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Patient-adjusted static elbow splints for elbow contractures: A preliminary report
Abstracts $73
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
225
CLINICAL RESULTS OF ARTHROSCOHCALLY ASSISTED ROTATOR CUFF REPAIR SUNAO FUKUSHIIVIAMD, KENJI OKAMURA MD, SEIICHI ISHII MD., and MASAM/CHI USUI MD. Dept.of OrthopSurg.,Sapporo Med. Univ, Sapporo, JAPAN.
226
Purpose : The purpose of this study was to investigate the results of arthroscopically assisted rotator cuff repair. Materials and Methods : Fifty one patients (52 joi.tRs) were studied at more than 6 mouths postoperatively. The mean age at operation was 57.3 ye~a's(range:32-79) and the mean duration of follow up was 18.7 months (range:6-23). The procedure was as follows. First, arthroscopic examination of the glenohumeral joint and subacromlal bursa was performed, and the size, location, and repairability of the tear were determined. Then the edges of the tear madany coexisting glenohumeral lesions were debrided. Next, arthroscopic subacromial decompressionwas petf~mned,followed by rel~r of the cuff by splitting the deltoid muscle fibers bluntly about 4cm in llne with the anterolateral arthroscopy portal. The tom cuff was repifired according to MeLaughlin's method or using side-to:side suture and the deltoid muscle fascia was never detached from the acromion. Postoperative rehabilitation : Passive devation exercises were usually stmaedthe day after surgery and assisted active elevation in the 2rid week. Cuff strengthening exercises were started in the 8th week. Results : All patients had supraspinatus tears, including 45 complete tears and 7 partial tears (Snyder's A4 and B4). There were small tears (< I on) in 7 cases, medium tears (1-3 era) in 25 cases, and large tears (3-5 can) in 20 CaSes:Suture method : McLanghlin's repair was used in 43 cases and side-to-side suture in 9 cases. Concomitant lesions : There was a labra/teurs in 14 jdiuts and synovitis ia 20 joints. Using the UCLA Shoulder Rating Scale, the total score improved from an average of I3.6 points pranperativeIy to of 32.8 points postoperatively. Strength of abduction (Constaafs evaluation) improved signifieamly 55.1% to 90. 1% (affected / unaffected side). Discussion : Atthroscopically assisted rotator cuff rep~r offers the following advantages. I) The extent of pathology in the ghinohtmaeraljoint can be correctly determined (size, location, and repalrabilily of the tear). 2) Treatment of coexisting glenohumeral pathology is possible. 3) Arthroscopic subacromial decompression can be done to avoid detaching deltoid f~m the aeromaon.This makes early rehabilitation possible and reduces postoperative pain because there is less soft tissue damage.
225
PATIENT-ADJUSTED STATIC ELBOW SPLINTS FOR ELBOW CONTRACTURES: A PRELIMINARY REPORT. S.W. O'Driscoll, M.D., Ph.D., S.W. Shankland*, D. Beaten*, Dept. of Orthopedics, Mayo Clinic, Rochester, MN & *St. Michael's Hospital, Toronto, Canada.
Stiffness is a common and disabling complication of elbow trauma and some forms of surgery. Various forms of static and dynamic splints have been used to gain motion. PURPOSE: The purpose of this preliminary report is to present the early results of a prospective study of patient-adjusted static splints for nonoperative treatment of elbow contractures. METHODS: Six patients have been treated with splints that they adjust themselves, and wear for eighteen hours a day. Follow-up averaged 8 months (range 2 to 12). Their ages ranged from 6 to 50 years, averaging 34. The time from injury to commencing splinting averaged 6 months (range 1 - 9 months). Additionally, in one boy with a 65 ~ congenital flexion contracture splinting was started at the age of six years. Splinting was continued for 1 to 6 months (mean 5 months). RESULTS: It took 3 to 6 weeks for each patient to reach a plateau in range of motion. All 6 patients gained motion with the splinting (p=.02). Before splinting, two patients had full flexion and lacked only extension, whereas the remaining four lacked both flexion and extension. The average initial motion was from 46 ~ - 119 ~ (arc = 73~ final ROM was 29 ~ - 132 ~ (arc = 103~ After splinting, all patients gained both flexion and extension (except of course those two who started with full flexion; they gained extension only). The average gains were 18 ~ (38%) in extension, 15 ~ (57%) in flexion, and 33 ~ (45%) in the arc of motion. The minimum gain was 15~ (57%) in flexion, and 33 ~ (45%) in the arc of motion. The minimum gain was 15~ in the arc of motion. At follow-up all had within 5~ of a functional arc of motion (i.e. 30 ~ - 130 ~ except the patient with the congenital contracture who still lacked 40 ~ of extension. DISCUSSION: The functional arc of motion or very close to it was achieved using patient*adjusted static splints after failure of conservative treatment. These splints have been beneficial in our nonoperative and postoperative treatment of stiff elbows and for prevention of contracture following surgery and trauma. They work on the principle of viscoelastic "stress relaxation".
