Bio

Clinical Focus


  • Orthopaedic Surgery
  • Sports Medicine
  • Ankle Injuries
  • Sports Injuries
  • shoulder and elbow surgery
  • Knee Injuries
  • knee surgery
  • hand surgery

Academic Appointments


Administrative Appointments


  • Team Physician, San Francisco 49ers (2007 - Present)
  • Team Physician, Golden State Warriors (2011 - Present)
  • Team Physician, Stanford Men's Basketball (2004 - 2007)
  • Program Director, Department of Orthopaedic Surgery (2002 - 2008)

Honors & Awards


  • Certificate of Added Qualification (CAQ), Sports Medicine (2007)
  • Certificate of Added Qualification (CAQ), Hand Surgery (2004)
  • Alpha Omega Alpha Medical Honor Society, Georgetown University School of Medicine (1994)
  • Magna Cum Laude, Georgetown University School of Medicine (1995)
  • Teacher of the Year Award, Stanford Orthopaedic Surgery (June 2002)

Professional Education


  • Residency:University Of New Mexico Hospital (2000) NM
  • Internship:University Of New Mexico Hospital (1996) NM
  • Fellowship:Stanford University School of Medicine (2001) CA
  • Board Certification: Hand Surgery, American Board of Orthopaedic Surgery (2004)
  • Board Certification: Orthopaedic Surgery, American Board of Orthopaedic Surgery (2003)
  • Board Certification: Orthoped Surg/Sports Med, American Board of Orthopaedic Surgery (2007)
  • Medical Education:Georgetown University Hospital (1995) DC
  • MD, Georgetown University, Medicine, Magna Cum Laude (1995)

Research & Scholarship

Current Research and Scholarly Interests


Athlete's shoulder: Dynamic open MRI evaluation of "peel-back" SLAP lesions of the shoulder.

Elbow MCL: Biomechanical comparison of two techniques for reconstruction of the elbow MCL with palmaris autograft.

Athlete's knee articular cartilage: Investigation of articular cartilage replacement techniques

Scaphoid fractures: CT and arthroscopic study of effect of pronation-supination on scaphoid fractures. Also investigating placement of percutaneous screw fixation of screw.

Elbow arthroscopy: Arthroscopy lab set up in Anatomy building (both wrist and elbow). Looking at lateral ligament complex of the elbow and its role in stability.

Rotator cuff: Rabbit study in which massive rotator cuff tears are simulated and grafted with either fascia lata alone, or fascia lata with a deltoid flap procedure. Histological and Biomechanical analysis of specimens at 3 and 6 months post-operatively.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Biomechanical Evaluation of a Novel Reverse Coracoacromial Ligament Reconstruction for Acromioclavicular Joint Separation AMERICAN JOURNAL OF SPORTS MEDICINE Shu, B., Johnston, T., Lindsey, D. P., McAdams, T. R. 2012; 40 (2): 440-446

    Abstract

    Enhancing anterior-posterior (AP) stability in acromioclavicular (AC) reconstruction may be advantageous.To compare the initial stability of AC reconstructions with and without augmentation by either (1) a novel "reverse" coracoacromial (CA) ligament transfer or (2) an intramedullary AC tendon graft.Reverse CA transfer will improve AP stability compared with isolated coracoclavicular (CC) reconstruction.Controlled laboratory study.Six matched pairs of cadaveric shoulders underwent distal clavicle resection and CC reconstruction. Displacement (mm) was measured during cyclic loading along AP (±25 N) and superior-inferior (SI; 10-N compression, 70-N tension) axes. Pairs were randomized to receive each augmentation and the same loading protocol applied.Reverse CA transfer (3.71 ± 1.3 mm, standard error of the mean [SEM]; P = .03) and intramedullary graft (3.41 ± 1.1 mm; P = .03) decreased AP translation compared with CC reconstruction alone. The SI displacement did not differ. Equivalence tests suggest no difference between augmentations in AP or SI restraint.Addition of either reverse CA transfer or intramedullary graft demonstrates improved AP restraint and provides similar SI stability compared with isolated CC reconstruction.Reverse CA ligament transfer may be a reasonable alternative to a free tendon graft to augment AP restraint in AC reconstruction.

