Journal of the American Society for Surgery of the Hand最新文献

Cuff-tear arthropathy is a progressive and often disabling pathologic process affecting the shoulder. With a growing elderly population, the incidence is increasing. Initial treatment is conservative; however, when conservative treatment fails then surgery is indicated. To date, the best results for the surgical treatment of cuff-tear arthropathy appear to be for patients treated with hemiarthroplasty. This report reviews our use of hemiarthroplasty with extended-coverage humeral head prosthesis in the surgical management of cuff-tear arthropathy.

The rotator cuff is the most common source of shoulder pain and disability. The majority of rotator cuff injuries are caused by overuse, with the supraspinatus, a small tendon with a poor blood supply, most commonly affected. The major function of the rotator cuff is to stabilize the glenohumeral joint during active arm elevation by opposing the superior vector of the deltoid’s force. As long as the ability to actively elevate the arm is maintained, all rotator cuff injuries, including full-thickness tears, are candidates for nonsurgical management, the basis of which is strengthening of the rotator cuff and scapulothoracic stabilizers. Surgery should be considered for those patients who fail to improve after at least 3 months of nonsurgical management. Arthroscopic rotator cuff debridement without acromioplasty has short-term and long-term results equal to, if not superior to, subacromial decompression. Avoidance of iatrogenic injury to the coracoacromial arch, which is a secondary static stabilizer of the humeral head against anterosuperior migration, contributes to a low complication rate.

The dorsal radiocarpal ligament (DRCL) has been implicated in both volar and dorsal intercalated segmental instabilities and has a role in midcarpal instability. Tears of the DRCL are more common than previously suspected. They are best seen through a volar radial portal and are amenable to arthroscopic repair. DRCL tears appear to be part of a spectrum of radial- and ulnar-sided carpal instability as evidenced by the frequent association with scapholunate and lunotriquetral ligament injuries as well as triangular fibrocartilage tears. Isolated DRCL tears can be solely responsible for wrist pain. The presence of an associated DRCL tear when seen in combination with a scapholunate, lunotriquetral, or triangular fibrocartilage tear connotes a greater degree and/or duration of carpal instability, and portends a poorer prognosis after treatment. Good results are obtained after arthroscopic repair of isolated DRCL tears. Results of DRCL repairs are less predictable when seen in combination with other types of carpal pathology. Recognition of this condition and further research into treatment methods is needed.

Wrist arthroscopy has become an indispensable tool for the hand surgeon. An effective arthroscopy is possible only with an appreciation for the surface anatomy, sound technique for establishing portals, and an understanding of intra-articular anatomy. This article reviews the radiocarpal, midcarpal, and special-use portals of wrist arthroscopy.

We describe a surgical technique for the treatment of thumb carpometacarpal joint osteoarthritis that we call suture anchor arthroplasty. This technique is similar to ligament reconstruction tendon interposition arthroplasty except that the entire flexor carpi radialis tendon is secured to the thumb metacarpal base by using suture anchors instead of a bone tunnel. The use of suture anchors eliminates the need for a transosseous bone tunnel, simplifying the procedure.