Farivar A Lahiji, MD; Hamidreza Aslani, MD; Amir Bisadi, MD; Seyed Mahdi Hosseini Khameneh, MD; Elham Rahimian, MD; Ali Fotouhi Maleki, MD; Seyyed Rouhollah Mousavi, MD; Farshad Safdari, MSc
Abstract
Background: Some authors suggested using ultrasound
in diagnosis of carpal tunnel syndrome (CTS), however the efficacy of
ultrasound in determining the severity of disease is unclear. In current study,
we aimed to investigate the diagnostic efficacy of ultrasound in determining
the severity of ...
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Background: Some authors suggested using ultrasound
in diagnosis of carpal tunnel syndrome (CTS), however the efficacy of
ultrasound in determining the severity of disease is unclear. In current study,
we aimed to investigate the diagnostic efficacy of ultrasound in determining
the severity of CTS in comparison with NCV using measurement of cross-sectional
area of median nerve. Methods: In
a prospective study, 181 CTS suspected wrists (94 patients) were investigated.
The cross-sectional area of the median nerve was measured using ultrasound and
the severity of disease was determined based on criteria of El Miedany et al. Based on the NCV,
the patients were divided into four groups of normal, mild, moderate or severe
CTS. Finally, the mean cross-sectional area was compared between the groups and
the kappa agreement coefficient for determining the severity of disease by the two
methods was calculated. Results: The mean cross-sectional area increased
significantly with increase in disease severity (p < /i>>.001). Conclusions: Determination of cross-sectional area of
median nerve with ultrasound can be a useful tool in decision-making about
surgical intervention in carpal tunnel syndrome. However, the clinical
correlation is mandatory.
Hamid Reza Aslani; Amin karimi; Zohreh Zafarani
Abstract
Background: In massive irreparable shoulder rotator cuff tears in older patients, an alternative surgery is debredement of subacromial bursa, biceps tendon and tuberoplasty. This is a short-term report of such a treatment performed arthroscopically in a small group of patients. Methods: In a prospective ...
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Background: In massive irreparable shoulder rotator cuff tears in older patients, an alternative surgery is debredement of subacromial bursa, biceps tendon and tuberoplasty. This is a short-term report of such a treatment performed arthroscopically in a small group of patients. Methods: In a prospective study, in a 2 year interval, 8 patients with massive irreparable rotator cuff tear with mean age of 65 (60-75) underwent arthroscopic debridement of necrotic rotator cuff tendon remnants and tuberoplasty without coracoaromial ligament excision. The sign and symptoms of patients before and after surgery were evaluated with modified UCLA score. Results: With a mean follow-up of 12 months (6-18 months), the modified UCLA score improved from 9.2 to 27.5. In 7 patients, pain and range of motion improved to near normal and 6 cases obtained near normal function. Although the acromiohumeral distance decreased from 5 to 4 millimeters and slight increase in degenerative changes was observed, the functional outcome was good. Conclusion: This simple arthroscopic procedure is recommended in massive irreparable rotator cuff tear especially in elderly patients.
Hamid Reza Aslani, MD; Khalil Alizadeh, MD; Amin Karimi, MD; Mohammad Hossein Karimi, MD; Zohreh Zaferani, MD
Abstract
Background: Carpal tunnel syndrome is one of the most common compression neuropathies in the upper limb and requires surgery if conservative treatment fails. This article compares the result of regular open incision, midpalmar mini incision and endoscopic technique in carpal tunnel release.Methods: This ...
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Background: Carpal tunnel syndrome is one of the most common compression neuropathies in the upper limb and requires surgery if conservative treatment fails. This article compares the result of regular open incision, midpalmar mini incision and endoscopic technique in carpal tunnel release.Methods: This is a clinical trial study on 53 patients (5 males, 48 females) within one year, who were surgical candidates. The surgery was done by arthroscopy, with regular open incision or with mid palmar small incision. The clinical outcomes were evaluated one week, 4 weeks and 4 months post surgery.Results: Relief and satisfaction were better in the first month in the arthroscopic and mini-incision group. All 3 techniques had similar outcomes after 4 months. In 4-months follow-up, night pain relief, followed by parasthesia relief were the ones with the best improvement. Weakness was the symptom with the least improvement. Longer incision cases were associated with more delay to return to work.Conclusion: Carpal tunnel release with endoscopic and mini incision techniques have a better early satisfaction rates compared to regular open incision, but no difference is seen between the two groups after four months.
Hamid Reza Aslani, MD; Mehdi Abooei Mehrizi, MD; Amin Karimi, MD; Zohreh Zaferani, MD
Abstract
Background: Rotator cuff muscles are the milestone of shoulder function. Tear of the rotator cuff could result in shoulder pain and deterioration of the function. The purpose of this study was to evaluate the outcome of arthroscopically repaired large and massive rotator cuff tears in short term. Methods: ...