    View details for DOI 10.1177/0363546511426099

    View details for Web of Science ID 000299781300024

    View details for PubMedID 22085727

  • An anatomic study of the coracoid process as it relates to bone transfer procedures JOURNAL OF SHOULDER AND ELBOW SURGERY Dolan, C. M., Hariri, S., Hart, N. D., McAdams, T. R. 2011; 20 (3): 497-501

    Abstract

    The Latarjet and Bristow procedures address recurrent anterior shoulder instability in the context of a significant bony defect. However, the bony and soft tissue anatomy of the coracoid as they relate to coracoid transfer procedures has not yet been defined. The purpose of this study was to describe the soft tissue attachments of the coracoid as they relate to the bony anatomy and to define the average amount of bone available for use in coracoid transfer.Ten paired fresh frozen shoulders from deceased donors were dissected, exposing the coracoid, lateral clavicle, and acromion, along with the coracoid soft tissue attachments. The bony dimensions of the coracoid and the locations and sizes of the soft tissue footprints of the coracoid were measured.The mean maximum length of the coracoid available for transfer (ie, distance from the coracoid tip to the anterior border of the coracoclavicular ligament) was 28.5 mm. The mean distance from the coracoid tip to the anterior pectoralis minor was 4.6 mm, to the posterior pectoralis minor was 17.7 mm, to the anterior coracoacromial ligament was 7.8 mm, and to the posterior coracoacromial ligament was 25.7 mm.Average dimensions of the bony coracoid and average locations and sizes of coracoid soft tissue footprints are provided. This anatomic description of the coracoid bony anatomy and its soft tissue insertions allows surgeons to correlate the location of their coracoid osteotomy with the soft tissue implications of the coracoid transfer as the native anatomy is manipulated in these nonanatomic procedures.

    View details for DOI 10.1016/j.jse.2010.08.015

    View details for Web of Science ID 000289888400032

    View details for PubMedID 21106399

  • Arthroscopic repair of the scapholunate interosseous ligament. Techniques in hand & upper extremity surgery Stuffmann, E. S., McAdams, T. R., Shah, R. P., Yao, J. 2010; 14 (4): 204-208

    Abstract

    Scapholunate injuries are the most frequent of the intercarpal ligament injuries in the wrist. Current repair methods generally involve an open approach the dorsal capsule of the wrist. Arthroscopic repair of the dorsal portion of the scapholunate interosseus ligament would carry the advantages of less stiffness and would preserve the important dorsal capsular stabilizers. In the development of this technique, we first sought to determine the anatomic location and accessibility of the dorsal scapholunate ligament and the site in which a suture anchor would be placed. Ten fresh-frozen cadaver limbs were used. With the arthroscope in the 4 to 5 portal, the most dorsal portion of the SLIL was visualized in each specimen. K-wires were inserted through the 3 to 4 portal into the scaphoid adjacent to most distal portion of the dSLIL visualized. All limbs were dissected and the location of the wires relative to the prominence on the scaphoid directly adjacent to the central portion of the dSLIL was measured. The location of the prominence relative to the dSLIL was studied through magnified photography of a stained section of a cadaveric scaphoid. The mean distance of these wires distal to the center of the dSLIL is presented. Then the technique of arthroscopic repair of the dSLIL was developed using additional cadaveric wrist specimens. The technique is described.

    View details for DOI 10.1097/BTH.0b013e3181df0a93

    View details for PubMedID 21107214

  • Nerve Injuries About the Elbow CLINICS IN SPORTS MEDICINE Hariri, S., McAdams, T. R. 2010; 29 (4): 655-?

    Abstract

    The ulnar, radial, median, medial antebrachial cutaneous, and lateral antebrachial cutaneous nerves are subject to traction and compression in athletes who place forceful, repetitive stresses across their elbow joint. Throwing athletes are at greatest risk, and cubital tunnel syndrome (involving the ulnar nerve) is clearly the most common neuropathy about the elbow. The anatomy and innervation pattern of the nerve involved determines the characteristic of the neuropathy syndrome. The most important parts of the work-up are the history and physical examination as electrodiagnostic testing and imaging are often not reliable. In general, active rest is the first line of treatment. Tailoring the surgery and rehabilitation protocol according to the functional requirements of that athlete's sport(s) can help optimize the operative outcomes for recalcitrant cases.

    View details for DOI 10.1016/j.csm.2010.06.001

    View details for Web of Science ID 000283562000010

    View details for PubMedID 20883903

  • Arthroscopic Treatment of Triangular Fibrocartilage Wrist Injuries in the Athlete AMERICAN JOURNAL OF SPORTS MEDICINE McAdams, T. R., Swan, J., Yao, J. 2009; 37 (2): 291-297

