Muscles, ligaments and tendons journal, Jun 1, 2023
Objective. This study evaluated the midterm clinical results of doing the arthroscopic proximal l... more Objective. This study evaluated the midterm clinical results of doing the arthroscopic proximal long head of the biceps tenodesis with an anchor suture of subscapularis or supraspinatus repair in patients with arthroscopic rotator cuff repair. Methods. We evaluated the clinical results of long head of biceps tendon tenodesis in patients with single-row rotator cuff repair. They were all treated with our technique in which we did the tenodesis with anchor suture of rotator cuff repair in a manner that provides both bony and soft tissue attachment for the tendon. We evaluated the results of the long head of the biceps (LHB) tenodesis in all patients by looking for Popeye deformity, anterior shoulder tenderness, asking for anterior shoulder pain, and measuring elbow flexion and forearm supination force compared to the normal side as a primary goal, and compared results of LHB tenodesis with subscapularis or supraspinatus tendon suture as a secondary goal too. Results. A number of 131 patients participated in the final follow-up: 34 patients had LHB tenodesis with subscapularis tendon suture and 95 patients with supraspinatus tendon suture. Mean of follow-up time was four years (24 to 71 months). Two patients had the Popeye deformity (1.5%), five patients had the anterior shoulder tenderness (3.8%), and seven patients suffered from anterior shoulder pain (5.3%). Elbow flexion and forearm supination forces were measured in the affected and non-affected limbs. There was no significant difference between the two limbs. Those who had LHB tenodesis with supraspinatus anchor suture had better results and less complications. Conclusions. Arthroscopic tenodesis of the LHB tendon incorporated into single-row rotator cuff repair is a cost-efficient method, leading to better results for implant or soft tissue tenodesis too. Fixing to supraspinatus tendon seems to have better results and fewer complications compared to subscapularis tendon.
Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as de... more Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as deformity, instability, and degenerative changes. Open reconstruction could jeopardize vascular supply and cause capsular contracture. Arthroscopic treatment of scaphoid nonunion is an effort to avoid such complications. Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion. Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surg...
Background An effective treatment for the elbow recalcitrant lateral epicondylitis is arthroscopi... more Background An effective treatment for the elbow recalcitrant lateral epicondylitis is arthroscopic surgery. This study evaluated the midterm results of treating recalcitrant lateral epicondylitis with arthroscopic surgery. Methods A total of 40 subjects with recalcitrant lateral epicondylitis prepared for arthroscopic surgery on their elbows participated in this study. The elbow function was evaluated using the Quick disabilities of the arm, shoulder, and hand (Quick DASH) score. Pain intensity was assessed before and after the surgery by the visual analog scale (VAS). Grip and pinch strengths were assessed by a dynamometer. Results In this study, the mean age of the participants was 42.9±6.4 years. The average follow-up time was 42 months. The mean of VAS (pain intensities) were 7.05 and 3.20 before and after the surgery, respectively (P=0.001). The Quick DASH score decreased from 63.18 to 25.68 from before to after the surgery (P=0.001). The mean grip strength of the operated and ...
Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain... more Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain and dysfunction in the past decade, thanks to arthroscopic evaluation of the shoulder and biomechanical and anatomical studies of the tendon. Current classification of subscapularis tendon tear is based on insertion site of the tendon. Recently, a classification for non-insertional types of subscapularis tendon tear has been published. Interstitial tear of subscapularis tendon has not been described in classifications available in the literature. This report describes significant interstitial tear of the subscapularis tendon. This tear looks normal in superior, bursal and articular sides. Then its specific arthroscopic findings as "Air bag sign" and repair technique of the pathology is explained.
Background: There have been many studies on arthroscopic rotator cuff surgery outcomes. However, ... more Background: There have been many studies on arthroscopic rotator cuff surgery outcomes. However, few studies have investigated the outcomes of the arthroscopic repair of isolated subscapularis tendon tear. Objectives: This study aimed to evaluate the medium-term clinical outcomes of the arthroscopic repair of an isolated subscapularis tendon tear in a four-year follow-up. Methods: This prospective cohort study was performed on all patients with shoulder pain who had isolated subscapularis tendon on magnetic resonance imaging and underwent arthroscopic evaluation and repair at Besat Hospital, Hamadan, Iran, during 2011 - 2017. The mean follow-up time was 4 years. The modified UCLA, Quick DASH, and visual analogue scale (VAS) were measured, and the belly-press test and lift-off test were completed in the examination. Data were analyzed by the SPSS software version 24. Results: Out of 11 patients, three were female (27.3%), and seven were male (72.7%). The mean age of patients was 59.4...