227
SURGICAL RELEASE OF POST-TRAUMATIC STIFF E L B O W . Hughes, JS, and Sonnabend, DH. Sydney Shoulder & Elbow Associates, Sydney, 2031, Australia. This paper reviews 17 consecutive open surgical releases for posttraumatic elbow contractures (flexion contracture > 45 degrees and/or flexion to < 110 degrees). CPM, axillary sheath catheters with Bupivicaine infusions and "offset hinge" turnbuckle static braces were used. Associated procedures included: corrective valgus/medial displacement osteotomy (1), ulnar nerve release (2), radial head excision (1), removal of implants (10) and biceps tendon tengthening (1). Range of movement, pain, function and x-ray findings were assessed before and after surgery. Primary pathology included: supracondylar fracture (6), radial head fracture (6), olecranon fracture (3), Monteggia fracture (1) and compound dislocation (1). Three patients had associated radio-ulnar dissociation. Previous surgical procedures included: radial head excision (2), Silastic radial head (1), O.R.I.F (12) and surgical release (2). Pre-operatively the average arc of m o v e m e n t was 57 degrees (mean flexion contracture 55 degrees, mean flexion 112 degrees). At follow-up (4 to 35 months), the average total arc was 118 degrees ( m e a n flexion conlracture 13 degrees, m e a n flexion 131 degrees). All patients' pain scores remained the same or were improved. (Mean pre-op 74, mean pre-op 91). All patients had improved elbow evaluation scores. There was no sepsis or delayed wound healing. Complications included one partial ulnar nerve palsy which recovered fully over 16 weeks and one oIecranon bursa effusion requiting asp/ration. One patient had a subluxation episode 3 weeks post-operatively and developed aa olecranon spur 12 months post-op. If normal iatraarticular architecture of the h u m e r o - u l n a r joint is preserved, significant m o v e m e n t can be restored, with good function, and no deterioration in pain. The long term prognosis following elbow release has yet to be established.
THE STIFF ELBOW : FACTORS OF PROGNOSIS
ABOUT 280 OPERATED CASES
Travers, V., Chambaud-Roanne, D., and Caille-Valence, J.P. Lyon, France. A retrospective and multicentric studyof 280 operated patients between 1968 and 1994 for stiff elbow was reviewed with a minimal follow up of 6 months. Global results are presented. The factors influencing, the final result were especially studies : age, delay before operation, initial gravity, and surgical approach were the most determinant factors influencing the result. The correlation between gravity and approach was particulary important.
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
225
CLINICAL RESULTS OF ARTHROSCOHCALLY ASSISTED ROTATOR CUFF REPAIR SUNAO FUKUSHIIVIAMD, KENJI OKAMURA MD, SEIICHI ISHII MD., and MASAM/CHI USUI MD. Dept.of OrthopSurg.,Sapporo Med. Univ, Sapporo, JAPAN.
226
Purpose : The purpose of this study was to investigate the results of arthroscopically assisted rotator cuff repair. Materials and Methods : Fifty one patients (52 joi.tRs) were studied at more than 6 mouths postoperatively. The mean age at operation was 57.3 ye~a's(range:32-79) and the mean duration of follow up was 18.7 months (range:6-23). The procedure was as follows. First, arthroscopic examination of the glenohumeral joint and subacromlal bursa was performed, and the size, location, and repairability of the tear were determined. Then the edges of the tear madany coexisting glenohumeral lesions were debrided. Next, arthroscopic subacromial decompressionwas petf~mned,followed by rel~r of the cuff by splitting the deltoid muscle fibers bluntly about 4cm in llne with the anterolateral arthroscopy portal. The tom cuff was repifired according to MeLaughlin's method or using side-to:side suture and the deltoid muscle fascia was never detached from the acromion. Postoperative rehabilitation : Passive devation exercises were usually stmaedthe day after surgery and assisted active elevation in the 2rid week. Cuff strengthening exercises were started in the 8th week. Results : All patients had supraspinatus tears, including 45 complete tears and 7 partial tears (Snyder's A4 and B4). There were small tears (< I on) in 7 cases, medium tears (1-3 era) in 25 cases, and large tears (3-5 can) in 20 CaSes:Suture method : McLanghlin's repair was used in 43 cases and side-to-side suture in 9 cases. Concomitant lesions : There was a labra/teurs in 14 jdiuts and synovitis ia 20 joints. Using the UCLA Shoulder Rating Scale, the total score improved from an average of I3.6 points pranperativeIy to of 32.8 points postoperatively. Strength of abduction (Constaafs evaluation) improved signifieamly 55.1% to 90. 1% (affected / unaffected side). Discussion : Atthroscopically assisted rotator cuff rep~r offers the following advantages. I) The extent of pathology in the ghinohtmaeraljoint can be correctly determined (size, location, and repalrabilily of the tear). 2) Treatment of coexisting glenohumeral pathology is possible. 3) Arthroscopic subacromial decompression can be done to avoid detaching deltoid f~m the aeromaon.This makes early rehabilitation possible and reduces postoperative pain because there is less soft tissue damage.