    Abstract

    Triangular fibrocartilage (TFC) injuries are an increasingly recognized cause of ulnar-sided wrist pain and can be particularly disabling in the competitive athlete. Previous studies show that arthroscopic debridement or repair can improve symptoms, but the results of arthroscopic treatment of TFC injuries in high-level athletes have not yet been reported.Arthroscopic debridement or repair of wrist TFC injury will allow a high rate of return to full function in the elite athlete.Case series; Level of evidence, 4.Between 2001 and 2005, 16 competitive athletes (mean age, 23.4 years) with wrist TFC injuries underwent arthroscopic surgery. Repair was performed in unstable tears, and all others underwent debridement alone. Presurgery and post-surgery mini-DASH (Disabilities of the Arm, Shoulder, and Hand) scores were recorded for each athlete through medical record review and clinical evaluation. The mean duration of follow-up was 32.8 months (range, 24-51 months).The TFC was repaired in 11 (68.8%) and debrided in 5 (31.3%) patients. The tear was ulnar-sided in 12 (75%), radial-sided in 2 (12.5%), combined radial-ulnar in 1, and central-sided in 1 patient. Mean mini-DASH scores improved from 47.3 (range, 25-65.9) to 0 (all patients) (P = .002), and the mean mini-DASH sports module improved from 79.7 (range, 68.8-100) to 1.95 (range, 0-18.8) (P = .002). Return to play averaged 3.3 months (range, 3-7 months). Associated conditions in the 2 patients unable to return to play at 3 months were distal radioulnar joint (DRUJ) instability with ulnar-carpal abutment (n = 1) and extensor carpi ulnaris (ECU) tendinosis (n = 1).Arthroscopic debridement or repair of wrist TFC injury provides predictable pain relief and return to play in competitive athletes. Return to play may be delayed in athletes with concomitant ulnar-sided wrist injuries.

    View details for DOI 10.1177/0363546508325921

    View details for Web of Science ID 000262954200008

    View details for PubMedID 19059892

  • An analysis of four ulnar collateral ligament reconstruction procedures with cyclic valgus loading JOURNAL OF SHOULDER AND ELBOW SURGERY Shah, R. P., Lindsey, D. P., Sungar, G. W., McAdams, T. R. 2009; 18 (1): 58-63

    Abstract

    We describe a new transolecranon fossa ulnar (TOFU) collateral ligament reconstruction technique and compare its response to cyclic valgus loading with the Jobe, Docking, and DANE procedures. TOFU is an arthroscopically assisted, modified all-interference screw technique. A cyclic valgus moment was applied to 32 intact and reconstructed, unembalmed elbows. Valgus angles were measured at 1, 10, 100, and 1000 cycles. At all cycles, there was no difference between intact and TOFU-treated elbows. TOFU resulted in significantly smaller angles than DANE at cycles 10, 100, and 1000; Docking at cycle 1000; and Jobe at cycles 10, 100, and 1000. The TOFU procedure shows superior resistance to valgus loading than DANE and Jobe by cycle 10, and Docking by cycle 1000. Further study is needed to evaluate the clinical value of the TOFU procedure as an arthroscopically assisted technique.

    View details for DOI 10.1016/j.jse.2008.06.011

    View details for Web of Science ID 000262050300010

    View details for PubMedID 19095176

  • Articular Cartilage Injury in the Athlete Clin Sports Med Kai Mithoefer, Timothy R McAdams, Bert Mandelbaum 2009; 28 (1): 25-40
  • Tibial aperture bone disruption after retrograde versus antegrade tibial tunnel drilling: a cadaveric study KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY McAdams, T. R., Biswal, S., Stevens, K. J., Beaulieu, C. F., Mandelbaum, B. R. 2008; 16 (9): 818-822

    Abstract

    The purpose of this study is to compare the local microfracture effects of antegrade versus retrograde drilling of the tibial tunnel in ACL reconstruction. Arthroscopic ACL excision was performed on eight matched cadaveric knees. Arthroscopic guided tibial tunnel reaming was performed in either an antegrade (four) or retrograde (four) direction. A 3 x 3 cm section of proximal tibial surrounding the tibial aperture was removed with open dissection, and each section underwent micro-computed tomography analysis. Three musculoskeletal radiologists graded the specimens for bone aperture disruption and discrete fracture lines. Tibial aperture irregularity was seen in all four of the antegrade specimens (mean, Grade 1.5), and in none of the retrograde specimens. Discrete fracture lines were present in all four antegrade specimens (mean 10.13 mm depth; 8.95 mm length). No fracture lines were seen in the retrograde group. Retrograde drilling of the tibial tunnel in ACL reconstruction results in less microfracture trauma to the surrounding aperture bone. The use of retrograde drilling in ACL reconstruction may decrease synovialization of the graft-tissue interface when compared to antegrade drilling.

    View details for DOI 10.1007/s00167-008-0554-6

    View details for Web of Science ID 000258718100004

    View details for PubMedID 18516594

  • Surgical decompression of the quadrilateral space in overhead athletes AMERICAN JOURNAL OF SPORTS MEDICINE McAdams, T. R., Dillingham, M. F. 2008; 36 (3): 528-532