Journal of Advances in Medical and Biomedical Research
10.30699/jambs.30.140.299 This is a report of a 17-year-old wrestler who had suffered from a spor... more 10.30699/jambs.30.140.299 This is a report of a 17-year-old wrestler who had suffered from a sport injury during an international competition that led to recurrent shoulder dislocation. Physical examination showed that he had a severe ligamentous laxity. In the magnetic resonance images there were combined humeral avulsion of the glenohumeral ligament (HAGL) and Bankart lesions. Combination of Bankart and HAGL lesions, severe ligamentous laxity, being adolescent and requiring a full recovery to resume wrestling professionally, made this case unique. Here we explain his imaging and arthroscopic findings, the technique used for arthroscopic repair, and his midterm follow-up results.
Recurrent dislocation is not common in small joints. This report presents a recurrent dislocation... more Recurrent dislocation is not common in small joints. This report presents a recurrent dislocation of the proximal interpha-langeal joint of the ring finger in a 23-years-old man. Recurrent dislocation was addressed successfully by repairing the avulsed volar plate to the base of the middle phalanx, followed by 6 weeks of splint immobilization.
Primary intraosseous malignant glomus tumor is very rare and is often presented as an osteolytic ... more Primary intraosseous malignant glomus tumor is very rare and is often presented as an osteolytic lesion. The present case study reports a malignant intraosseous glomus tumor of the index finger that was presented as an osteosclerotic lesion and invaded adjacent tissues, leading to ray amputation. We also reported result of a five-year follow-up and presented a short literature review for the lesion.
Ganglion cysts commonly occur around the shoulder, mostly in the spinoglenoid and suprascapular n... more Ganglion cysts commonly occur around the shoulder, mostly in the spinoglenoid and suprascapular notches. We report a very rare case of intra articular Ganglion cyst of the long head of the biceps tendon that originated from the bicipital groove as a rare cause of shoulder pain.
Background and Objective: Carpal Tunnel Syndrome is the most prevalent type of peripheral neuropa... more Background and Objective: Carpal Tunnel Syndrome is the most prevalent type of peripheral neuropathy due to neural entrapment. This syndrome is primarily diagnosed based on clinical symptoms, and it is subsequently confirmed by electro-diagnostic studies. Ultrasonography as a safe, available, and inexpensive method is also valuable in the follow-up of patients. This study aimed to evaluate the ultrasound findings before and after local corticosteroid injection. Materials and Methods: This interventional study was conducted on 45 patients referring to the orthopedic clinic of Besat Hospital, Hamadan, Iran, during 2017. The patients who were selected by convenient sampling method had the symptoms of carpal tunnel syndrome and were diagnosed positive based on electrodiagnostic studies indicating a moderate grade of the disease. Wrist ultrasound was performed before and after the injection of corticosteroid (two months later). Moreover, the ultrasound indices were compared before and after the injection. Data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant. Results: According to the results, 80% of the patients were female. Moreover, the mean age of the patients was 47.9±11.6 years (age range: 22-72 years). About 20% of the cases were left-handed. The right hand was mostly affected by carpal tunnel syndrome (70%). After injection, there were reductions in the median nerve thickness (P=0.95), retinaculum thickness (P=0.001), and nerve cross-sectional area (P=0.001). The Disabilities of the Arm, Shoulder, and Hand (DASH) scale showed that the clinical symptoms of the patients were significantly reduced at the end of the study (P=0.001). Conclusion: Corticosteroid injection in patients with moderate severity of carpal tunnel syndrome improved the clinical symptoms and caused reductions in median nerve thickness, cross-sectional area, and flexor retinaculum thickness.
INTRODUCTION Lower extremity trauma due to a car crash or war mine explosion is still challenging... more INTRODUCTION Lower extremity trauma due to a car crash or war mine explosion is still challenging. The early history of the lower extremity reconstruction dates back to the Hippocrates (460-370BC). Since then, until the First World War, amputation was the best option for saving the lives of the patients.(1) Sushruta Sumhita (600BC) was the first person who used the cheek flap for nasal reconstruction.(2) However, the new era of the flap reconstruction commenced during the First World War. Although in that time Stark was the first person who used muscle flap to cover lower extremity due to osteomyelitis, the first report of the lower extremity reconstruction by muscle flap was done by Ger.(2) Gastrocnemius muscle has also been used to cover the exposed implant of tibia and knee prosthesis.(3,4) Early coverage of the complicated wound of the tibia by the gastrocnemius muscle flap can prevent major complications.(5,6) Based on the Mathes and Nahai classification(7) for vascular pedicle...
BACKGROUND To evaluate safety and efficacy of percutaneous release of trigger finger in multiple ... more BACKGROUND To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with single digit involvement. METHOD A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single digit (group A) and multiple digits (group B). They were followed up for one year. Success rate, pain, complications and duration of analgesic use were studied and then compared in both groups. RESULTS All patients in both groups were treated successfully without any recurrence in a one-year follow-up. No complication was observed, but postoperative duration of pain was significantly different between the two groups. Period of painkiller use was also different between the two groups. CONCLUSION Percutaneous release is a safe and effective treatment for trigger fingers even if multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients.
