Pressure between the humeral head and the subscapularis tendon after the modified Boytchev procedure

Shibata, Yozo; Honjo, Noriaki; Shinoda, Tsuyoshi; Kumano, Takafumi; Naito, Masatoshi

doi:10.1016/j.jse.2003.12.010

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…This procedure creates a dynamic sling mechanism, which in turn provides immediate stability to the shoulder, thereby enabling for immediate rehabilitation of the shoulder joint. [10] In study done by G. B. Ha Eri et al [11] , out of 26 patients, 22 patients were males and 4 were females and belongs to the age group 16 years to 39 years with mean age 22 years. In 2001, Chatterjee et al [8] proposed a study with 48 patients of age group 18 years to 35 years with mean age 24.5 years.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of modified Boytchev procedure in recurrent shoulder dislocation

Suryakumar¹,

Ram²

2018

Int. J. Orthop. Sci.

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Objective: To evaluate functional outcome of recurrent anterior shoulder dislocation by modified Boytchev procedure. Materials and Method: This prospective study was done in 30 patients with recurrent dislocation of the shoulder, treated in the department of Orthopaedics Rajah Muthiah Medical Hospital and Sri Ramachandra Medical centre. The inclusion criteria were patients with recurrent anterior shoulder dislocation with minimum 5 to 8 episodes and age more than 18 years and less than 50 years. The exclusion criteria were fresh dislocation, dislocations with fracture of Coracoid process and patients with ligamentous laxity. The functional statuses of the patients were assessed using the Modified Rowe's Scale. Results: out of thirty patients treated by modified Boytchev procedure 93% of patients had excellent/good outcome. Two patients, who had fair outcome in our study, were due to traumatic dislocation one year following the procedure, which leads to periarthritis of the affected shoulder and restricting abduction and external rotation movements. Conclusion: Modified Boytchev procedure is cost effective and has an easy learning curve. Therefore it is the ideal management in rural area.

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Section: Discussionmentioning

confidence: 99%

Functional outcome of modified Boytchev procedure in recurrent shoulder dislocation

Suryakumar¹,

Ram²

2018

Int. J. Orthop. Sci.

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“…The rerouted conjoint tendon increases tension in the subscapularis and reinforces the anterior muscular support and it prevents the superior displacement of the subscapularis and thereby prevents the dislocation. [6][7][8][9][10][11][12][13][14][15] The rerouted conjoint tendon between the head of the humerus and subscapularis, also exerts a pressure effect on the subscapularis tendon, thereby increasing the proprioceptive stimulus in the tendon, which increases the protective reflex to prevent the dislocation. The other advantages of modified Boytchev procedure are, this is an extra articular procedure, with a very low recurrence rate, lower complication rate, lower re-operation rate, less intra operative time, maintains reasonably good range of abduction and external rotation, and the procedure is easy to perform.…”

Section: Discussionmentioning

confidence: 99%

A Study of Management of Recurrent Anterior Dislocation Shoulder by Modified Boytchev Procedure

Prashanth¹,

Reddy²,

Ohatker³

et al. 2015

jemds

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Recurrent dislocation of shoulder limits the activity of the shoulder and impairs the functional efficiency of the modern man. So far more than 150 surgical procedures were described for the treatment of recurrent dislocation of shoulder. There is no gold standard among them with each having its own advantages and disadvantages. In modified Boytchev procedure, the osteotomised and detached tip of coracoid process with its conjoint tendon attachment is rerouted deep to the subscapularis muscle, and reattached to its original anatomical location. The conjoint tendon with short head of biceps and coracobrachialis in its transferred position produces a strong dynamic buttress effect across the anterior and inferior aspects of the shoulder, when the joint is in the vulnerable position of abduction and external rotation. This is the key for the success of this procedure. Our study evaluates the results of the procedure performed at our institute in 23 subjects during the period of 2002-March 2015. We achieved good to excellent results in 87% of the cases who regained almost full range of motion. One case was noted to have screw loosening on follow up and one case developed shoulder stiffness due to improper physiotherapy. In conclusion, Modified Boytchev procedure is an effective and a simple procedure to perform, in the management of recurrent dislocation of shoulder.

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“…The modified Boytchev procedure is biomechanically sound that acts by two possible mechanisms: dynamic muscular sling effect89 and improved shoulder joint proprioception 10. The subscapularis is pulled forward by the rerouted conjoined tendon during elevation of the shoulder thereby causing an increase in the lever arm and enhancing the internal rotational moment arm.…”

Section: Discussionmentioning

confidence: 99%

“…provides valid scientific reason for prevention of recurrence after modified Boytchev procedure. Study by Shibata et al 10. revealed that the efficacy of modified Boytchev procedure was not only due to the muscular sling effect but improved shoulder proprioception also played an important role in prevention of shoulder dislocation.…”

Section: Discussionmentioning

confidence: 99%

Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder

Garg

Ayan

Keshari

et al. 2011

IJOO

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Background:More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Modified Boytchev procedure employs rerouting of the detached tip of coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to subscapularis and reattaches to its anatomical location. We conducted a study on evaluation of long-term effect of modified Boytchev procedure and to compare our results with other studies published in literature.Materials and Methods:Since June 2002, modified Boytchev procedure was performed on 48 patients, who presented with recurrent anterior dislocation. 45 were men and 3 were women and were in the age group of 18-40 years (mean 27.83±4.95 years). Forty patients were affected on the dominant side and rest on the non-dominant side. The mean number of dislocations in these patients was 18.22±12.08. The mean followup period was 58.13±19.06 months (range 18-96 months). The patients were evaluated by visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup.Results:All the patients regained almost preoperative range of forward flexion at the last followup. In the preoperative period the mean external rotation deficit at 0° and at 90° of abduction was 13.22°±5.16° and 18.06°±6.50°, respectively. At the last followup, the mean external rotation deficit at 0° and at 90° of abduction was 8.06°±2.47° and 8.95°±2.07°, respectively. This improvement in external rotation deficit was statistically significant (P<.05). Preoperative scores were compared with the most recent followup scores for all variables with use of a paired t test. All patients had significant improvement in visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. Four of the patients developed superficial infection which got resolved after treating with antibiotics, and two of the patients developed transient musculocutaneous nerve paresis. There was no radiological evidence of loosening and migration of coracoid screw or any glenohumeral arthritis on subsequent followup of skiagrams in any of our patients.Conclusion:Modified Boytchev procedure is an efficacious and technically simple procedure to treat recurrent anterior dislocation of shoulder.

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Pressure between the humeral head and the subscapularis tendon after the modified Boytchev procedure

Cited by 12 publications

References 15 publications

Functional outcome of modified Boytchev procedure in recurrent shoulder dislocation

Functional outcome of modified Boytchev procedure in recurrent shoulder dislocation

A Study of Management of Recurrent Anterior Dislocation Shoulder by Modified Boytchev Procedure

Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder

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