    Abstract

    Quadrilateral space syndrome is an uncommon condition that can disable the overhead athlete. The authors describe 4 cases of quadrilateral space syndrome that may assist clinicians in recognition of this problem in patients with posterior shoulder pain.Quadrilateral space syndrome can present as posterior shoulder pain in the overhead athlete, and surgical decompression can relieve symptoms and allow full return to activity.Case series; Level of evidence, 4.Between 2004 and 2006, the authors performed surgical decompression of the quadrilateral space in 4 overhead athletes (4 shoulders; mean age, 24 years). They evaluated the clinical presentations, diagnostic tests, surgical procedures, and results of treatment. Mean follow-up was 24.5 months.All 4 patients underwent surgical decompression of the quadrilateral space. Fibrous bands entrapped the axillary nerve in 3 shoulders, and venous dilation was found in the fourth shoulder. All patients returned to full activity without pain or limitation of overhead function 12 weeks after surgery.Quadrilateral space syndrome is an uncommon cause of posterior shoulder pain that is easily overlooked and can severely limit overhead function in the athlete. Surgical decompression can predictably relieve pain and improve function in patients who do not respond to nonoperative regimens.

    View details for DOI 10.1177/0363546507309675

    View details for Web of Science ID 000253374000013

    View details for PubMedID 18055916

  • Articular cartilage regeneration in the knee Current Opinions in Orthopaedics McAdams TR, Mandelbaum BR 2008; 19: 37-43
  • Deltoid flap combined with fascia lata autograft for rotator cuff defects: a histologic study KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY McAdams, T. R., Knudsen, K. R., Yalamanchi, N., Chang, J., Goodman, S. B. 2007; 15 (9): 1144-1149

    Abstract

    The purpose of this study was to compare the histological characteristics of an autogenous fascia lata graft alone and a fascia lata graft combined with a deltoid flap in the reconstruction of rotator cuff tears. Ten New Zealand white rabbits were divided into two groups. Infraspinatus tendon defects (1 x 1 cm) were created in each animal. Reconstruction consisted of either a fascia lata graft alone or a fascia lata graft combined with a distally based deltoid flap. At 3 months, tissue harvest and histological analysis was performed. Compared to the fascia lata graft alone, there was significantly increased remodeling activity and neovascularization in the group that included a deltoid flap. Also, there was pronounced interdigitation at the graft/flap interface in the latter group. A mutually beneficial relationship may exist when an autogenous fascial graft is combined with a functional deltoid flap for reconstructing large rotator cuff defects.

    View details for DOI 10.1007/s00167-006-0281-9

    View details for Web of Science ID 000249212700015

    View details for PubMedID 17279424

  • Abduction and external rotation in shoulder impingement: An open MR study on healthy volunteers - Initial experience RADIOLOGY Gold, G. E., Pappas, G. P., Blemker, S. S., Whalen, S. T., Campbell, G., McAdams, T. A., Beaulieu, C. F. 2007; 244 (3): 815-822

    Abstract

    To prospectively evaluate rotator cuff contact with the glenoid in healthy volunteers placed in the unloaded and loaded abduction and external rotation (ABER) positions in an open magnetic resonance (MR) imager.The study was institutional review board approved and HIPAA compliant, and informed consent was received. Eight male volunteers with no history of shoulder pain or pathology were imaged in a 0.5-T open MR imager. Volunteers were imaged in an unloaded ABER position with the arm at 90 degrees abduction and in a loaded ABER position, with a 1-kg load that produced an average external rotation of 111 degrees+/-6 (standard deviation). Two radiologists graded rotator cuff contact on a three-point scale. Three-dimensional anatomic models generated from the MR images were used to measure distances. Minimum distances were computed between the tendon insertion sites and the glenoid, acromion, and coracoid for the loaded ABER position. Minimum distances were compared by using a paired Student t test.In the unloaded ABER position, contact was seen between the infraspinatus and supraspinatus tendons and the glenoid in all eight volunteers. In the loaded ABER position, contact was also observed between the infraspinatus and supraspinatus and the posterior and posterosuperior glenoid, respectively. Deformation of the infraspinatus on the glenoid was seen in four volunteers, whereas supraspinatus deformation was only seen in one volunteer. The minimum distance between the supraspinatus insertion and acromion in the loaded ABER position decreased significantly (P<.01). Supraspinatus tendon to glenoid and infraspinatus tendon to glenoid minimum distances also decreased significantly (P<.01).The unloaded and loaded ABER positions resulted in contact of the supraspinatus and infraspinatus with the glenoid in all volunteers. Distances between the rotator cuff insertion sites and the glenoid decreased in the loaded ABER position.