Background and Objective: Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy ... more Background and Objective: Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy of the upper limb and one of the causes of disability. The current study aimed to compare the therapeutic effects of Low-Level Laser Therapy (LLLT) and therapeutic ultrasound (US) in patients with mild to moderate carpal tunnel syndrome. Materials and Methods: This single-blind randomized trial was conducted on 30 patients with CTS (58 wrists) who were randomly assigned to two treatment groups: laser therapy group (15 patients, 29 wrist (and Ultrasound therapy group (15 patients, 29 wrists). Low-level laser therapy (9 joules, 808 nm infrared laser at five points) and Ultrasound treatment (1 MHz, 1.5 W/cm2, duty cycle 20%, 5 min/session) were applied to the carpal tunnel for 10 daily treatment sessions (5 sessions/week). Outcome measures were Visual analogue scale, pinch & grip strength and Boston questionnaire (BQ), which measured before and after treatment (the end of the study). The pair and independent t-test were used to evaluate the variables. Results: In both groups (laser therapy and Ultrasound therapy), there was a significant improvement in visual analog scale (P=0.000 and P=0.000, respectively), grip strength (P=0.01 and P=0.004, respectively), and pinch strength (P=0.001 and P=0.009, respectively). The results of the Boston Questionnaire also demonstrated an improvement (P=0.000 and P=0.000, respectively) at the end of the study, compared to baseline values. However, there was no significant difference in any of the measured variables between the two treatment groups. Conclusion: As evidenced by the obtained results, both low-level laser therapy and ultrasound are effective in the reduction of pain and improvement of hand function in patients with mild-to-moderate CTS in the short-term.
Background: Many people suffer from ligamentous laxity even in the absence of other diseases. Thi... more Background: Many people suffer from ligamentous laxity even in the absence of other diseases. This is called the benign generalized ligamentous laxity. It can be a predisposing factor for musculoskeletal and joint injuries. We did this research to determine the prevalence of generalized ligamentous laxity in different ethnic groups of Hamadan province as a pilot study for a future national investigation. Materials and methods: In this descriptive-analytical study, 378 people were selected by simple sampling in 2017 from a province in northwest of Iran. We looked for the ligamentous laxity in them with clinical examination according to Beighton's score criteria using goniometer for measuring the joint movement's angle. The population included people between 17 and 40 years old. They were from various Iranian ethnic backgrounds who were living in this province. Results: Eighty-six participants (22.8%) had generalized ligamentous laxity. Generalized ligamentous laxity was more prevalent in women (31.5% compared to 14.7% in men). The most common ligament laxity was on the fingers. Most participants with generalized ligamentous laxity (78 of 86 participants) had no knowledge of their problem and its importance in choosing the appropriate sports activities; 12 of 86 participants (14%) had a history of sports-related injuries, and 31 of 86 participants (36.5%) had a musculoskeletal disease. Conclusion: The prevalence of generalized ligamentous laxity is considerably higher in women regardless of their ethnicity. Most people are unaware of their problem. Also, the history of musculoskeletal diseases is significantly higher in people with this problem compared to those without it.
Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.], Jan 6, 2018
The aim of this double-blind, randomized, controlled clinical study was to assess the efficacy of... more The aim of this double-blind, randomized, controlled clinical study was to assess the efficacy of low-level laser therapy (LLLT) combined with 5000 ppm fluoride dentifrice on postbleaching sensitivity in teeth exposed to 35% hydrogen peroxide for four weeks. Twenty-five volunteers were evaluated using the split-mouth model in which the right and left maxillary/mandibular quadrants were randomized and allocated to one of two groups: GPLACEBO, in which the laser tip was positioned without the emission of light (placebo effect) + 5000 ppm sodium fluoride, or GLASER, which comprised LLLT + 5000 ppm sodium fluoride. For both groups, LLLT and placebo were used before bleaching, whereas fluoride was applied after bleaching. LLLT was applied at two points: on the central cervical and medial regions of the incisors, canines, and premolars in the corresponding hemi-arch. At each point, 60 J/cm was applied for 16 seconds with an irradiance of 3.75 W/cm using the therapeutic infrared device. To...
Background: Generalized ligamentous laxity is defined as an increased range of joint motion compa... more Background: Generalized ligamentous laxity is defined as an increased range of joint motion compared to that of the general population. It is a predisposing factor for sports injuries, especially in the lower extremities. Nevertheless, there is little evidence about the relationship between generalized ligamentous laxity and sports injuries in the upper extremities. Objectives: To evaluate the relationship of generalized ligamentous laxity with acute and chronic shoulder injuries in athletes. Patients and Methods: Our study comprised 118 volunteer athletes with a history of at least six months of sports activities and a shoulder injury in the three years prior to participation in our study. The athletes were divided into two groups: those with or without generalized ligamentous laxity. Acute and chronic shoulder injuries, shoulder pain, shoulder instability, and functional status assessed via the QuickDASH measure were determined and compared between the two groups. A P value of less than 0.05 was considered significant. Results: Group A (with ligamentous laxity) consisted of 43 participants (36.4%) and group B (without ligamentous laxity) consisted of 75 participants (63.6%). The athletes in group A had more shoulder pain (P = 0.016), chronic shoulder injuries (P = 0.032), and shoulder instability (P = 0.004), and less functionality (P = 0.030) than those in group B. If fracture were not considered an acute injury in both groups, the athletes with generalized ligamentous laxity would have had more acute shoulder injuries. Conclusions: Generalized ligamentous laxity is an important predisposing factor for acute and chronic shoulder injuries in athletes. Prescreening programs for beginners and rehabilitation shoulder programs for sports athletes at high risk are strongly recommended.
