Carlos A. Guanche

A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report.

PURPOSEnOur purpose was to develop an alternative method to divide the acetabulum and femoral head into different zones based on anatomic landmarks clearly visible during arthroscopy to facilitate reporting the geographic location of intra-articular injuries.nnnMETHODSnTwo vertical lines are positioned across the acetabulum aligned with the anterior and posterior limits of the acetabular notch. A horizontal line is positioned aligned with the superior limit of the notch perpendicular to the previous lines. The lines divide the acetabulum into 6 zones. Numbers are assigned to each zone in consecutive order. Zone 1 is the anterior-inferior acetabulum. The numbers progress around the notch until zone 5 is assigned to the posterior-inferior acetabulum. Zone 6 is the acetabular notch. The same method is applied to the femoral head. Six experienced hip arthroscopists were instructed in the zone and clock-face methods and were asked to identify and describe the geographic locations of lesions at the acetabular rim, acetabular cartilage, and femoral head in the same cadaveric specimen.nnnRESULTSnThe zone method was more reproducible than the clock-face method in the geographic description of intra-articular injuries on the acetabulum and the femoral head.nnnCONCLUSIONSnAmong a group of expert hip arthroscopists, the zone method was more reproducible than the clock-face method.nnnCLINICAL RELEVANCEnThe presented method divides the acetabulum into 6 different zones based on the acetabular notch. The zones are the same for right- and left-side hips. The same method is applied for the femoral head allowing, for the first time, a geographic description of pathology.

Shoulder Kinematics in Subjects With Frozen Shoulder

OBJECTIVESnTo describe 3-dimensional humeral motion in subjects with frozen shoulder and to determine whether a consistent capsular pattern of restriction was present.nnnDESIGNnDescriptive study including repeated measurements of shoulder kinematics.nnnSETTINGnMotion-analysis laboratory.nnnPARTICIPANTSnTen (9 women, 1 man) volunteers with a diagnosis of idiopathic adhesive capsulitis and 10 (9 women, 1 man) subjects with asymptomatic shoulders as comparison subjects.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnElectromagnetic tracking sensors monitored the 3-dimensional position of the trunk, scapula, and humerus throughout active shoulder motions. Peak humeral positions relative to the trunk and scapula were determined for shoulder flexion, abduction, scapular plane abduction, external rotation (ER), and internal rotation (IR). Descriptive statistics (means, standard deviations, percentage of normal) were calculated and capsular patterns described.nnnRESULTSnFor humeral position relative to the trunk, subjects mean peak motion was as follows: abduction, 98.4 degrees; ER at the side, 4.5 degrees; ER with the arm abducted, 33.5 degrees; flexion, 116.9 degrees; IR at the side, 54.3 degrees; IR with the arm abducted, 17.8 degrees; and scapular plane abduction, 113.4 degrees. For humeral position relative to the scapula, subjects mean peak motion was as follows: abduction, 46.4 degrees; ER at the side, 34.7 degrees; ER with the arm abducted, 45.3 degrees; flexion, 70.5 degrees; IR at the side, 10.3 degrees; IR with the arm abducted, -6.4 degrees; and scapular plane abduction, 61.7 degrees.nnnCONCLUSIONSnSymptomatic subjects demonstrated substantial kinematic deficits during humeral range of motion. No single capsular pattern emerged.

The 23-Point Arthroscopic Examination of the Hip: Basic Setup, Portal Placement, and Surgical Technique

The 23-point arthroscopic examination of the hip has been used for more than 400 arthroscopic hip procedures. It ensures that all components of the hip are carefully inspected and allows for proper documentation. It is vital that a precise knowledge of hip anatomy and common portal placement is coupled with proper patient selection, sound preoperative planning, and a consistent arthroscopic technique in order to maximize clinical outcomes. The 23-point arthroscopic examination of the hip uses 3 standard portals (anterior, anterolateral, and posterolateral) that provide a systematic method of examination of the key structures of the central and peripheral hip joint. The points are divided up into groups based on the portal through which they are viewed. The 23-point arthroscopic examination of the hip is reproducible, and offers some standardization within the evolving field of hip arthroscopy. It provides a consistent routine for hip arthroscopy that has yet to be published. Using this standardized examination can assist with the diagnostic accuracy of hip arthroscopy.

An Avulsion of the Subscapularis in a Skeletally Immature Patient

In 1835, Smith first reported an isolated tear of the subscapularis tendon in a cadaver. 10 Partial ruptures of the subscapularis associated with anterior dislocation are well documented. However, isolated avulsion of the subscapularis from the lesser tuberosity of the humerus is an uncommon injury typically described in older patients following traumatic anterior dislocation of the glenohumeral joint. In patients without a history of anterior dislocation, the diagnosis may be missed clinically. 2,7 In our case, a 14year-old male with no history of anterior dislocation had a complete avulsion of the subscapularis tendon with a bony fragment that included an avulsion of the lateral capsule. The diagnosis of the injury was delayed as a result of an incomplete examination specifically assessing the function of the subscapularis. We describe the case and surgical management.

Bilateral Fractures of the Scapula in a Professional Football Player A Case Report

skeletal injuries and 5% of shoulder fractures. They usually result from direct blows or macro trauma to the upper shoulder or scapular region. Vehicular trauma is the most frequent mechanism of scapular fractures and is associated with a high rate of other injuries and accompanying morbidity. Thus, scapular fractures are often initially overlooked because of the severity of associated injuries. There have been few reported cases of scapular fractures resulting from lower impact trauma with even fewer studies looking at scapular fractures in professional athletes. The purpose of this article is to describe the case of one professional football player who suffered a right scapula fracture one season, followed by a left scapula fracture the following season.

Editorial Commentary: Gluteal Pain Syndrome of the Hip: It's Been There All Along!

The diagnosis and management of deep gluteal syndrome of the hip is currently evolving and the lack of prospective studies makes it even more difficult to discern what is the appropriate treatment. The communication between physicians managing this problem needs to improve to coordinate care better and limit the amount of unnecessary studies that these patients typically undergo.

Editorial Commentary: Please Simplify Hip Arthroscopy

Hip arthroscopy is a challenging technical procedure for which basic science principles have not been thoroughly discerned with respect to the procedures we perform. In this commentary, a plea is made to continue to expand the science behind what we do, but in as simple a fashion as possible such that more surgeons are willing to learn perfect hip arthroscopy.