    View details for DOI 10.1148/radiol.2443060998

    View details for Web of Science ID 000248993500021

    View details for PubMedID 17690321

  • Two ulnar collateral ligament reconstruction methods: The docking technique versus bioabsorbable interference screw fixation - A biomechanical evaluation with cyclic loading JOURNAL OF SHOULDER AND ELBOW SURGERY McAdams, T. R., Lee, A. T., Centeno, J., Giori, N. J., Lindsey, D. P. 2007; 16 (2): 224-228

    Abstract

    We compared the effects of cyclic valgus loading on 2 techniques for reconstruction of the elbow ulnar collateral ligament (UCL): the docking procedure and the bioabsorbable interference screw procedure. A cyclic valgus load was applied to the 16 unembalmed elbows, and the valgus angle was measured at 1, 10, 100, and 1000 cycles. Testing was repeated after UCL palmaris tendon reconstruction via either the docking technique or bioabsorbable interference screw fixation. At cycle 1, the valgus angle was not different between treated and intact cases. At cycles 10 and 100, the valgus angle for the docking technique was significantly greater than that for both the intact cases and the interference screw technique. By the 1000th cycle, no difference was measured between the 2 techniques. In this study, bioabsorbable interference screw fixation resulted in less valgus angle widening in response to early cyclic valgus load as compared with the docking technique.

    View details for DOI 10.1016/j.jse.2005.12.012

    View details for Web of Science ID 000245426200016

    View details for PubMedID 17254812

  • Ligament and tendon injury to the elbow: clinical, surgical, and imaging features. Topics in magnetic resonance imaging Saliman, J. D., Beaulieu, C. F., McAdams, T. R. 2006; 17 (5): 327-336

    Abstract

    Significant advances in the understanding of elbow anatomy, biomechanics, imaging, and surgical technique have been made over the last decade. Tendon injuries are often seen in athletes and physical laborers from repetitive eccentric overload. Ligament injuries are commonly seen in throwing athletes or after elbow dislocation. Magnetic resonance imaging has proven valuable for diagnosing and monitoring most of these soft tissue injuries, and effective surgical techniques have evolved to address them. This article describes typical clinical findings associated with ligament and tendon injuries in the elbow as well as common surgical therapies. The use of magnetic resonance imaging is highlighted throughout because this modality has revolutionized noninvasive evaluation of the elbow.

    View details for PubMedID 17414994

  • Injury to the deep motor branch of the ulnar nerve during hook of hamate excision ORTHOPEDICS Fredericson, M., Kim, B., Date, E. S., McAdams, T. R. 2006; 29 (5): 456-458

    View details for Web of Science ID 000237773300015

    View details for PubMedID 16729750

  • In vivo anatomy of the Neer and Hawkins sign positions for shoulder impingement JOURNAL OF SHOULDER AND ELBOW SURGERY Pappas, G. P., Blemker, S. S., Beaulieu, C. F., McAdams, T. R., Whalen, S. T., Gold, G. E. 2006; 15 (1): 40-49

    Abstract

    The Neer and Hawkins impingement signs are commonly used to diagnose subacromial pathology, but the anatomy of these maneuvers has not been well elucidated in vivo. This 3-dimensional open magnetic resonance imaging study characterized shoulder anatomy and rotator cuff impingement in 8 normal volunteers placed in the Neer and Hawkins positions. Subacromial and intraarticular contact of the rotator cuff was graded, and minimum distances were computed between the tendon insertion sites and the glenoid, acromion, and coracoid. Both the Neer and Hawkins maneuvers significantly decreased the distance from the supraspinatus insertion to the acromion and posterior glenoid and from the subscapularis insertion to the anterior glenoid. However, the Hawkins position resulted in significantly greater subacromial space narrowing and subacromial rotator cuff contact than the Neer position. In the Hawkins position, subacromial contact of the supraspinatus and infraspinatus was observed in 7 of 8 and 5 of 8 subjects, respectively. In contrast, rotator cuff contact with the acromion did not occur in any subject in the Neer position. Intraarticular contact of the supraspinatus with the posterosuperior glenoid was observed in all subjects in both positions. Subscapularis contact with the anterior glenoid was also seen in 7 of 8 subjects in the Neer position and in all subjects in the Hawkins position. This extensive intraarticular contact suggests that internal impingement may play a role in the Neer and Hawkins signs.

    View details for DOI 10.1016/j.jse.2005.04.007

    View details for Web of Science ID 000234868300008

    View details for PubMedID 16414467

  • Acute compartment syndrome of the thigh in a football athlete - A case report and the role of the vacuum-assisted wound closure dressing JOURNAL OF ORTHOPAEDIC TRAUMA Lee, A. T., Fanton, G. S., McAdams, T. R. 2005; 19 (10): 748-750

    Abstract

    We present a case of compartment syndrome of the thigh due to blunt injury in a Division I American football player managed with fasciotomy and vacuum-assisted wound closure. This case report discusses the vacuum-assisted wound closure dressing as an alternative to more traditional closure techniques such as suture retention devices and split-thickness skin grafting. We feel that any surgeon involved in performing fasciotomies should be familiar with this increasingly used closure device and its potential complications.