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Background: Rotator cuff muscles are the milestone of shoulder function. Tear of the rotator cuff could result in shoulder pain and deterioration of the function. The purpose of this study was to evaluate the outcome of arthroscopically repaired large and massive rotator cuff tears in short term. Methods: Fifity one consecutive patients (41 males, 10 females) with average age of 49 years old (38-62 y/o) who had arthroscopically repairable large or massive tears during a 3 year period in two hospitals in Tehran were included in the study. Ten of these patients were lost to follow-up and were excluded from the study. The remaining 41 were the focus of this study. Results: 28 patients had large tears and 13 had massive tears. Follow-up averaged 25 months (range, 12 to 48 months). Based on the University of California Los Angeles shoulder rating (UCLA), 88% of patients had good or excellent outcomes. Although 5 patients were considered failures based on the UCLA score, 98% of patients were satisfied with the result. Only 1 of these failures underwent a second operation for revision repair. There was no significant difference in final scores when comparing the massive tears with the entire group. The preoperative scores however for massive tears were lower than the large tears.Conclusion: Arthroscopic management of large and massive of rotator cuff tears results in good or excellent outcomes comparable to reported outcomes following open repair
Hamid Reza Aslani, MD; Mehdi Abooei Mehrizi, MD; Zohreh Zafarani, MD
Abstract
Background: Ganglion cyst is one of the common causes of wrist mass, presenting with weakness and pain in the wrist. Among the arrays of treatment options for this problem arthroscopic resection is probably the most recent treatment modality. We would like to review a short-term result of such a treatment ...
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Background: Ganglion cyst is one of the common causes of wrist mass, presenting with weakness and pain in the wrist. Among the arrays of treatment options for this problem arthroscopic resection is probably the most recent treatment modality. We would like to review a short-term result of such a treatment in a small group of patients.Methods: In a case series study, 13 patients (10 women, 3 men) with dorsal wrist ganglion treated with arthroscopic resection in a two-year period, were evaluated for post operative recurrence pain swelling or wrist motion limitation and grip strength. The mean age was 29.8 years old. The cases had an average of 12 months (7-19 months) follow-up.Results: In the all cases no intra-or post operative complication was encountered. The wrist range of motion, and grip strength showed improvement no scapholunate instability was seen. One recurrence after 6 months had occurred.Conclusion: Arthroscopic ganglionectomy is a swelling surgical alternative for dorsal wrist ganglion with less scar, and comparative results to open surgery.
Hamid Reza Aslani, MD; Manoochehr Ghazaleh, MD; Zohreh Zafarani, MD
Abstract
Background: The superior labral lesion causes shoulder pain, disability and severe dysfunction. These lesions can see separated or with rotator cuff tear. The pain and recurrent instability require surgical repairing. The purpose of this study was to evaluate the results of arthroscopy surgery of superior ...
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Background: The superior labral lesion causes shoulder pain, disability and severe dysfunction. These lesions can see separated or with rotator cuff tear. The pain and recurrent instability require surgical repairing. The purpose of this study was to evaluate the results of arthroscopy surgery of superior labral lesion of the shoulder.Methods: In a case series study, we evaluated 29 patients (23 men, 6 women, mean age=26 years, range: 19-36 years) at a mean 31 months (12 ـ 47 months) following arthroscopic surgery of superior labral lesion of the shoulder. The outcome of treatment was evaluated with the University of California-Los Angeles Shoulder Scale (UCLA). 13 patients were involved in athletic activities, 7 of which in “overhead” sports and one contact sport. 8 patients had type I, 17 type II, 3 type III, and 1 patient type IV of slap lesions. The treatment included debridment for type I, debridment and decortication of glenoid and anchor suture in type II, debridment and excision of labral tear in type 3 and, excision and anchor suture of labral tear in type IV.Results: Surgery of the superior labral lesion resulted in satisfactory UCLA score. 19 regained their preinjury level of shoulder function. The shoulder score and the return to activity were correlated with the type of sports activity. The patients participating in overhead sports had significantly lower shoulder scores and a lower percentage of return to their preinjury level of shoulder function compared with patients who were not engaged in overhead activity.Conclusion: arthroscopic surgery of superior labral is successful in the majority of patients but less satisfactory in those doing “overhead” sports. However, the result in patient who participates not involved in overhead sports.
Hamidreza Aslani, MD; Hamid Farrokhi, MD; Hamed Vahedi, MD; Manoochehr Ghazaleh, MD
Abstract
Background: Rotator cuff tear is one of the most prevalent shoulder disorders in middle aged and old people and MRI is gold standard paraclinic diagnostic test. This research is aimed at assessing the accuracy of MRI reports in rotator cuff tears.Methods: A cross-sectional study was done from May 2005 ...