Background: Nonunion of distal radius fractures is disabling. Treatment is difficult and the resu... more Background: Nonunion of distal radius fractures is disabling. Treatment is difficult and the results are not predictable. However, posterior interosseous bone flap (PIBF) has been successful in treating forearm nonunion. Objectives: To treat distal radius fracture nonunion with PIBF as a new procedure. Patients and Methods: This prospective non-randomized cohort study was performed at two hospitals in Tehran between January 2011 and September 2015. PIBFs were applied in nine patients (10 nonunions) with a mean age of 55 years. Union success rate, grip strength, wrist range of motion, and forearm rotation were then evaluated. Results: Although four of the patients had a history of infection, all participants achieved fracture union at a mean time of 3.8 months. Grip strength improved by 12.4 kg. There was also 36°improvement in wrist flexion, 20°improvement in wrist extension, 60°improvement in forearm supination, and 46°improvement in forearm pronation. The range of motion and grip strength improvements were significant. Conclusions: Pedicled PIBF is a new option for treating distal radius fracture nonunion. The results are predictable in achieving union and good function, and this technique can be successfully used in cases with extensive soft-tissue damage or infection.
In this report we describe our encounter of a case of hand trauma referred to our center presenti... more In this report we describe our encounter of a case of hand trauma referred to our center presenting with incomplete left thumb amputation at metacarpal level with extensor pollicis longus (EPL) and flexor pollicis longus (FPL) tendon avulsion from the tenomuscular junction. After metacarpal bone fixation the ulnar digital artery was anastomosed and the digital nerves were coapted. Transfer of extensor indicis proprius (EIP) to EPL and side-to-side suturing of the FPL to the deep flexor tendon of the index finger were performed.
Background: Evolving wrist arthroscopy requires creating new portals, and creating portals recipr... more Background: Evolving wrist arthroscopy requires creating new portals, and creating portals reciprocally leads to increased indications for arthroscopic wrist procedures. To facilitate access to the lunate bone and fossa for new arthroscopic procedures, a new portal was used. This is a cadaveric study of this portal. Objectives: In this cadaveric study, we evaluated a portal in wrist arthroscopy for procedures involving the lunate bone and lunate fossa. Materials and Methods: Seventeen wrists from 10 fresh cadavers were included in this study. After diagnostic arthroscopy, a portal (Trans-4) was made through the fourth extensor compartment, exactly along the lunate's long axis under direct visualization from the 3-4 portal. Strand retractors were used to protect the extensor tendons and posterior capsule. Lunate bone core decompression and osteoscopy were done through the portal. At the end of the procedure, the position of the decompression hole in the lunate and any possible injury to the extensor tendons, distal radius cartilage, lunate cartilage, and perilunate ligaments were investigated. Results: Lunate bone decompression was performed successfully in all cases using the trans-4 portal. In 15 wrists, the lunate hole was located in the middle third. In the other two wrists, it was located slightly radial in one case and slightly on the ulnar side in the other case. There was no cortical penetration during decompression, and no extensor tendon, superficial nerve branches, or peri-lunate ligament injuries were observed. Conclusions: The trans-4 portal could be a safe working portal in wrist arthroscopy that enables access to the lunate bone and lunate fossa.