    View details for Web of Science ID 000233682100012

    View details for PubMedID 16314725

  • The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability JOURNAL OF SHOULDER AND ELBOW SURGERY McAdams, T. R., Masters, G. W., Srivastava, S. 2005; 14 (3): 298-301

    Abstract

    This study evaluates the relative roles of the radial collateral ligament, the lateral ulnar collateral ligament, and the overlying musculature in posterolateral rotatory instability of the elbow. Fourteen cadaveric upper limbs underwent sequential arthroscopic sectioning of the lateral collateral ligament complex. After sectioning, arthroscopic and fluoroscopic evaluation of a lateral pivot shift test was done. Minimal instability was noted after the first section, but no difference between radial collateral or lateral ulnar collateral ligament sectioning was found. A greater degree of instability was seen between the first and second cut ( P = .0001), but no significant difference was seen between sectioning the 2 groups ( P = .61). Complete instability occurred only after sectioning the overlying musculature. On the basis of this study, injury to both the radial collateral and lateral ulnar collateral ligaments is necessary to cause significant posterolateral rotatory instability of the elbow. Furthermore, the overlying musculature plays an important role in overall stability.

    View details for DOI 10.1016/j.jse.2004.08.003

    View details for Web of Science ID 000229244200011

    View details for PubMedID 15889029

  • CT angiography in complex upper extremity reconstruction JOURNAL OF HAND SURGERY-BRITISH AND EUROPEAN VOLUME Bogdan, M. A., Klein, M. B., Rubin, G. D., McAdams, T. R., Chang, J. 2004; 29B (5): 465-469

    Abstract

    Computed tomography angiography is a new technique that provides high-resolution, three-dimensional vascular imaging as well as excellent bone and soft tissue spatial relationships. The purpose of this study was to examine the use of computed tomography angiography in planning upper extremity reconstruction. Seventeen computed tomography angiograms were obtained in 14 patients over a 20-month period. All studies were obtained on an outpatient basis with contrast administered through a peripheral vein. All the studies demonstrated the pertinent anatomy and the intraoperative findings were as demonstrated in all cases. Information from two studies significantly altered pre-operative planning. The average charge for computed tomography angiography was 1,140 dollars, compared to 3,900 dollars for traditional angiography.

    View details for DOI 10.1016/j.jhsb.2004.04.006

    View details for Web of Science ID 000224045800011

  • Arthroscopic evaluation of scaphoid waist fracture stability and the role of the radioscaphocapitate ligament ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY McAdams, T. R., Srivastava, S. 2004; 20 (2): 152-157

    Abstract

    The purpose of this article is to arthroscopically evaluate the effect of forearm rotation on scaphoid fracture displacement and the impact of intra-articular ligament sectioning.Controlled laboratory study.Scaphoid fracture stability is studied arthroscopically in 10 cadaveric upper limbs. Displacement of the osteotomized scaphoid with and without forearm rotation is arthroscopically evaluated before and after radioscaphocapitate (RSC) ligament sectioning.No rotation at the fracture site was identified in full pronation and full supination with the wrist immobilized. With the RSC ligament intact, no immobilization, and the wrist fully pronated, 25% of scaphoid fractures rotated less than 1 mm, 62.5% rotated 1 to 2 mm, and 12.5% rotated more than 2 mm. After sectioning the RSC ligament, the fully pronated wrist resulted in rotation of less than 1 mm in 75% and 1 to 2 mm in 25%. No rotation at the fracture site was seen with supination, with or without immobilization. No difference was found between loaded and unloaded trials.Based on this observational data, it appears safe to use a below-elbow thumb spica cast in the treatment of minimally displaced scaphoid waist fractures. Sectioning of the RSC ligament resulted in reduced amount of rotation at the scaphoid waist fracture; thus the RSC ligament may be a deforming force rather than a stabilizing force in scaphoid waist fractures. Arthroscopy may be a valuable tool in the study of the effect of ligament sectioning on fracture stability.

    View details for DOI 10.1016/j.arthro.2003.11.023

    View details for Web of Science ID 000220090600006

    View details for PubMedID 14760347

  • Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques. journal of hand surgery Chan, K. W., McAdams, T. R. 2004; 29 (1): 74-79

    Abstract

    Percutaneous screw fixation of acute minimally displaced scaphoid fractures is an attractive treatment alternative compared with cast immobilization and can be performed with either a distal/volar or proximal/dorsal approach. Central screw placement within the scaphoid appears to be an important factor for successful fixation. The purpose of this cadaveric study is to investigate whether the proximal or distal approach for percutaneous screw scaphoid fixation allows for more central placement of the screw.Twelve fresh frozen cadaveric upper limbs were studied, with 6 specimens assigned to scaphoid screw placement with a proximal approach and 6 matched specimens assigned to scaphoid screw placement with a distal approach. After screw placement, the scaphoid was sectioned evenly into quarters along the longitudinal proximal-distal axis. For each section, the distance from the center of the screw hole to the edges of the dorsal/volar/radial/ulnar axes was measured, and the means of the 2 groups were compared with a Hotelling's T(2) test to determine statistically significant central screw placement.A statistically significant difference was found between the mean location of the distal fixation group and the center of the scaphoid in the midwaist and distal pole of the scaphoid (p =.007 and.012, respectively) and between the mean location of the proximal and distal fixation groups in the distal pole of the scaphoid (p =.045).We find that the proximal/dorsal approach to the percutaneous screw fixation of scaphoid waist fractures allows for a more central placement in the distal pole, but there is no significant difference when it is used in the proximal or waist region. It remains unclear whether the more central screw placement afforded by the proximal approach might translate into an improved clinical outcome.

