.rot. - b a c k of the h a n d r e a c h e d T ~ . O v e r a l l , there w e r e ten excellent and 03 good r e s u l t s (UCLA method). It was c o n c l u d e d that t r a n s f e r of the l a t i s s i m u s d o r s i t e n d o n from the humeral shaft to the s u p e r o l a t e r a l humeral head can be an effetive h e a d d e p r e s s o r and ex t e r n a l r o t a t o r and should be c o n s i d e r e d in s!mptomatic i r r e p a i r a b l e r o t a t o r cuff tears. •
,
U
$96 Abstracts
20
21
22
ROTATOR CUFF LESIONS: DO ULTRASSONOGRAPHY AND PNEUMOARTHROGRAPHY IMPROVE THE CLINICAL SUPRASPINATUS TEST RELIABILITY. Nicoletti, S. J.,MD & Moura, L. MD. Escola Paulista de Medicina. S~o Paulo, Brazil. Forty-eigth consecutives patients with painful shoulder and no improvement of pain with a specific rehabilitation program were sequencially submited to Supraspinatus Clinical Test (SCT), Ultrassonograpy (US) and Pneumoarthrography (PA) prior to Arthros-copic examination (Gold Standard). Sensitivity and Specificity were calculated for each isolated examination, for SCT associated with PA and finally for SCT associated with US and PA. Results: When SCT was positive the use of either one or the other imagenologic test improved diagnostic sensitivity in 7%. When SCT plus US and PA was used the diagnostic sensitivity improved only 10% in relation to the clinical test alone. Specificity on the other hand was found to improve from 43% for SCT to 60% for SCT+ PA and to 80% for SCT+US. Conclusions: US and PA did not significantly improve the reliability of the positive Supraspinatus Test but it did improve the chances to detect a supraspinatus lesion in a patient with negative clinical test.
SURGICAL TREATMENT OF ACROMIOCLAVICULAR DISLOCATIONS THE VUKOV TECHNIQUE.
cont.
3) M.U.A. and s u r g e r y (15,7%) ; 4 ) s u p r a s e a p u l a r nerve b l o c k and P.T. (3,5%). The f i n a l r e s u l t s show t h a t o n l y 19 p a t i e n t s (33,3%) were c o n s i d e r e d e x c e l e n t ; 38 p a t i e n t s (67,7%) remain w i t h some type o f d i s a b i l i t y .
23
CORACO-ACROMIAL AND CORACO-HUMERAL LIGAMENTS. MICRO AND MACROSCOPIC ASPECTS. O.Lech, MD, A.Kuhn, MD, P.Siqueira, MD., & P.Schmidt, MD. Passo F~ido, RS, and Curitiba, PR, Brazil. The C-A and C-H ligaments of 20 shoulders (12 fresh cadavers) were analysed. The C-A ligament has an average width of 24,70~m in its origin, 14,55nm in the insertion and 36,25 nm in lenght. The average distance between the top of coraeoid process to the anterior acromion was 42,55nm. The C-A ligament is a pa~-t of the acromial arch, m~d its microscopic structure is formed by a dense, well-defined cormective tissue, similar to a normal ligament. The C-H ligament has its origin about 10,10ram rom the top of the coracoid process, with sn average width of 15,60n~n in the origin mld 23,95mm in the insertion, and 19,60ram of lenght. The C-H ligament is the main restrain of the external rotation. Its microscopic structure is formed by an irregular type of cor~ective tissue. It is considered a continuum of the G-H capsule, rather than a typicai ligament.
THE USING
Rui J. Fernandes, M.D., Marcos R. Fernandes, M.D• Hospital Ortop~dico de Goiania - Goias - Brazil
Twenty-seven cases of acromioclavicular dislocations, classified by Rockwood system, are presented by the authors. All the cases were treated by the Vukov technique ( n° 5 suture o f the clavicle to the coracoacromial ligament, and the resection of 0.8 cm. of the distal clavicle to prevent an articular degeneration). This operation have been used in the past four years, and the results are encouraging.
22 ADHESIVE CAPSULITIS - MULTIDISCIPLINAR APPROACH O.iech, MD, G.Sudbrack, MD, & C.Valenzuela,PT. Passo Fundo and Porto Alegre, RS, Brazil. 61 cases of adhesive capsulitis in 57 patier~s were evaluated after a multidisciplinar form of treatment (shoulder surgeon, algologist, physiotherapist). In average, the treatment was iniciated 7 months after the symptoms have started. 8 2 , 4 % o f the patients had a prior treatment without any improvement. The patients were evaluated in two groups, according to the etiology: i~) with systemic diseases associated, where the incidence of bad results was higher; 2~) with shoulder pathology associated. The treatment consiste of: l)medication and P.T. (66,6% of the cases); 2)M.U.A. and hidraulic capsular distention (22,8%); conL
24
LATISSIMUS DORSI TRANSFER TREATMENT OF MASSIVE ROTATOR
FOR THE CUFF T E A R S
S e r g i o A. R o d x i g u e s / H o s p i t a l de T r a u m a to-Ortopedia/Rio de J a n e i r o / B r a s i l E i g h t y - s i x r o t a t o r s cuff tears conf i r m e d by p n e u m o a r t h r o g r a p h y were t r e a t e d f r o m 1989 to 1994. S i x t y p a c i ents w e r e s u b m i t t e d to surgery. Seventeen tears were small, 23 large and 20 massive tears. From the massive ones, four, could be r e p a i r e d with local tissue, i n c l u d i n g teres m i n o r and s u b s c a p u l a r i s t r a n s f e r , three were d e b r i d e d and t h i r t e e n were treated with l a t i s s i m u s d o r s i t r a n s f e r . The p a t i e n t s w e r e o p e r a t e d on between 1993 a n d 1994, m e a n f o l l o w - u p of 14 months. E i g h t men and five women, w i t h an a v e r a g e of 56 yea~s (range 37-76)A The a v e r a g e galn in ant.flex, was 90~, abd. 60, ext.rot. 25 ° , int.rot. - b a c k of the h a n d r e a c h e d T ~ . O v e r a l l , there w e r e ten excellent and 03 good r e s u l t s (UCLA method). It was c o n c l u d e d that t r a n s f e r of the l a t i s s i m u s d o r s i t e n d o n from the humeral shaft to the s u p e r o l a t e r a l humeral head can be an effetive h e a d d e p r e s s o r and ex t e r n a l r o t a t o r and should be c o n s i d e r e d in s!mptomatic i r r e p a i r a b l e r o t a t o r cuff tears. •
,
U