Oke A. Anakwenze

Neuralgic amyotrophy (Parsonage-Turner syndrome).

&NA; Neuralgic amyotrophy (Parsonage‐Turner syndrome or brachial plexus neuritis) is an uncommon syndrome whose cause is unknown. The suprascapular and axillary nerves and corresponding muscles are affected most frequently. The disorder exhibits a broad range of clinical manifestations, and patients frequently present to physicians of different subspecialties. Accurate diagnosis can be challenging and requires a thorough history and physical examination. Nerve conduction velocity and imaging studies assist in the evaluation. Treatment consists of symptomatic management. Symptoms can persist for more than than a year, but most patients note resolution of symptoms over time.

Reverse shoulder arthroplasty for the management of proximal humerus fractures.

The use of reverse shoulder arthroplasty is becoming increasingly popular for the treatment of complex three- and four-part proximal humerus fractures in the elderly compared with the often unpredictable and poor outcomes provided by open reduction and internal fixation and by hemiarthroplasty. Inferior results with plate osteosynthesis are often a result of complications of humeral head osteonecrosis, loss of fixation, and screw penetration through the humeral head, whereas major concerns with hemiarthroplasty are tuberosity resorption, malunion, and nonunion resulting in pseudoparalysis. Comparative studies support the use of reverse shoulder arthroplasty in elderly patients with complex proximal humerus fractures because the functional outcomes and relief of pain are reliably improved. Repair and union of the greater tuberosity fragment during reverse shoulder arthroplasty demonstrates improved external rotation, clinical outcomes, and patient satisfaction compared with outcomes after tuberosity resection, nonunion, or resorption. Satisfactory results can be obtained with careful preoperative planning and attention to technical details.

Arthroscopic Rotator Cuff Repair: Impact of Diabetes Mellitus on Patient Outcomes

Abstract Introduction: Arthroscopic repair of rotator cuff tears has been associated with satisfactory improvement in pain and function. The goal of this study was to compare the results of patients with diabetes and patients without diabetes after the 2 cohorts underwent arthroscopic rotator cuff repair (RCR). Methods: We performed a retrospective review of 56 patients with type 1 diabetes mellitus or type 2 diabetes mellitus and 67 patients without diabetes, all of whom underwent arthroscopic RCR with 1 year of follow-up. Changes in range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) score, and Penn Shoulder Score (PSS) were compared between both groups at 1 year postoperatively. Results: There was a statistically significant improvement in ROM for both groups. However, patients without diabetes had greater forward flexion (P = 0.02), abduction (P = 0.04), and external rotation (P = 0.004). Both groups noted significant improvement in their respective ASES score and PSS. However, patients with diabetes had a lower ASES score (P < 0.01) and PSS (P < 0.01). There were no differences in recurrent tears or complications. Conclusion: Arthroscopic RCR in patients with diabetes resulted in improved postoperative ROM and function.

Concealed degloving injury (the Morel-Lavallée lesion) in childhood sports: a case report.

Morel-Lavallee lesions (MLLs), described in 1853 by Maurice Morel-Lavallee, are uncommon closed internal degloving injuries in which the subcutaneous tissues are stripped off the fascia with a hematoma and, in some cases, necrotic fat1-4. These lesions are most commonly noted with high-energy pelvic trauma1,3 and can require weeks to resolve. Accurate diagnosis is delayed in up to one-third of patients because of inconsistent clinical presentation and because initial skin bruising can mask the importance of the underlying soft-tissue injury5. These lesions occur less frequently in the knee region; knee MLLs have been reported in professional football players6. A few reports1,6,7 in the literature indicate that MLLs most commonly occur in people in their third and fourth decades of life. In 1986, Letts8 documented cases of degloving injuries in children following major trauma; we report the rare case of a boy who presented with an MLL two weeks after a football injury. The patient and parents were informed that nonidentifying information from the case would be submitted for publication, and they provided consent. While playing outdoor pick-up football, an eleven-year-old boy sustained a left knee injury after being tackled and falling onto the asphalt, landing directly on the anterior aspect of the knee. He was not wearing any protective padding at the time of injury. He developed left thigh and knee pain as well as a large bruise about the thigh and was taken to the local emergency department. He was healthy with no medical problems. On presentation, he had fully intact neurologic and vascular function in the lower extremities and had 5 of 5 hip and knee flexor and extensor strength despite some pain. He had moderate pain with knee motion, with an …

Calcific tendinitis of the rotator cuff: management options.