    View details for PubMedID 14751108

  • Magnetic resonance imaging in diagnosis of chronic posterolateral rotatory instability of the elbow. American journal of orthopedics (Belle Mead, N.J.) Grafe, M. W., McAdams, T. R., Beaulieu, C. F., Ladd, A. L. 2003; 32 (10): 501-503

    Abstract

    Posterolateral rotatory instability of the elbow can be difficult to diagnose and requires a high degree of clinical suspicion. Cases of chronic posterolateral rotatory instability (symptoms present more than 1 year) may be an even more perplexing subgroup. This is a case report of a patient with a 30-year history of intermittent elbow instability. Clinical examination was equivocal, and magnetic resonance imaging was unable to define any ligamentous injury around the elbow. Examination under anesthesia and surgical findings were consistent with complete disruption of the lateral ulnar collateral ligament. The 12-month follow-up after surgical reconstruction showed complete resolution of symptoms. Posterolateral rotatory instability is a diagnosis largely made by examination under anesthesia. A thorough history and a high clinical suspicion are necessary to support the physician's decision to place the patient under anesthesia. Confirmation of a chronic tear of the lateral ulnar collateral ligament of the elbow with magnetic resonance imaging can be difficult and sometimes misleading.

    View details for PubMedID 14620091

  • Improving resident work environment: Evaluation of a novel cooperative program SURGERY Curet, M. J., McAdams, T. R. 2003; 134 (2): 158-163

    Abstract

    Improving the resident work environment is a major concern for surgery faculty. This study evaluated the ability of a cooperative program with nurses and interns to decrease the number of nonurgent pages and consistently generate a 4-hour block of time at night without nonurgent pages.Multiple discussions with interns and with nurses on 2 nursing floors identified ways to improve nurse/resident communication. These included use of a notebook by nurses to record nonurgent issues and having on-call interns check with the night nurses after night shift report. For the week before and after institution of the program, interns logged each page received. Pretest and posttest data were compared by use of t testing.Interns logged fewer pages after intervention compared with preintervention (P <.01). In addition, the interns had a 4-hour block of time on call nights without pages more frequently during the posttest period (100% vs 25%, P <.01). The percent of necessary calls increased from 50% to 70% during day shifts (P <.01).A cooperative program that focused on decreasing nonurgent pages and maximizing efficient communication led to a decrease in the number of nonurgent pages received by interns and increased the number of call nights in which a 4-hour block of sleep or study time was generated, thereby improving residents' work environment.

    View details for DOI 10.1067/msy.2003.266

    View details for Web of Science ID 000185184900008

    View details for PubMedID 12947313

  • The effect of pronation and supination on the minimally displaced scaphoid fracture CLINICAL ORTHOPAEDICS AND RELATED RESEARCH McAdams, T. R., Spisak, S., Beaulieu, C. F., Ladd, A. L. 2003: 255-259

    Abstract

    The amount of rotation that occurs at the scaphoid waist fracture site with pronation and supination of the forearm is studied in 10 upper extremities from cadavers. Two colinear metal markers were placed in the osteotomized scaphoid and a below-the-elbow cast was applied. Spiral volumetric computed tomography scanning of the scaphoid was done with multiplanar reformation to evaluate displacement of the metal markers. Four of the 10 specimens also were studied without any immobilization. The total magnitude of motion from pronation to supination averaged 0.2 mm in the specimens with a below-the-elbow thumb spica cast, and 2.4 mm in specimens without immobilization. The current study showed no significant rotation at the minimally displaced scaphoid waist fracture site during pronation and supination in a below-the-elbow cast. Furthermore, there is unacceptable rotation at the fracture site in the absence of a cast. Based on this study, a below-the-elbow thumb spica cast seems adequate for fracture immobilization; however, clinical correlation is needed.