225
PATIENT-ADJUSTED STATIC ELBOW SPLINTS FOR ELBOW CONTRACTURES: A PRELIMINARY REPORT. S.W. O'Driscoll, M.D., Ph.D., S.W. Shankland*, D. Beaten*, Dept. of Orthopedics, Mayo Clinic, Rochester, MN & *St. Michael's Hospital, Toronto, Canada.
Stiffness is a common and disabling complication of elbow trauma and some forms of surgery. Various forms of static and dynamic splints have been used to gain motion. PURPOSE: The purpose of this preliminary report is to present the early results of a prospective study of patient-adjusted static splints for nonoperative treatment of elbow contractures. METHODS: Six patients have been treated with splints that they adjust themselves, and wear for eighteen hours a day. Follow-up averaged 8 months (range 2 to 12). Their ages ranged from 6 to 50 years, averaging 34. The time from injury to commencing splinting averaged 6 months (range 1 - 9 months). Additionally, in one boy with a 65 ~ congenital flexion contracture splinting was started at the age of six years. Splinting was continued for 1 to 6 months (mean 5 months). RESULTS: It took 3 to 6 weeks for each patient to reach a plateau in range of motion. All 6 patients gained motion with the splinting (p=.02). Before splinting, two patients had full flexion and lacked only extension, whereas the remaining four lacked both flexion and extension. The average initial motion was from 46 ~ - 119 ~ (arc = 73~ final ROM was 29 ~ - 132 ~ (arc = 103~ After splinting, all patients gained both flexion and extension (except of course those two who started with full flexion; they gained extension only). The average gains were 18 ~ (38%) in extension, 15 ~ (57%) in flexion, and 33 ~ (45%) in the arc of motion. The minimum gain was 15~ (57%) in flexion, and 33 ~ (45%) in the arc of motion. The minimum gain was 15~ in the arc of motion. At follow-up all had within 5~ of a functional arc of motion (i.e. 30 ~ - 130 ~ except the patient with the congenital contracture who still lacked 40 ~ of extension. DISCUSSION: The functional arc of motion or very close to it was achieved using patient*adjusted static splints after failure of conservative treatment. These splints have been beneficial in our nonoperative and postoperative treatment of stiff elbows and for prevention of contracture following surgery and trauma. They work on the principle of viscoelastic "stress relaxation".
227
SURGICAL RELEASE OF POST-TRAUMATIC STIFF E L B O W . Hughes, JS, and Sonnabend, DH. Sydney Shoulder & Elbow Associates, Sydney, 2031, Australia. This paper reviews 17 consecutive open surgical releases for posttraumatic elbow contractures (flexion contracture > 45 degrees and/or flexion to < 110 degrees). CPM, axillary sheath catheters with Bupivicaine infusions and "offset hinge" turnbuckle static braces were used. Associated procedures included: corrective valgus/medial displacement osteotomy (1), ulnar nerve release (2), radial head excision (1), removal of implants (10) and biceps tendon tengthening (1). Range of movement, pain, function and x-ray findings were assessed before and after surgery. Primary pathology included: supracondylar fracture (6), radial head fracture (6), olecranon fracture (3), Monteggia fracture (1) and compound dislocation (1). Three patients had associated radio-ulnar dissociation. Previous surgical procedures included: radial head excision (2), Silastic radial head (1), O.R.I.F (12) and surgical release (2). Pre-operatively the average arc of m o v e m e n t was 57 degrees (mean flexion contracture 55 degrees, mean flexion 112 degrees). At follow-up (4 to 35 months), the average total arc was 118 degrees ( m e a n flexion conlracture 13 degrees, m e a n flexion 131 degrees). All patients' pain scores remained the same or were improved. (Mean pre-op 74, mean pre-op 91). All patients had improved elbow evaluation scores. There was no sepsis or delayed wound healing. Complications included one partial ulnar nerve palsy which recovered fully over 16 weeks and one oIecranon bursa effusion requiting asp/ration. One patient had a subluxation episode 3 weeks post-operatively and developed aa olecranon spur 12 months post-op. If normal iatraarticular architecture of the h u m e r o - u l n a r joint is preserved, significant m o v e m e n t can be restored, with good function, and no deterioration in pain. The long term prognosis following elbow release has yet to be established.
THE STIFF ELBOW : FACTORS OF PROGNOSIS
ABOUT 280 OPERATED CASES
Travers, V., Chambaud-Roanne, D., and Caille-Valence, J.P. Lyon, France. A retrospective and multicentric studyof 280 operated patients between 1968 and 1994 for stiff elbow was reviewed with a minimal follow up of 6 months. Global results are presented. The factors influencing, the final result were especially studies : age, delay before operation, initial gravity, and surgical approach were the most determinant factors influencing the result. The correlation between gravity and approach was particulary important.