Introduction: The purpose of this study was to use 4D-CT to quantify the motion of the pisiform with relation to the triquetrum, in order to understand the piso-triquetral joint kinematics through active wrist movements.The use of 4D-CT allowed us to explore kinematic concepts objectively in a quantitative real-time manner, and has the advantage of visualisation in 6 degrees of freedom.Materials and Methods: A normal wrist as was imaged through FE and RUD.Surface rendered models were created from individual carpal bones in each wrist position through the motion arc.These bones were tracked during RUD and FE using a registration algorithm.Radio-ulnar and flexion-extension motions of the pisiform and triquetrum, as well as the piso-triquetral distance were graphed against the global wrist motion.Results: In wrist extension, the pisiform and triquetrum undergo more in-plane motion than the movement of the wrist, and are closest together.During flexion, the bones are furthest away
Background Single-photon emission computed tomography and computed tomography (SPECT/CT) is a hybrid diagnostic imaging modality that allows clinicians to integrate their diagnostic evaluations and deliver a definitive diagnosis in musculoskeletal disorders. Specifically, in identification of osseous pathology, the conventional bone scan delivers greater specificity compared with magnetic resonance imaging (MRI). However, use of SPECT/CT enhances the sensitivity and specificity. Use of this modality denotes the possibility to specify the lesion more accurately and precisely while grading the activity according to osseous structural changes. Purpose This study aimed to evaluate the clinical utility of SPECT/CT in the diagnoses and management of osseous wrist disorders. The objectives were to examine the value of SPECT/CT in the diagnosis of osseous-related wrist pain and whether the findings altered management. Patients and Methods A retrospective cohort study of 20 patients with such wrist pain was conducted. SPECT/CT was used in the diagnostic process for these patients. Results Following SPECT/CT imaging, the common final diagnoses were osteoarthritis (10; 50%) and avascular necrosis (5; 25%). Less common diagnoses included ulnar carpal impact syndrome, infection, malunion, complex regional pain syndrome, and carpal boss. Some presented with multiple pathologies. SPECT/CT changed the final diagnosis in 11 cases, resulting in nonoperative treatment (7; 63%) or surgery (4; 37%). Conclusion Findings from this study and the literature demonstrate the clinical utility of SPECT/CT in the assessment of osseous-related wrist disorders. We present an algorithm for the assessment of wrist pain with osseous pathology. This commences with clinical assessment and plane radiographs (first-line investigation). Some cases will require a second-line investigation (ultrasound, CT, and/or MRI). If the diagnosis remains unclear, SPECT/CT is recommended as a third-line investigation.
The ideal surgical management of retracted rotator cuff tears has not been defined. Retraction of the tendon can make repair to the anatomic footprint on the humerus impossible. Various techniques have been described to address this problem, including medial repair, allograft and xenograft augmentation, but the results of these procedures have been mixed. The authors describe a hamstring tendon autograft reconstruction to augment the retracted rotator cuff tendons, allowing repair to the anatomic footprint of the humerus. Using this technique the length of the grafted muscle-tendon unit can be restored. The expense and potential complications associated with allograft and xenograft techniques are avoided.
Purpose: To review the clinical outcome of patients who have had complex radial head fractures managed with titanium radial head replacement. Methods: There were 17 patients who had insertion of the radial head replacement. The indications for the prosthesis included acute Mason type III fracture which could not be stabilised satisfactorily with internal fixation. Other indications included delayed presentation including previously failed treatment. Patients were managed with radial head excision and insertion of the Wright Medical titanium radial head replacement. The lateral ligamentous complex was stabilised. A back slab was applied for a period of one week and then the elbow mobilised. The patients were followed up for a minimum of one year. The Mayo elbow performance index was used. Results: There were 7 patients with acute injuries of which 6 had associated injuries such as dislocation or coronoid process fracture. 6 of these patients had an excellent result and 1 had a good result. There were 9 patients with a delayed insertion of the radial head replacement. There were 3 patients who had an isolated radial head fracture and 6 patients with associated injuries, there were 2 excellent, 3 fair and 4 poor. Three of the 4 poor results had associated capitellar chondral injury. Two patients with fair results had other significant pathology in the upper limb. In the delayed presentation group the average flexion arc improved from 78 degrees to 102 degrees and the pro-supination improved from 117 degrees to 142 degrees. The average level of satisfaction on a visual analog score was 92 per cent. Conclusion: Patients who present with acute complex radial head fractures (including associated injuries), the results of radial head replacement are generally excellent. If there are significant associated injuries and a delay in presentation, then the outcome is often only fair. However, this group of patients have improvement in their pain, level of satisfaction and range of motion. Associated capitellar damage is a poor prognostic indicator.
The purpose of the study was to describe the normal anatomy of glenoid labrum. Twenty dry bone scapulas and 19 cadaveric shoulders were examined. Light microscopy was performed on 12 radial slices through the glenoid. An external capsular circumferential ridge, 7–8mm medial to the glenoid rim marks the attachment of the capsule. A separate internal labral circumferential ridge 4mm central to the glenoid rim marks the interface for the labrum and articular cartilage. A superior-posterior articular facet contains the superior labrum. Two thirds of the long head of biceps arise from the supraglenoid tubercle, the remainder from the labrum. The superior labrum is concave and is loosely attached to the articular cartilage and glenoid rim. In contrast the anterior-inferior labrum is convex, attaches 4mm central to the glenoid rim and has a strong attachment to articular cartilage and bone. The anatomy of the superior and anteroinferior labrum are fundamentally different. Suture anchor repair of the superior labrum should be 7mm medial to the glenoid rim whereas the anterior-inferior labrum should be repaired to the face of the glenoid. By defining the normal anatomy of the superior labrum, pathological tears can be identified.
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