    View details for DOI 10.1097/01.blo.0000069886.31220.86

    View details for Web of Science ID 000183379000030

    View details for PubMedID 12782882

  • Injury to the dorsal sensory branch of the ulnar nerve in the arthroscopic repair of ulnar-sided triangular fibrocartilage tears using an inside-out technique: a cadaver study. journal of hand surgery McAdams, T. R., Hentz, V. R. 2002; 27 (5): 840-844

    Abstract

    This anatomic study of the commonly described inside-out Tuohy needle technique was performed to better define the course of needle passage relative to the anatomic structures in this region including the dorsal sensory branch of the ulnar nerve (DBUN) and extensor carpi ulnaris (ECU) tendon. Ten fresh-frozen cadaver specimens had arthroscopic-guided passage of a Tuohy needle through the triangular fibrocartilage (TFC). Dissection of the ulnar side of the wrist was performed and various measurements were recorded. The average minimum distance between suture A (the suture closest to the nerve) and the DBUN was 1.9 mm. The average minimum distance between suture B and the DBUN was 2.7 mm. The distance between the 2 sutures at the level of the capsule averaged 6.2 mm. The distance between the DBUN and the ECU averaged 7.2 mm. In 5 of 10 specimens the sutures exited on opposite sides of the DBUN. The DBUN is variable in its course but in every case it passes in close proximity to the sutures that exit the ulnar side of the wrist in arthroscopic repair of ulnar-sided TFC tears.

    View details for PubMedID 12239674

  • Long-term follow-up of surgical release of the A(1) pulley in childhood trigger thumb JOURNAL OF PEDIATRIC ORTHOPAEDICS McAdams, T. R., Moneim, M. S., Omer, G. E. 2002; 22 (1): 41-43

    Abstract

    Trigger thumb is an uncommon problem in infants and children. The authors reexamined 21 patients (30 thumbs) who underwent a release procedure, with an average follow-up of 181.3 months (15.1 years). Twenty-three percent of patients had a loss of interphalangeal motion and 17.6% had metacarpal phalangeal hyperextension, and this was unrelated to age at the time of surgery. There was no recurrence of triggering or nodules and no functional deficit. All seven patients who had a longitudinal incision had concerns about their scar appearance. It is the authors' belief that a transverse skin incision and surgical release of the A(1) pulley for trigger thumb in children is a successful procedure even when done after age 3, but interphalangeal motion loss and metacarpal phalangeal hyperextension may occur in the long term.

    View details for Web of Science ID 000172965800010

    View details for PubMedID 11744852

  • The role of plain films and computed tomography in the evaluation of scapular neck fractures JOURNAL OF ORTHOPAEDIC TRAUMA McAdams, T. R., Blevins, F. T., Martin, T. P., DeCoster, T. A. 2002; 16 (1): 7-11

    Abstract

    To assess the ability of plain films and computed tomography scans to show the pattern, displacement, and angulation of scapular neck fractures. To assess the ability of computed tomography to identify concomitant occult shoulder injuries.Masked retrospective radiographic review.Level I trauma center.Three orthopaedic surgeons (two attending physicians and one senior resident) and one musculoskeletal radiology attending physician reviewed the imaging studies of scapula neck fractures in twenty patients treated at our institution.Kappa analysis of agreement of fracture characteristics and benefits of computed tomography for scapular neck fractures.The mean weighted kappa coefficient for interobserver reliability of fracture displacement was 0.49 when the fractures were assessed by plain films alone, 0.15 when they were assessed by computed tomography scans alone, and 0.35 when they were assessed by plain films and computed tomography scans. The mean weighted kappa coefficients for fracture angulation were 0.30, 0.23, and 0.16, respectively. The mean simple kappa coefficients for fracture classification were 0.81, 0.20, and 0.33, respectively. Concomitant injury to the superior shoulder suspensory complex was seen in 57 percent of cases, including nine clavicle fractures, one coracoid fracture, and three acromion process fractures. The coracoid fracture and two of the acromion process fractures were minimally displaced and seen on computed tomography scans only.Scapular neck fracture displacement, angulation, and anatomic classification showed moderate interobserver reliability by plain films but were not enhanced by computed tomography. Computed tomography confused, rather than clarified, the assessment of these characteristics. Computed tomography may be useful to identify associated injuries to the superior shoulder suspensory complex, which can be missed by plain films alone. Routine computed tomography in patients with scapular neck fractures cannot be recommended based on this study. Computed tomography of scapular neck fractures may be useful in selected cases in which intraarticular extension is noted on plain films.

    View details for Web of Science ID 000173006300002

    View details for PubMedID 11782625

  • Frostbite: an orthopedic perspective. American journal of orthopedics (Belle Mead, N.J.) McAdams, T. R., Swenson, D. R., MILLER, R. A. 1999; 28 (1): 21-26

    Abstract

    Frostbite injury to the extremities has the potential for disastrous effects. This review provides information valuable to the orthopedic surgeon to aid in the evaluation and treatment of frostbite. The pathophysiology and predisposing factors that provide a basic understanding of the nature of frostbite are discussed. Accepted and experimental imaging studies and treatment options are also reviewed. An effort is made to give the orthopedic perspective on each issue, providing a valuable resource for all orthopedic surgeons involved in the care of the patient with frostbite.

    View details for PubMedID 10048354

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