3,521 research outputs found
Shoulder pain in general practice
Case scenario
A 65 year old gentleman presented with a 1 week history of pain in the left shoulder. Pain started after spending 2 days painting his house. He was taking paracetamol regularly yet it only gave him minor relief. On examination he had a painful arch and was tender under the acromium.peer-reviewe
Revision of reversed shoulder arthroplasty : is a reoperation possible?
Introduction. As the number of reversed shoulder arthroplasty (RSA) procedures increases, the revision rate will also increase. In case of severe bone insufficiency, instability or infection of the primary RSA, revision to another RSA is preferable but not always possible. Hemiarthroplasty (HA), spacers and resection arthroplasty (RA) have been described in this indication.
Materials and methods. Between 2004 and 2016, 20 shoulders in 19 patientswere treated at Ghent University Hospital for failed revision of RSA. Nine received a megahead prosthesis, a spacerwas implanted in 6, and 5 underwent RA.
Results. Indications for implantation of a megahead prosthesis were loosening RSA (n = 5), infection (n = 4), dislocation (n = 1) and nerve irritation (n = 1). Improvement of range ofmotionwas observed. Anterosuperior migration of the prosthesis was noted in 2 patients. Another 2 patients were ultimately revised to RSA. Seven permanent spacerswere implanted for infection, of which 2 remain in place till today. The other 5 were revised to RSA. Of the 5 patients treated with RA, 3 were revised further on to RSA, resulting in pain relief and regain of function. Discussion. Our study shows that amegahead prosthesis has better functional results than RA, but is inferior to RSA. Due to increasing surgical experience and improving technique, 9 patients could ultimately be reconverted to another RSA. A review of current literature is presented. In HA and RA, the functional results are poor, and pain relief is uncertain. Results of spacers are variable and can be satisfactory. Arthrodesis is a last resort.
Conclusion. In our case series study, a hemiarthroplasty can be performed in case of failure of RSA. However, the results are inferior to another RSA
Helical mutations in type I collagen that affect the processing of the amino-propeptide result in an Osteogenesis Imperfecta/Ehlers-Danlos Syndrome overlap syndrome
Background: Whereas mutations affecting the helical domain of type I procollagen classically cause Osteogenesis Imperfecta (OI), helical mutations near the amino (N)-proteinase cleavage site have been suggested to result in a mixed OI/Ehlers-Danlos syndrome (EDS)-phenotype.
Methods: We performed biochemical and molecular analysis of type I (pro-) collagen in a cohort of seven patients referred with a clinical diagnosis of EDS and showing only subtle signs of OI. Transmission electron microscopy of the dermis was available for one patient.
Results: All of these patients harboured a COL1A1 / COL1A2 mutation residing within the most N-terminal part of the type I collagen helix. These mutations affect the rate of type I collagen N-propeptide cleavage and disturb normal collagen fibrillogenesis. Importantly, patients with this type of mutation do not show a typical OI phenotype but mainly present as EDS patients displaying severe joint hyperlaxity, soft and hyperextensible skin, abnormal wound healing, easy bruising, and sometimes signs of arterial fragility. In addition, they show subtle signs of OI including blue sclerae, relatively short stature and osteopenia or fractures.
