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Paper #216 Arthroscopic treatment of painful snapping of the scapula
ABSTRACTS subjects had flattening of the humeral head by an average of 3.8mm. All patients had grade 4 chondral change of the glenoid, and 16 had grade 4 change of the humeral head. The rotator cuff was intact in 12, torn in 4 and partially torn in 2. The labrum was intact in 9, while 5 had unstable articular cartilage flaps and 6 had loose bodies. Assessment of synovitis was mild in 2, mildmoderate in 5, moderate in 5, and marked in 6. The biceps was normal in 6, torn in 3, partially torn in 7, inflamed in 1 and 1 had a type I SLAP lesion. There were no post-operative complications. Fourteen of 18 subjects (78%) were classified as good to excellent at an average of 24 months (12 - 50 months). Three patients were classified as poor at final follow up (1 underwent a TSA at 9 months). One patient underwent a repeat arthroscopic debridement at 37 months. Pain and function scores improved from the first visit as compared with pre-op, with maximal pain benefit (2.7 to 6.3) and overall UCLA rating (14 to 24) at 3 months, and maximal function improvement at 6 months. Pain improvement was noted in 60% of subjects at 2 weeks, and greater than 80% of patients thereafter, while patient satisfaction was over 80% at all visits except the 6 week visit. Satisfaction scale improved steadily and reached at plateau at 6 months. Functional improvement was small (UCLA from 4.1 pre-op to 6.7; ASES from 27 pre-op to 36). Discussion: Isolated arthroscopic debridement relieves pain in nearly 80% of patients with severe glenohumeral arthritis by 3 months and may provide relief for more than 4 years. Some improvement in function may be seen. Isolated arthroscopic debridement can be considered as a temporizing procedure that may be included in the algorithm of management of severe shoulder arthritis. This includes patients with large osteophytes, obliteration of joint space and flattening of the humeral head. Paper #215 The “hourglass Biceps”: Another Cause Of Shoulder Pain. Pascal Boileau, Presenter, Hoˆ pital Archet 2, Nice, France, Philip Michael Ahrens, Nice, France, Christophe Trojani, Nice, France, Jean Sebastien Coste, Nice, France Aim: We present a mechanical condition affecting the long head of the biceps tendon in which incarceration within the joint is an unrecognised cause of pain. This is caused by a hypertrophic intra-articular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm. Materials and Methods: Retrospective review of 16 patients identified with a hypertrophic intra-articular por-
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tion of the long head of the biceps tendon during open (13 cases) or arthroscopic surgery (3 cases). All of our cases occurred in the presence of a rotator cuff rupture except one who had a partial deep tear. All patients were treated by biceps tenodesis and appropriate treatment of the concomitant lesions. Results: All patients presented with anterior shoulder pain and a loss of passive elevation of 10-200. A dynamic test at operation, involving elevation of the arm with the elbow extended, demonstrated incarceration of the tendon within the joint. This causes a characteristic buckling of the tendon and squeezing of the tendon between the humeral head and the glenoid. Constant score increased from 37 points pre-operatively to 77 points post-operatively. Discussion: The clinical sign of a loss of 10-200 of passive elevation, bicipital groove tenderness as well as the MRI/ arthrographic finding of a hypertrophied tendon can alert the clinician to the possibility of an “hourglass biceps.”
Definitive diagnosis is made at surgery, either open or arthroscopic, demonstrating the incarceration and squeezing of the tendon within the joint when elevating the arm with the elbow extended (the “hourglass test”). Simple tenotomy cannot resolve this mechanical block, and tenotomy with excision of the intraarticular portion of the tendon or tenodesis must be performed. Paper #216 Arthroscopic Treatment Of Painful Snapping Of The Scapula. Simon Nicholas Bell, Presenter, Monash University Department of Orthopaedic Surgery, Melbourne, Australia, Attila Pavlik, Budapest, Hungary Aim Of The Study: To evaluate the results of arthroscopic resection of the superomedial corner of the scapular, using a new superior portal, in patients with a painful snapping scapular. Materials and Methods: An analysis was made of 10 patients who had arthroscopic resection of the superomedial corner of the scapula. There were 4 women and 6 men with a mean age 26.9 years (range 16 to 40). The average duration of symptoms was 53.2 months (range 12 to 154). X-ray and CT scans were normal. The patients were evaluated by questionnaire and clinical examination, and the results assessed by the UCLA rating score.
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ABSTRACTS
Results: Average follow-up period was 11.3 months (range 3 to 23). There were no post operative complications. The scapulothoracic crepitus disappeared in 2 patients, decreased in 7 patients and remained the same in 1 patient. The mean postoperative visual analog pain scale was 2.7. All felt the procedure to be worthwhile.
On the UCLA score there were 4 excellent, 4 good and 2 fair results. Conclusion: Scapulothoracic arthroscopy using medial and superior portals is a safe procedure. Resection of the superomedial corner of the scapula reliably improves symptoms from the painful snapping scapula.
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tion of the long head of the biceps tendon during open (13 cases) or arthroscopic surgery (3 cases). All of our cases occurred in the presence of a rotator cuff rupture except one who had a partial deep tear. All patients were treated by biceps tenodesis and appropriate treatment of the concomitant lesions. Results: All patients presented with anterior shoulder pain and a loss of passive elevation of 10-200. A dynamic test at operation, involving elevation of the arm with the elbow extended, demonstrated incarceration of the tendon within the joint. This causes a characteristic buckling of the tendon and squeezing of the tendon between the humeral head and the glenoid. Constant score increased from 37 points pre-operatively to 77 points post-operatively. Discussion: The clinical sign of a loss of 10-200 of passive elevation, bicipital groove tenderness as well as the MRI/ arthrographic finding of a hypertrophied tendon can alert the clinician to the possibility of an “hourglass biceps.”
Definitive diagnosis is made at surgery, either open or arthroscopic, demonstrating the incarceration and squeezing of the tendon within the joint when elevating the arm with the elbow extended (the “hourglass test”). Simple tenotomy cannot resolve this mechanical block, and tenotomy with excision of the intraarticular portion of the tendon or tenodesis must be performed. Paper #216 Arthroscopic Treatment Of Painful Snapping Of The Scapula. Simon Nicholas Bell, Presenter, Monash University Department of Orthopaedic Surgery, Melbourne, Australia, Attila Pavlik, Budapest, Hungary Aim Of The Study: To evaluate the results of arthroscopic resection of the superomedial corner of the scapular, using a new superior portal, in patients with a painful snapping scapular. Materials and Methods: An analysis was made of 10 patients who had arthroscopic resection of the superomedial corner of the scapula. There were 4 women and 6 men with a mean age 26.9 years (range 16 to 40). The average duration of symptoms was 53.2 months (range 12 to 154). X-ray and CT scans were normal. The patients were evaluated by questionnaire and clinical examination, and the results assessed by the UCLA rating score.
110
ABSTRACTS
Results: Average follow-up period was 11.3 months (range 3 to 23). There were no post operative complications. The scapulothoracic crepitus disappeared in 2 patients, decreased in 7 patients and remained the same in 1 patient. The mean postoperative visual analog pain scale was 2.7. All felt the procedure to be worthwhile.
On the UCLA score there were 4 excellent, 4 good and 2 fair results. Conclusion: Scapulothoracic arthroscopy using medial and superior portals is a safe procedure. Resection of the superomedial corner of the scapula reliably improves symptoms from the painful snapping scapula.