Annals of Military and Health Sciences Research, 2022
Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as de... more Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as deformity, instability, and degenerative changes. Open reconstruction could jeopardize vascular supply and cause capsular contracture. Arthroscopic treatment of scaphoid nonunion is an effort to avoid such complications. Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion. Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surgery. Results: Based on radiographic findings, all patients' fractures were satisfactorily united after three months. Functional scores, motion range, and grip strength improved to an acceptable level. There was no complication, including infection or nerve damage. Conclusions: Arthroscopic treatment of scaphoid nonunion seems to be an effective method with low complications and favorable results
Muscles, ligaments and tendons journal, Jun 1, 2023
Objective. This study evaluated the midterm clinical results of doing the arthroscopic proximal l... more Objective. This study evaluated the midterm clinical results of doing the arthroscopic proximal long head of the biceps tenodesis with an anchor suture of subscapularis or supraspinatus repair in patients with arthroscopic rotator cuff repair. Methods. We evaluated the clinical results of long head of biceps tendon tenodesis in patients with single-row rotator cuff repair. They were all treated with our technique in which we did the tenodesis with anchor suture of rotator cuff repair in a manner that provides both bony and soft tissue attachment for the tendon. We evaluated the results of the long head of the biceps (LHB) tenodesis in all patients by looking for Popeye deformity, anterior shoulder tenderness, asking for anterior shoulder pain, and measuring elbow flexion and forearm supination force compared to the normal side as a primary goal, and compared results of LHB tenodesis with subscapularis or supraspinatus tendon suture as a secondary goal too. Results. A number of 131 patients participated in the final follow-up: 34 patients had LHB tenodesis with subscapularis tendon suture and 95 patients with supraspinatus tendon suture. Mean of follow-up time was four years (24 to 71 months). Two patients had the Popeye deformity (1.5%), five patients had the anterior shoulder tenderness (3.8%), and seven patients suffered from anterior shoulder pain (5.3%). Elbow flexion and forearm supination forces were measured in the affected and non-affected limbs. There was no significant difference between the two limbs. Those who had LHB tenodesis with supraspinatus anchor suture had better results and less complications. Conclusions. Arthroscopic tenodesis of the LHB tendon incorporated into single-row rotator cuff repair is a cost-efficient method, leading to better results for implant or soft tissue tenodesis too. Fixing to supraspinatus tendon seems to have better results and fewer complications compared to subscapularis tendon.
Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as de... more Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as deformity, instability, and degenerative changes. Open reconstruction could jeopardize vascular supply and cause capsular contracture. Arthroscopic treatment of scaphoid nonunion is an effort to avoid such complications. Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion. Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surg...
Background An effective treatment for the elbow recalcitrant lateral epicondylitis is arthroscopi... more Background An effective treatment for the elbow recalcitrant lateral epicondylitis is arthroscopic surgery. This study evaluated the midterm results of treating recalcitrant lateral epicondylitis with arthroscopic surgery. Methods A total of 40 subjects with recalcitrant lateral epicondylitis prepared for arthroscopic surgery on their elbows participated in this study. The elbow function was evaluated using the Quick disabilities of the arm, shoulder, and hand (Quick DASH) score. Pain intensity was assessed before and after the surgery by the visual analog scale (VAS). Grip and pinch strengths were assessed by a dynamometer. Results In this study, the mean age of the participants was 42.9±6.4 years. The average follow-up time was 42 months. The mean of VAS (pain intensities) were 7.05 and 3.20 before and after the surgery, respectively (P=0.001). The Quick DASH score decreased from 63.18 to 25.68 from before to after the surgery (P=0.001). The mean grip strength of the operated and ...
Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain... more Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain and dysfunction in the past decade, thanks to arthroscopic evaluation of the shoulder and biomechanical and anatomical studies of the tendon. Current classification of subscapularis tendon tear is based on insertion site of the tendon. Recently, a classification for non-insertional types of subscapularis tendon tear has been published. Interstitial tear of subscapularis tendon has not been described in classifications available in the literature. This report describes significant interstitial tear of the subscapularis tendon. This tear looks normal in superior, bursal and articular sides. Then its specific arthroscopic findings as "Air bag sign" and repair technique of the pathology is explained.
Background: There have been many studies on arthroscopic rotator cuff surgery outcomes. However, ... more Background: There have been many studies on arthroscopic rotator cuff surgery outcomes. However, few studies have investigated the outcomes of the arthroscopic repair of isolated subscapularis tendon tear. Objectives: This study aimed to evaluate the medium-term clinical outcomes of the arthroscopic repair of an isolated subscapularis tendon tear in a four-year follow-up. Methods: This prospective cohort study was performed on all patients with shoulder pain who had isolated subscapularis tendon on magnetic resonance imaging and underwent arthroscopic evaluation and repair at Besat Hospital, Hamadan, Iran, during 2011 - 2017. The mean follow-up time was 4 years. The modified UCLA, Quick DASH, and visual analogue scale (VAS) were measured, and the belly-press test and lift-off test were completed in the examination. Data were analyzed by the SPSS software version 24. Results: Out of 11 patients, three were female (27.3%), and seven were male (72.7%). The mean age of patients was 59.4...
Journal of Advances in Medical and Biomedical Research
10.30699/jambs.30.140.299 This is a report of a 17-year-old wrestler who had suffered from a spor... more 10.30699/jambs.30.140.299 This is a report of a 17-year-old wrestler who had suffered from a sport injury during an international competition that led to recurrent shoulder dislocation. Physical examination showed that he had a severe ligamentous laxity. In the magnetic resonance images there were combined humeral avulsion of the glenohumeral ligament (HAGL) and Bankart lesions. Combination of Bankart and HAGL lesions, severe ligamentous laxity, being adolescent and requiring a full recovery to resume wrestling professionally, made this case unique. Here we explain his imaging and arthroscopic findings, the technique used for arthroscopic repair, and his midterm follow-up results.
