Core Decompression for Class I Avascular Necrosis of Humeral Head

Avascular necrosis of the humeral head is a diagnosis of multiple etiologies and unclear prognosis. Prompt diagnosis and treatment are essential to prevent head collapse and avoid resurfacing or joint replacement procedures. Imaging modalities including standard radiography and magnetic resonance imaging establish the diagnosis and stage it according to the degree of necrosis, head collapse, or extension into the glenoid. If the patient stays persistently symptomatic despite conservative treatments and is still in the early stages of the disease course, humeral head core decompression is a reasonable option as it has been shown to decrease disease progression and provide symptomatic relief. Here, we present a case of a 52-year-old female with a history of adhesive capsulitis status postmanipulation and arthroscopic lysis of adhesions, now presenting with Cruess Stage I avascular necrosis of the humeral head. This technique (Supplemental Video, Supplemental Digital Content 1, http://links.lww.com/TSES/A36) demonstrates core decompression and grafting of the humeral head using a percutaneous expandable reamer. Level of Evidence: Level V (expert opinion).
Source: Techniques in Shoulder and Elbow Surgery - Category: Orthopaedics Tags: Video Technique Source Type: research

Related Links:

J Knee Surg DOI: 10.1055/s-0039-1700978To improve the long-term outcomes of high tibial osteotomy (HTO) for gonarthritis, many cartilage repair procedures appeared, but their effects were controversial. To evaluate the efficacy of cartilage repair procedures during HTO for gonarthritis, we performed this update meta-analysis. We performed the system retrieval for clinical trials using various databases and then pooled the outcomes of the included studies. Fifteen studies were involved. The pooled results indicated that there were no significant differences in Kellgren and Lawrence (KL) scale (mean difference [MD] =&...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
Publication date: Available online 11 December 2019Source: Orthopaedics &Traumatology: Surgery &ResearchAuthor(s): Joong-Bae Seo, Sung-Joon Kim, Hee Jung Ham, Kwon Young Kwak, Jaesung YooAbstractBackgroundThe pathogenesis of degenerative subscapularis (SC) tear is not clear, several mechanisms are involved: intrinsic tendon degeneration or subcoracoid impingement. The aim of this study was to propose new radiographic markers, the coraco-lesser tuberosity angle (CLA), lesser tuberosity angle (LTA) and lesser tuberosity height (LTH). The hypothesis was that higher values of CLA, LTA, and LTH would be associated with ...
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
ConclusionPAIS as a diagnosis is commonly delayed clinically in young patients with radiologic misinterpretation being a contributing factor. Increased awareness about this condition is needed among radiologists and physicians treating young athletes.
Source: Pediatric Radiology - Category: Radiology Source Type: research
Lateral patellofemoral (PF) soft tissue abnormalities range from excessive lateral PF tightness (lateral patellar compression syndrome, lateral patellar instability and arthritis), to excessive laxity (iatrogenic lateral PF soft tissue insufficiency postlateral release). The lateral soft tissue complex is composed of the iliotibial band extension to the patella, the vastus lateralis tendon, the lateral PF ligament, lateral patellotibial ligament, and lateral patellomeniscal ligament, with intimate connections between those structures. To identify lateral retinaculum tightness or insufficiency the most important tests are t...
Source: Sports Medicine and Arthroscopy Review - Category: Sports Medicine Tags: Digital Exclusive Source Type: research
ConclusionBimeniscal replacement by an allograft and/or substitute provides good short-term functional and anatomical outcomes. Nevertheless, this procedure is warranted only in highly selected patients.Level of evidenceIV, retrospective study.
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
Publication date: Available online 26 September 2019Source: Arthroscopy TechniquesAuthor(s): Ravi Vaswani, Sean J. Meredith, Jayson Lian, Ryan Li, Michael Nickoli, Freddie H. Fu, Volker MusahlAbstractSmall intercondylar notch size is associated with increased risk of anterior cruciate ligament (ACL) injuries and increased difficulty of ACL reconstruction. When encountering a small notch during surgery, some surgeons may resort to a notchplasty, which has been shown to have associated morbidity. The ability to predict notch size on preoperative imaging could allow the orthopaedic surgeon to anticipate surgical difficulty su...
Source: Arthroscopy Techniques - Category: Surgery Source Type: research
Background: Recently, a resurgence of interest has been noted in anterior cruciate ligament (ACL) preservation in pediatric and adolescent patients. Different tear types, defined by their tear location, require different preservation techniques: proximal and distal avulsion tears can be treated with arthroscopic primary repair, whereas primary repair with biological scaffold has been proposed for midsubstance tears. The goal of this study was to assess the distribution of different tear types in pediatric and adolescent patients, as these are currently unknown. Methods: A retrospective search in an institutional radio...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Sports Medicine Source Type: research
J Knee Surg DOI: 10.1055/s-0039-1694742Patellar sleeve fractures primarily occur in the adolescent population from a rapid contraction of the quadriceps with the knee in a flexed position. Several small case reports describe operative reduction and fixation for displaced fractures. However, there is sparse literature on nonoperative management of these injuries. Retrospective review and prospective follow-up of all patients diagnosed with patellar sleeve fracture between 1991 and 2014 at a single institution. Patients with superior pole avulsion fractures, history of prior knee surgery, and fractures managed operatively we...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
r F Abstract Primary osteoarthritis of the shoulder represents a destructive joint disease with associated synovitis, which in the first line seems to be genetically determined. Clinically, patients suffer from shoulder pain with progressive impairment of both active and passive range of motion. The diagnostics include a clinical examination, imaging by native radiography and magnetic resonance imaging (MRI) for assessment of the rotator cuff. Current classification systems consider the formation of humeral osteophytes, glenoid morphology and loss of humeral sphericity. Non-surgical measures include, apa...
Source: Der Orthopade - Category: Orthopaedics Authors: Tags: Orthopade Source Type: research
The diagnosis of femoroacetabular impingement (FAI) syndrome requires that 3 prerequisites are met. Patient symptoms and physical examination must be combined with imaging to appropriately make the diagnosis. Imaging, including plain radiographs, magnetic resonance imaging (MRI), and computed tomography, should be interpreted in the context of a high prevalence of cam and pincer morphology, in addition to labral injury, in the general population. All images routinely obtained in current clinical practice are 2-dimensional representations of complex 3-dimensional processes.
Source: Arthroscopy - Journal of Arthroscopic and Related Surgery - Category: Surgery Authors: Tags: Editorial Commentary Source Type: research
More News: Arthroscopy | MRI Scan | Orthopaedics | Radiography