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial.

Myotendinous lengthening of the elbow flexor muscles to improve active motion in patients with elbow spasticity following brain injury

BACKGROUND The objective of this study was to evaluate the outcomes of a novel technique of fractional myotendinous lengthening of the elbow flexors in patients with volitional motor control and spastic elbow flexion deformities after brain injury. METHODS A retrospective review of 42 consecutive patients with spastic elbow flexion deformities and upper motor neuron (UMN) syndrome was performed. Each patient had volitional motor control but limited elbow extension and underwent myotendinous lengthening of the elbow flexor muscles. Outcome measures included pre and post-operative active and passive arc of motion, Modified Ashworth Scale (MAS) of spasticity, and complications. RESULTS There were 26 men and 16 women. The etiologies of UMN syndrome were stroke (30 patients), traumatic brain injury (11 patients), and cerebral palsy (1 patient). Average duration between injury and surgery was 6.6 years. At an average follow-up of 14 months, improvements were noted in active extension (42° to 20°; P < .001). In addition, active arc of motion increased from 77° (range of motion [ROM]: 42° to 119°) to 113° (ROM: 20° to 133°) (P < .001) and passive arc of motion increased from 103° (ROM: 24°-127°) to 131° (ROM: 8°-139°) (P < .001). Significant improvement in MAS was also noted after surgery (2.7 to 1.9; P < .001). Superficial wound dehiscence occurred in 2 patients and was successfully treated nonoperatively. CONCLUSION In patients with spastic elbow flexion deformities and active motor control, fractional myotendinous lengthening of the elbow flexors safely improves active extension and the overall arc of motion while affording immediate postoperative elbow motion. LEVEL OF EVIDENCE Level IV, Case Series, Treatment Study.

Orthopaedic Residency Applications Increase After Implementation of 80-hour Workweek

BackgroundThe factors that influence interest among medical students toward different medical specialties with time are important. The potential impact of changes in work-hour rules on orthopaedic applications in comparison to that of primary care medicine has not been reported. The change in number of applicants to general surgery during this period also is unknown.Questions/purposesThe goals of our study were to assess the changes in orthopaedic applications relative to the 80-hour workweek and to compare these changes with those in the primary care field. We also documented the change in applications to general surgery after the work-hour changes.MethodsA retrospective analysis of data from the National Resident Matching Program, San Francisco Matching Programs, and the American Urological Association from 1997 to 2010 was performed. Two cohorts of medical school applicants to primary care and surgery were established: those who applied from 1997 to 2002, predating work-hour changes, and those who applied from 2005 to 2010, after implementation of the 80-hour regulation. From the surgical data, applications to orthopaedic and general surgery were subselected and analyzed. Data were analyzed from a total applicant pool of 111,973 representing primary care and surgery applications. There were 59,996 and 51,977 applicants before and after the work-hour changes, respectively.ResultsApplications to orthopaedics increased by 21% (3310 to 4011 applicants) after implementation of work-hour changes, whereas primary care applications decreased by 18% (42,587 to 34,884 applicants) after the work-hour rules. General surgery applications decreased by 24% during this period.ConclusionsResidency applications to orthopaedic surgery have increased since inception of the 80-hour workweek. By contrast, applications to primary care programs and general surgery have decreased after implementation of work-hour restrictions.

The role of concurrent fusion to prevent spinal deformity after intramedullary spinal cord tumor excision in children.

