Tenodesis of the long head of the biceps tendon (LHB) at the upper part of the bicipital groove has been related to persistent postoperative bicipital pain. This is possibly due to the inflammation of the remaining tendon within the groove. This, in turn, could be attributed to the continual mechanical stress placed on the tendon in the narrow bicipital groove. Theoretically, should the LHB be more "relaxed," the mechanical stress applied on it would be diminished. On the basis of this rationale, we present an arthroscopic biceps tenodesis technique, according to which the tendon is fixed at the entrance of the bicipital groove, using a bioabsorbable screw, relaxed by 5 mm. In this lax position, the residual LHB tension is expected to be decreased compared with the initial tension, whereas no cosmetic deformity (Popeye sign) or impaired muscular performance is anticipated.
Objective: To evaluate the results from subcutaneous anterior transposition of the cubital nerve for treating cubital tunnel syndrome (CTS) and the influence of prognostic factors such as preoperative McGowan stage, age and duration of symptoms. Methods: 36 patients with CTS who underwent subcutaneous anterior transposition of the cubital nerve between 2006 and 2009 were evaluated after an average follow-up of 28 months. Their mean age was 41.6 years. Nine patients were in McGowan stage I, 18 in stage II and nine in stage III. Results: There was a statistically significant improvement in sensory and motor deficits. 78% of the patients with severe neuropathy improved after surgery. According to the modified Bishop score, 21 patients (58.3%) had excellent results, seven (19.4%) good, six (16.7%) satisfactory and two (5.55%) poor. The satisfaction rate was 86% and 72% of the patients recovered their daily activities without limitations. Conclusion: The severity of neuropathy and preoperative duration of symptoms, but not age, had a negative influence on the outcome. The subcutaneous anterior transposition of the cubital nerve is safe and effective for treating CTS of different degrees of severity. Given the major prognostic factors identified, surgical treatment should be advised as soon as axonal loss has become clinically evident.
Posterior sternoclavicular dislocation is a rare traumatic injury that presents a potential risk of injury to mediastinal structures. The diagnosis is fundamentally clinical and treatment is done on an emergency basis. The authors report the clinical case of a young judo athlete with post-traumatic medial epiphyseal fracture-detachment, with posterior displacement (lesion equivalent to posterior sternoclavicular dislocation at pediatric ages). He underwent open reduction and ligament repair by means of a mini-anchor. The radiological and clinical outcome was excellent, and the athlete returned to his sports activity without limitations. We discuss the particular features of this pathological condition, along with the different therapeutic approaches and their complications.
after surgery. According to the modified Bishop score, 21 patients (58.3%) had excellent results, seven (19.4%) good, six (16.7%) satisfactory and two (5.55%) poor. The satisfaction rate was 86% and 72% of the patients recovered their daily activities without limitations. Conclusion: The severity of neuropathy and preoperative duration of symptoms, but not age, had a negative influence on the outcome. The subcutaneous anterior transposition of the cubital nerve is safe and effective for treating CTS of different degrees of severity. Given the major prognostic factors identified, surgical treatment should be advised as soon as axonal loss has become clinically evident.
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