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Journal of Clinical Orthopaedics and... May 2022Among pathologies of the shoulder, rotator cuff tear is the most common. Diagnosis of cuff tear around mid twenties is unusual, but the prevalence increases... (Review)
Review
Among pathologies of the shoulder, rotator cuff tear is the most common. Diagnosis of cuff tear around mid twenties is unusual, but the prevalence increases significantly after the age of forty. The prevalence after the age of 60 is around 20-30%. A well recognised feature of cuff tear is being asymptomatic but, tear progression in asymptomatic is a known consequence. The spectrum of cuff tear ranges from partial, full thickness cuff tear with or without retraction. The mainstay of treatment for partial thickness cuff tear is systematic rehabilitation and for the full thickness cuff tear an initial rehabilitation is an accepted management. Failed rehabilitation for 3 months, acute traumatic tear, younger age, intractable pain, good quality muscle would be the indications for repair of a full thickness cuff tear. Though there are defined indications for surgical intervention in the full thickness rotator cuff tear, differentiating an asymptomatic tear that would not progress or identifying a tear that would become better with rehabilitation is an undeniable challenge for even the most experienced surgeon. Rehabilitation in cuff tear consists of strengthening the core stabilizers along with rotator cuff and deltoid muscles. In a symptomatic cuff tear that merits surgical intervention the objective is to do an anatomical foot print repair. In scenarios where the cuff is retracted, one has to settle for a medialised repair. As, a repair done in tension is more likely to fail than a tensionless medialised repair. The success rate of all these non anatomical procedures varies from series to series but it approximates around 60-80%. Augmenting cuff repair to enhance biological healing is a recent advance in rotator cuff repair surgery. The augmentation factors can be growth factors like PRP, scaffolds both auto and allografts. The outcome of these procedures from literature has been variable. As there are no major harmful effects, it can be viewed as another future step in bringing better outcomes to patients having rotator cuff tear surgery. Despite being the commonest shoulder pathology, the rotator cuff tear still remains as a condition with varied presenting features and a wide variety of management options. The goal of the treatment is to achieve pain free shoulders with good function. Correcting altered scapular kinematics by systematic rehabilitation of the shoulder would be the first choice in all partial thickness cuff tear and also as an initial management of full thickness cuff tears. Failure of rehabilitation would be the step forward for a surgical intervention. While embarking on a surgical procedure, correct patient selection, sound surgical technique, appropriate counselling about expected outcome are the most essential in patient satisfaction.
PubMed: 35402155
DOI: 10.1016/j.jcot.2022.101808 -
Current Reviews in Musculoskeletal... Dec 2014Calcaneal osteotomy is an extra-articular, joint-sparing procedure that is used in the correction of cavovarus and planovalgus foot deformity. Careful indications and...
Calcaneal osteotomy is an extra-articular, joint-sparing procedure that is used in the correction of cavovarus and planovalgus foot deformity. Careful indications and contraindications for the procedure, with meticulous surgical technique, should be followed to avoid complications and to achieve optimal outcomes. Multiple options of osteotomies exist, including translational (medializing and lateralizing calcaneal osteotomy, with ability to slide proximally or distally, closing wedge (Dwyer), and rotational type osteotomies (Evans, Z-osteotomy). Future directions for innovation include developments of both implants and surgical techniques.
PubMed: 25186724
DOI: 10.1007/s12178-014-9237-8 -
Journal of Functional Morphology and... Jan 2022The reverse total shoulder arthroplasty (rTSA) prosthesis has been demonstrated to be a viable treatment option for a variety of end-stage degenerative conditions of the... (Review)
Review
The reverse total shoulder arthroplasty (rTSA) prosthesis has been demonstrated to be a viable treatment option for a variety of end-stage degenerative conditions of the shoulder. The clinical success of this prosthesis is at least partially due to its unique biomechanical advantages. As taught by Paul Grammont, the medialized center of rotation fixed-fulcrum prosthesis increases the deltoid abductor moment arm lengths and improves deltoid efficiency relative to the native shoulder. All modern reverse shoulder prostheses utilize this medialized center of rotation (CoR) design concept; however, some differences in outcomes and complications have been observed between rTSA prostheses. Such differences in outcomes can at least partially be explained by the impact of glenoid and humeral prosthesis design parameters, surgical technique, implant positioning, patient-specific bone morphology, and usage in humeral and glenoid bone loss situations on reverse shoulder biomechanics. Ultimately, a better understanding of the reverse shoulder biomechanical principles will guide future innovations and further improve clinical outcomes.
PubMed: 35225900
DOI: 10.3390/jfmk7010013 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Calcaneal osteotomy is an extra-articular procedure used for conservative surgical treatment of hindfoot deformity. It has static, architectural and dynamic effects,... (Review)
Review
Calcaneal osteotomy is an extra-articular procedure used for conservative surgical treatment of hindfoot deformity. It has static, architectural and dynamic effects, reorienting the tuberosity action point of the digastric muscle formation of the sural triceps and plantar aponeurosis. Calcaneal osteotomies vary in location, form and displacement, but can be categorized as tuberosity osteotomy, acting on talar position, and cervical osteotomy, acting on Chopart joint-line orientation. We here describe the 3 main calcaneal osteotomies we use for hindfoot deformity: talar varus/valgus, valgus flatfoot, and midfoot abductus/adductus. In each case, we describe our technique, resulting from our responses to the difficulties we have had to deal with: medializing osteotomy: performed percutaneously to limit skin complications, and easily associated to cervical calcaneal osteotomy to manage valgus flatfoot; Hintermann cervical adduction osteotomy: providing excellent angular correction, while conserving a medial cortical hinge; lateralizingosteotomy: performed on a medial approach, to enhance translation capacity and prevent the acute tarsal tunnel syndrome with which we have been otherwise confronted. Correcting foot deformities involves complex, multi-dimensional, multi-tissue surgery that is risky as it concerns a segment with terminal vascularization. The present three techniques need to be mastered, as they are usually associated to other tendon and/or ligament reconstruction procedures, and tourniquet time is limited. LEVEL OF EVIDENCE: V; expert opinion.
Topics: Calcaneus; Flatfoot; Foot; Humans; Osteotomy; Plastic Surgery Procedures; Tendons
PubMed: 34687951
DOI: 10.1016/j.otsr.2021.103121 -
Current Opinion in Neurobiology Feb 2014Parietal cortex has long been known to be a site of sensorimotor integration. Recent findings in humans have shown that it is divided up into a number of small areas... (Review)
Review
Parietal cortex has long been known to be a site of sensorimotor integration. Recent findings in humans have shown that it is divided up into a number of small areas somewhat specialized for eye movements, reaching, and hand movements, but also face-related movements (avoidance, eating), lower body movements, and movements coordinating multiple body parts. The majority of these areas contain rough sensory (receptotopic) maps, including a substantial multisensory representation of the lower body and lower visual field immediately medial to face VIP. There is strong evidence for retinotopic remapping in LIP and face-centered remapping in VIP, and weaker evidence for hand-centered remapping. The larger size of the functionally distinct inferior parietal default mode network in humans compared to monkeys results in a superior and medial displacement of middle parietal areas (e.g., the saccade-related LIP's). Multisensory superior parietal areas located anterior to the angular gyrus such as AIP and VIP are less medially displaced relative to macaque monkeys, so that human LIP paradoxically ends up medial to human VIP.
Topics: Animals; Brain Mapping; Humans; Movement; Nerve Net; Parietal Lobe
PubMed: 24492077
DOI: 10.1016/j.conb.2013.08.014