Objectives Spinal deformity is a common development after laminectomy and resection of pediatric intramedullary spinal cord tumors. Our objective is to compare the occurrence of postlaminectomy spinal deformity in children with intramedullary spinal cord tumors that underwent decompression with fusion at the time of surgery to those that did not undergo fusion. Methods A retrospective chart review of 255 children with spinal cord tumors treated at 2 tertiary pediatric cancer centers between was performed. Of these, 52 patients with a biopsy-proven intramedullary spinal cord tumor had complete clinical records and radiographic data. Preoperative spinal alignment, surgical treatment, postoperative deformity, and risk factors for deformity were evaluated. All patients had at least 2-year follow-up. Results There were 18 females and 34 males with an average age of 8.1±4.1 years. The average time to latest follow-up was 7.6±5.3 years. Moderate or severe postresection spinal deformity (scoliosis >25 degrees and/or sagittal plane abnormality >20 degrees requiring bracing or surgery) developed in 57% (21/37) of resections without fusion (laminectomy or laminoplasty alone), and in 27% (4/15) of those with fusion (P=0.05). Among skeletally mature children, 18 of 28 (64%) developed deformity after laminectomies and laminoplasties, compared with 22% (2/9) of the patients in the fusion group (P=0.03). Removal of >3 lamina (P=0.04) was associated with development of postoperative deformity. Conclusions In the surgical treatment of patients with intramedullary spinal cord tumors, those that undergo instrumentation or in situ fusion at the time of spinal cord tumor excision are significantly less likely to develop postresection spinal deformity. Level of Evidence 3, Retrospective comparative study.

Complications in total shoulder and reverse total shoulder arthroplasty by body mass index

INTRODUCTION The purpose of this study was to identify the effects of body mass index (BMI) on long-term outcomes (revision rate, 1-year mortality rate, 3-year surgical site infection rate, and 90-day inpatient all-cause readmission rate) after total shoulder arthroplasty (TSA) and reverse TSA (RTSA). METHODS A large shoulder arthroplasty registry was used to review outcomes after TSA and RTSA. The registry monitors patients revision, mortality, infection, and readmission rates. The exposure of interest was the patients BMI at the time of the surgery, which was stratified by 5 kg/m2 increments. RESULTS Selected for this study were 4630 patients who underwent TSA and RTSA between 2007 and 2013, of which 3483 (75.2%) were TSA and 1147 (24.8%) were RTSA. The overall combined (TSA and RTSA) revision rate was 1.7%. After adjusting for confounders in the overall models (TSA and RTSA combined), higher BMI was not associated with higher risk of aseptic revision, 1-year mortality, or 3-year deep infection. In TSA-specific models, every 5 kg/m2 increase in BMI was marginally associated with a 16% increase in the likelihood of 90-day readmission. This association was not observed in the RTSA model. In RTSA-specific models, every 5 kg/m2 increase in BMI was marginally associated with higher risk of 3-year deep infection. This association was not observed in the TSA model. CONCLUSION Shoulder arthroplasty in obese patients is not associated with higher risk of aseptic revision. The BMI has different effects on TSA and RSA. The surgeon should anticipate increased risk of readmission after TSA and infection after RSA.

Arthroscopic repair of large rotator cuff tears using the double-row technique: an analysis of surgeon experience on efficiency and outcomes

BACKGROUND Arthroscopic rotator cuff repair is one of the most commonly performed procedures in the orthopaedic specialty. The goal of this study was to evaluate the effect(s) of surgical experience on efficiency and patient outcomes after double-row rotator cuff repair. METHODS A retrospective review of 69 consecutive patients with large rotator cuff tears who underwent double-row arthroscopic rotator cuff repair by 1 surgeon from the start of practice was conducted. We divided the patients into 2 cohorts: group 1, early (first 18 months of study period) (n = 35), and group 2, recent (final 12 months of study period) (n = 34). Outcome measures including American Shoulder and Elbow Surgeons score, Penn Shoulder Score, and range of motion were assessed preoperatively and at final follow-up. In addition, we compared the operative times between the groups. RESULTS At a mean follow-up of 13.25 months, both cohorts showed significant improvement (P < .001) in American Shoulder and Elbow Surgeons scores (from 47.9 to 76.5 and from 43.6 to 79.4 in groups 1 and 2, respectively) and Penn Shoulder Scores (from 45.8 to 80 and from 38.7 to 79.6 in groups 1 and 2, respectively) postoperatively. The magnitude of change and final scores were similar between the groups. Similar improvements in range of motion were noted in both groups. Patients in group 1 had a statistically significantly longer mean operative time than those in group 2 (116 minutes vs 99.7 minutes, P = .036). CONCLUSION Double-row rotator cuff repair provides predictable improvement in pain and function. It can be performed effectively early in a surgeons career. However, with experience, efficiency is improved.