Recurrent dislocation is not common in small joints. This report presents a recurrent dislocation... more Recurrent dislocation is not common in small joints. This report presents a recurrent dislocation of the proximal interpha-langeal joint of the ring finger in a 23-years-old man. Recurrent dislocation was addressed successfully by repairing the avulsed volar plate to the base of the middle phalanx, followed by 6 weeks of splint immobilization.
Primary intraosseous malignant glomus tumor is very rare and is often presented as an osteolytic ... more Primary intraosseous malignant glomus tumor is very rare and is often presented as an osteolytic lesion. The present case study reports a malignant intraosseous glomus tumor of the index finger that was presented as an osteosclerotic lesion and invaded adjacent tissues, leading to ray amputation. We also reported result of a five-year follow-up and presented a short literature review for the lesion.
Ganglion cysts commonly occur around the shoulder, mostly in the spinoglenoid and suprascapular n... more Ganglion cysts commonly occur around the shoulder, mostly in the spinoglenoid and suprascapular notches. We report a very rare case of intra articular Ganglion cyst of the long head of the biceps tendon that originated from the bicipital groove as a rare cause of shoulder pain.
Background and Objective: Carpal Tunnel Syndrome is the most prevalent type of peripheral neuropa... more Background and Objective: Carpal Tunnel Syndrome is the most prevalent type of peripheral neuropathy due to neural entrapment. This syndrome is primarily diagnosed based on clinical symptoms, and it is subsequently confirmed by electro-diagnostic studies. Ultrasonography as a safe, available, and inexpensive method is also valuable in the follow-up of patients. This study aimed to evaluate the ultrasound findings before and after local corticosteroid injection. Materials and Methods: This interventional study was conducted on 45 patients referring to the orthopedic clinic of Besat Hospital, Hamadan, Iran, during 2017. The patients who were selected by convenient sampling method had the symptoms of carpal tunnel syndrome and were diagnosed positive based on electrodiagnostic studies indicating a moderate grade of the disease. Wrist ultrasound was performed before and after the injection of corticosteroid (two months later). Moreover, the ultrasound indices were compared before and after the injection. Data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant. Results: According to the results, 80% of the patients were female. Moreover, the mean age of the patients was 47.9±11.6 years (age range: 22-72 years). About 20% of the cases were left-handed. The right hand was mostly affected by carpal tunnel syndrome (70%). After injection, there were reductions in the median nerve thickness (P=0.95), retinaculum thickness (P=0.001), and nerve cross-sectional area (P=0.001). The Disabilities of the Arm, Shoulder, and Hand (DASH) scale showed that the clinical symptoms of the patients were significantly reduced at the end of the study (P=0.001). Conclusion: Corticosteroid injection in patients with moderate severity of carpal tunnel syndrome improved the clinical symptoms and caused reductions in median nerve thickness, cross-sectional area, and flexor retinaculum thickness.
INTRODUCTION Lower extremity trauma due to a car crash or war mine explosion is still challenging... more INTRODUCTION Lower extremity trauma due to a car crash or war mine explosion is still challenging. The early history of the lower extremity reconstruction dates back to the Hippocrates (460-370BC). Since then, until the First World War, amputation was the best option for saving the lives of the patients.(1) Sushruta Sumhita (600BC) was the first person who used the cheek flap for nasal reconstruction.(2) However, the new era of the flap reconstruction commenced during the First World War. Although in that time Stark was the first person who used muscle flap to cover lower extremity due to osteomyelitis, the first report of the lower extremity reconstruction by muscle flap was done by Ger.(2) Gastrocnemius muscle has also been used to cover the exposed implant of tibia and knee prosthesis.(3,4) Early coverage of the complicated wound of the tibia by the gastrocnemius muscle flap can prevent major complications.(5,6) Based on the Mathes and Nahai classification(7) for vascular pedicle...
BACKGROUND To evaluate safety and efficacy of percutaneous release of trigger finger in multiple ... more BACKGROUND To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with single digit involvement. METHOD A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single digit (group A) and multiple digits (group B). They were followed up for one year. Success rate, pain, complications and duration of analgesic use were studied and then compared in both groups. RESULTS All patients in both groups were treated successfully without any recurrence in a one-year follow-up. No complication was observed, but postoperative duration of pain was significantly different between the two groups. Period of painkiller use was also different between the two groups. CONCLUSION Percutaneous release is a safe and effective treatment for trigger fingers even if multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients.