Conclusion: Recognition of this distinct phenotype is important for accurate genetic counselling, clinical management and surveillance, particularly in relation to the potential risk for vascular rupture associated with these mutations. Because these patients present clinical overlap with other EDS subtypes, biochemical collagen analysis is necessary to establish the correct diagnosis
Step-cut, biplanar, elongation and angulation ulnar osteotomy with annular ligament reconstruction in neglected Monteggia fracture dislocation in children: a retrospective study
Monteggia fracture dislocation is an infrequent injury in children, with around 20-50% cases being missed on initial consultation; leading to their chronic and neglected forms leading to number of complications; thus justifying their operative management. Various treatment modalities have been suggested in the literature for these neglected injuries. A retrospective study of 7 patients (5 males and 2 females), with mean age of 9.58 years (7-14 years); with neglected Monteggia fracture dislocation undergoing corrective reconstructive surgery in the form of elongation and angulation proximal ulnar osteotomy with radial head reduction combined with annular ligament reconstruction was conducted and was then evaluated clinically and functionally using Mayo Elbow Performance Index (MEPI) score; and radiographicaly were graded as good, moderate or poor. The mean interval from time of injury to the time to corrective surgery was 10.58 weeks (range 6-16 weeks). The mean improvement in the post operative MEPI score was 23.57. The mean improvement in the post operative flexion-extension arc was 28.57˚, while that in the supination-pronation arc was 20.72˚. We concluded that Step-cut, biplanar, elongation and angulation proximal ulnar osteotomy with additional reinforcement in the form of annular ligament reconstruction is an effective technique to treat neglected Monteggia fracture dislocations in children; having excellent clinical, functional and radiological outcomes
Congenital radial head dislocation with a progressive cubitus valgus: a case report
Congenital dislocation of the radial head is rare, although it is the most common congenital anomaly of the elbow. A concomitant progressive cubitus valgus of the elbow has not previously been described in literature. We describe a case of an 8-year-old girl with an unilateral congenital radial head dislocation with a progressive cubitus valgus of 35°, caused by a prematurely closing physis of the lateral humeral condyle. This might be caused by an increased pressure on the lateral physis by the anteriorly dislocated radial head. As no complaints or limitations were present, treatment was non-operative with clinical observation, with satisfactory results after a follow-up of 18 months. A concomitant progressive cubitus valgus can be present in patients with a congenital radial head dislocation. Non-operative treatment can provide satisfactory results
Occult Interpositional Rotator Cuff - an Extremely Rare Case of Traumatic Rotator Cuff Tear
Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed
Transolecranon fracture-dislocations of the elbow: a case series of 15 patients
Transolecranon fracture-dislocations are rare, misdiagnosed, and challenging traumatic injuries. Consensually, they are managed surgically to restore a mobile, stable and painless elbow joint. There is a relative paucity of studies on this subject in the literature. The purpose of this case series was to establish the epidemiological profile and to describe clinical, radiological, therapeutic and outcome characteristics of these lesions. Between 2007 and 2016, fifteen patients with median age of 36 years (18-65 years) presented to us with transolecranon fracture-dislocations. They were treated surgically and followed regularly with a mean follow-up of 46 months. The cause in the majority of cases was high-energy trauma, mainly traffic accidents (80%). Proximal ulna fractures were comminuted in 12 patients (80%) and open in three cases (25%). Open reduction and internal fixation with 3.5 mm reconstruction plates through a posterior approach was used in all cases. During follow up, one patient (6%) had developed wound infection with skin necrosis which was successfully managed by antibiotics and controlled wound healing. Solid osseous union was confirmed for all fractures with an average of 13.5 weeks. At final follow-up, 14 patients (93%) reported excellent outcome with a mean Broberg and Morrey score (BMS) of 86.3. Although rare, transolecranon fracture-dislocations found in patients hospitalized in a high-complexity service occurred in young men who were involved in motor vehicle accidents. These injuries can be treated successfully with reconstruction plate through a posterior approach to achieve and maintain anatomical reduction by rigid internal fixation, which is essential for promoting early rehabilitation
Upper extremity compartment syndrome after minor trauma: an imperative for increased vigilance for a rare, but limb-threatening complication
BACKGROUND: Compartment syndrome of any extremity is a limb-threatening emergency requiring an emergent surgical management. Thus, ruling out compartment syndrome is often high on the list of priorities when treating high-energy injuries and fractures. However, even in the most seemingly benign injuries, this dangerous diagnosis must always remain on the differential and suspicion must remain high. CASE PRESENTATION: 23-year-old factory worker presents after a low energy entrapment injury to his left forearm. Initial work-up and evaluation noted an isolated radial head dislocation with a normal physical motor and sensory exam. However, maintaining high suspicion for compartment syndrome despite serial normal physical exams, led objective compartment pressure measurement leading to definitive diagnosis. Emergent surgical intervention via compartment fasciotomies was performed, along with closed reduction and ligament repair. At 1 year follow-up, the patient was well-healed, back to work with full range of motion and not activity limitations. CONCLUSION: Despite a seemingly benign injury pattern, and a relatively low energy mechanism, vigilant concern for compartment syndrome following any kind of entrapment injury should initiate serial examinations and compartment pressure measurements especially in circumstances with continued swelling and inability to perform an accurate clinical assessment due to an obtunded or medicated patient
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