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Background: Rotator cuff tear is one of the most prevalent shoulder disorders in middle aged and old people and MRI is gold standard paraclinic diagnostic test. This research is aimed at assessing the accuracy of MRI reports in rotator cuff tears.Methods: A cross-sectional study was done from May 2005 to February 2006 in two hospitals in Tehran. Fifty consecutive patients who had been investigated with MRI and then undergone shoulder arthroscopy were assessed. The reports on MRI findings of the shoulder were compared with the arthroscopic findings. The sensitivity, specificity, positive and negative predictive values of MRI in reference to the arthroscopic findings were studied.Results: MRI in these 27 men and 23 women showed 97.4% sensitivity, 45.4% specificity, 86.3% positive predictive value, 83.3% negative predictive value and 84% accuracy. The values for the same parameters were respectively 83.9%, 78.9%, 86.7%, 75% and 82% for complete and 50%, 76.2%, 28.6%, 88.9% and 70% for partial rotator cuff tears.Conclusions: The MRI reports for rotator cuff disease, in our center, are reliable for complete tears, but not for partial tears.
Hamidreza Aslani, MD; Hamid Farrokhi, MD
Abstract
Background: Despite being the largest rotator cuff tendon of the shoulder, the function and clinical relevance of subscapularis pathology has been largely ignored in the literature. Although more recent studies have focused on subscapularis tears, all have reported on techniques of open repair. The advent ...
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Background: Despite being the largest rotator cuff tendon of the shoulder, the function and clinical relevance of subscapularis pathology has been largely ignored in the literature. Although more recent studies have focused on subscapularis tears, all have reported on techniques of open repair. The advent of arthroscopy and arthroscopic repair techniques has opened new frontiers in the diagnosis and repair of torn rotator cuff tendons, including the subscapularis. In this article, we review the short-term results of arthroscopic subscapularis repair. Methods: Ten patients with subscapularis tendon tear of the rotator cuff were analyzed in 8 men and 2 women with an average age of 49.7 years who had an average delay in treatment of 23.5 months. The clinical outcome, including the UCLA score was assessed prospectively for all patients with 3 month intervals.Results: The score for pain improved from 1.75 to 9 points (p < /em>
Hamidreza Aslani, MD; Hamed Vahedi, MD
Abstract
Background: Rotator cuff tear is one of the most common causes of shoulder complaint in the older age group. Treatments differ depending on the severity of tear and patient’s condition. Surgery is one of the important treatment options which may be done arthroscopically or by open technique. In this ...
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Background: Rotator cuff tear is one of the most common causes of shoulder complaint in the older age group. Treatments differ depending on the severity of tear and patient’s condition. Surgery is one of the important treatment options which may be done arthroscopically or by open technique. In this study we would like to report a short-term result of arthroscopic repair of complete tears of rotator cuff.Methods: A cross-sectional study was done in 3 hospitals in Tehran, Iran. 183 patients were treated for their rotator cuff disease by arthroscopic technique from January 2003 to August 2006. 107 cases that had complete tears, and had at least one year follow-up were considered for the study. 89 patients (56 male, 33 female) attended the assessment sessions and were evaluated by UCLA (University of California, Los Angeles) Shoulder and Elbow scoring system. The scores were compared with the preoperative UCLA scores. Acromioplasty was performed in 83 patients.Results: With a mean age of 53.2 (32-71) years, the average UCLA score was 11.3 before surgery and 31.4 in follow-ups. There were 11 patients with excellent, 62 good, 11 fair and 5 poor scores. Nine of the 11 cases with excellent scores and 34 of the good scores were younger than 55 years of age. Out of the 16 fair or poor results, 13 were older than 60 years of age.Conclusions: A significant improvement in UCLA scores is possible after arthroscopic repair of complete rotator –cuff tear, in short term. The treatment results are better in younger patients.
Hamidreza Aslani, MD; Hamed Vahedi, MD
Abstract
Background: Ipsilateral fractures of tibia and femur or’ “floating knee”, commonly occur as a result of high energy trauma. It is, therefore, associated with high chance of knee injuries. This articles looks at the prevalence of intra-articular knee injury in “floating knee” when the fractures ...
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Background: Ipsilateral fractures of tibia and femur or’ “floating knee”, commonly occur as a result of high energy trauma. It is, therefore, associated with high chance of knee injuries. This articles looks at the prevalence of intra-articular knee injury in “floating knee” when the fractures are extra-articular, both in tibia and femur.Methods: During a 3.5 year period of time (March 2002-Oct 2005), 61, out of total of 76 cases of “floating knees” that had extra-articular femur and tibia fractures, had no history of prior knee problems, and the fractures of both segments had been internally fixed were studied. Each knee was examined for any possible ligamentous injury, following rigid fixation of the fractures, under the same anesthesia. The findings were documented and the patients were later followed for any new findings or complaints up to nine months after the incident.Results: The mean age in these 61 cases (57 males, 4 females) was 29.3 (18-46). Lachman and Pivot tests were positive in 5 and Posterior Drawer test in 3 cases. Valgus instability in 9 and varus instability in 6 other cases were detected. After the 9-months follow-up, knee pain was the chief complaint in 19 patients, while the MRI study which was done in 16 cases was positive for meniscal damage in 13 patients.Conclusions: Concomitant knee insults are fairly common in “floating knee” injuries. A thorough knee examination, following fixation of "floating knee” fractures, while the patient is still under anesthesia is essential. Further evaluation during the course of fracture treatment for any knee complaint is also recommended.