Background and Objective: Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy ... more Background and Objective: Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy of the upper limb and one of the causes of disability. The current study aimed to compare the therapeutic effects of Low-Level Laser Therapy (LLLT) and therapeutic ultrasound (US) in patients with mild to moderate carpal tunnel syndrome. Materials and Methods: This single-blind randomized trial was conducted on 30 patients with CTS (58 wrists) who were randomly assigned to two treatment groups: laser therapy group (15 patients, 29 wrist (and Ultrasound therapy group (15 patients, 29 wrists). Low-level laser therapy (9 joules, 808 nm infrared laser at five points) and Ultrasound treatment (1 MHz, 1.5 W/cm2, duty cycle 20%, 5 min/session) were applied to the carpal tunnel for 10 daily treatment sessions (5 sessions/week). Outcome measures were Visual analogue scale, pinch & grip strength and Boston questionnaire (BQ), which measured before and after treatment (the end of the study). The pair and independent t-test were used to evaluate the variables. Results: In both groups (laser therapy and Ultrasound therapy), there was a significant improvement in visual analog scale (P=0.000 and P=0.000, respectively), grip strength (P=0.01 and P=0.004, respectively), and pinch strength (P=0.001 and P=0.009, respectively). The results of the Boston Questionnaire also demonstrated an improvement (P=0.000 and P=0.000, respectively) at the end of the study, compared to baseline values. However, there was no significant difference in any of the measured variables between the two treatment groups. Conclusion: As evidenced by the obtained results, both low-level laser therapy and ultrasound are effective in the reduction of pain and improvement of hand function in patients with mild-to-moderate CTS in the short-term.
Background: Many people suffer from ligamentous laxity even in the absence of other diseases. Thi... more Background: Many people suffer from ligamentous laxity even in the absence of other diseases. This is called the benign generalized ligamentous laxity. It can be a predisposing factor for musculoskeletal and joint injuries. We did this research to determine the prevalence of generalized ligamentous laxity in different ethnic groups of Hamadan province as a pilot study for a future national investigation. Materials and methods: In this descriptive-analytical study, 378 people were selected by simple sampling in 2017 from a province in northwest of Iran. We looked for the ligamentous laxity in them with clinical examination according to Beighton's score criteria using goniometer for measuring the joint movement's angle. The population included people between 17 and 40 years old. They were from various Iranian ethnic backgrounds who were living in this province. Results: Eighty-six participants (22.8%) had generalized ligamentous laxity. Generalized ligamentous laxity was more prevalent in women (31.5% compared to 14.7% in men). The most common ligament laxity was on the fingers. Most participants with generalized ligamentous laxity (78 of 86 participants) had no knowledge of their problem and its importance in choosing the appropriate sports activities; 12 of 86 participants (14%) had a history of sports-related injuries, and 31 of 86 participants (36.5%) had a musculoskeletal disease. Conclusion: The prevalence of generalized ligamentous laxity is considerably higher in women regardless of their ethnicity. Most people are unaware of their problem. Also, the history of musculoskeletal diseases is significantly higher in people with this problem compared to those without it.
Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.], Jan 6, 2018
The aim of this double-blind, randomized, controlled clinical study was to assess the efficacy of... more The aim of this double-blind, randomized, controlled clinical study was to assess the efficacy of low-level laser therapy (LLLT) combined with 5000 ppm fluoride dentifrice on postbleaching sensitivity in teeth exposed to 35% hydrogen peroxide for four weeks. Twenty-five volunteers were evaluated using the split-mouth model in which the right and left maxillary/mandibular quadrants were randomized and allocated to one of two groups: GPLACEBO, in which the laser tip was positioned without the emission of light (placebo effect) + 5000 ppm sodium fluoride, or GLASER, which comprised LLLT + 5000 ppm sodium fluoride. For both groups, LLLT and placebo were used before bleaching, whereas fluoride was applied after bleaching. LLLT was applied at two points: on the central cervical and medial regions of the incisors, canines, and premolars in the corresponding hemi-arch. At each point, 60 J/cm was applied for 16 seconds with an irradiance of 3.75 W/cm using the therapeutic infrared device. To...
Background: Generalized ligamentous laxity is defined as an increased range of joint motion compa... more Background: Generalized ligamentous laxity is defined as an increased range of joint motion compared to that of the general population. It is a predisposing factor for sports injuries, especially in the lower extremities. Nevertheless, there is little evidence about the relationship between generalized ligamentous laxity and sports injuries in the upper extremities. Objectives: To evaluate the relationship of generalized ligamentous laxity with acute and chronic shoulder injuries in athletes. Patients and Methods: Our study comprised 118 volunteer athletes with a history of at least six months of sports activities and a shoulder injury in the three years prior to participation in our study. The athletes were divided into two groups: those with or without generalized ligamentous laxity. Acute and chronic shoulder injuries, shoulder pain, shoulder instability, and functional status assessed via the QuickDASH measure were determined and compared between the two groups. A P value of less than 0.05 was considered significant. Results: Group A (with ligamentous laxity) consisted of 43 participants (36.4%) and group B (without ligamentous laxity) consisted of 75 participants (63.6%). The athletes in group A had more shoulder pain (P = 0.016), chronic shoulder injuries (P = 0.032), and shoulder instability (P = 0.004), and less functionality (P = 0.030) than those in group B. If fracture were not considered an acute injury in both groups, the athletes with generalized ligamentous laxity would have had more acute shoulder injuries. Conclusions: Generalized ligamentous laxity is an important predisposing factor for acute and chronic shoulder injuries in athletes. Prescreening programs for beginners and rehabilitation shoulder programs for sports athletes at high risk are strongly recommended.
Background: Nonunion of distal radius fractures is disabling. Treatment is difficult and the resu... more Background: Nonunion of distal radius fractures is disabling. Treatment is difficult and the results are not predictable. However, posterior interosseous bone flap (PIBF) has been successful in treating forearm nonunion. Objectives: To treat distal radius fracture nonunion with PIBF as a new procedure. Patients and Methods: This prospective non-randomized cohort study was performed at two hospitals in Tehran between January 2011 and September 2015. PIBFs were applied in nine patients (10 nonunions) with a mean age of 55 years. Union success rate, grip strength, wrist range of motion, and forearm rotation were then evaluated. Results: Although four of the patients had a history of infection, all participants achieved fracture union at a mean time of 3.8 months. Grip strength improved by 12.4 kg. There was also 36°improvement in wrist flexion, 20°improvement in wrist extension, 60°improvement in forearm supination, and 46°improvement in forearm pronation. The range of motion and grip strength improvements were significant. Conclusions: Pedicled PIBF is a new option for treating distal radius fracture nonunion. The results are predictable in achieving union and good function, and this technique can be successfully used in cases with extensive soft-tissue damage or infection.
In this report we describe our encounter of a case of hand trauma referred to our center presenti... more In this report we describe our encounter of a case of hand trauma referred to our center presenting with incomplete left thumb amputation at metacarpal level with extensor pollicis longus (EPL) and flexor pollicis longus (FPL) tendon avulsion from the tenomuscular junction. After metacarpal bone fixation the ulnar digital artery was anastomosed and the digital nerves were coapted. Transfer of extensor indicis proprius (EIP) to EPL and side-to-side suturing of the FPL to the deep flexor tendon of the index finger were performed.
Background: Evolving wrist arthroscopy requires creating new portals, and creating portals recipr... more Background: Evolving wrist arthroscopy requires creating new portals, and creating portals reciprocally leads to increased indications for arthroscopic wrist procedures. To facilitate access to the lunate bone and fossa for new arthroscopic procedures, a new portal was used. This is a cadaveric study of this portal. Objectives: In this cadaveric study, we evaluated a portal in wrist arthroscopy for procedures involving the lunate bone and lunate fossa. Materials and Methods: Seventeen wrists from 10 fresh cadavers were included in this study. After diagnostic arthroscopy, a portal (Trans-4) was made through the fourth extensor compartment, exactly along the lunate's long axis under direct visualization from the 3-4 portal. Strand retractors were used to protect the extensor tendons and posterior capsule. Lunate bone core decompression and osteoscopy were done through the portal. At the end of the procedure, the position of the decompression hole in the lunate and any possible injury to the extensor tendons, distal radius cartilage, lunate cartilage, and perilunate ligaments were investigated. Results: Lunate bone decompression was performed successfully in all cases using the trans-4 portal. In 15 wrists, the lunate hole was located in the middle third. In the other two wrists, it was located slightly radial in one case and slightly on the ulnar side in the other case. There was no cortical penetration during decompression, and no extensor tendon, superficial nerve branches, or peri-lunate ligament injuries were observed. Conclusions: The trans-4 portal could be a safe working portal in wrist arthroscopy that enables access to the lunate bone and lunate fossa.
Annals of Military and Health Sciences Research, 2022
Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as de... more Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as deformity, instability, and degenerative changes. Open reconstruction could jeopardize vascular supply and cause capsular contracture. Arthroscopic treatment of scaphoid nonunion is an effort to avoid such complications. Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion. Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surgery. Results: Based on radiographic findings, all patients' fractures were satisfactorily united after three months. Functional scores, motion range, and grip strength improved to an acceptable level. There was no complication, including infection or nerve damage. Conclusions: Arthroscopic treatment of scaphoid nonunion seems to be an effective method with low complications and favorable results
Uploads
Papers by Hossein Saremi
Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion.
Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surgery.
Results: Based on radiographic findings, all patients' fractures were satisfactorily united after three months. Functional scores, motion range, and grip strength improved to an acceptable level. There was no complication, including infection or nerve damage.
Conclusions: Arthroscopic treatment of scaphoid nonunion seems to be an effective method with low complications and favorable results
Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion.
Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surgery.
Results: Based on radiographic findings, all patients' fractures were satisfactorily united after three months. Functional scores, motion range, and grip strength improved to an acceptable level. There was no complication, including infection or nerve damage.
Conclusions: Arthroscopic treatment of scaphoid nonunion seems to be an effective method with low complications and favorable results