Fracture–dislocation of the shoulder and brachial plexus palsy: a terrible association

Primary post-traumatic anterior dislocation of the shoulder with associated fracture of the greater tuberosity and brachial plexus injury is rare and, to our knowledge, has never previously been reported in the literature. We present a case of this unhappy triad in which a brachial plexus injury was diagnosed and treated 3 weeks later. The characteristics of this rare condition are discussed on the basis of our case and the published literature in order to improve early diagnosis and treatment of this lesion

Myofascial syndromes

Myofascial forearm pain can be caused by chronic exertional compartment syndrome of the forearm (CECSf) and forearm splints. These conditions are rare in the general population, however, amongst athletes participating in particular sports they are common. This chapter outlines the pathophysiology, clinical presentation, investigation and treatment of ECSF and forearm splints. Other causes of forearm pain that affect athletes are outside the scope of this chapter and are outlined in Table 9.2.</p

Reliability of the 8 Week Time Point for Single Assessment of Midcarpal Fusion by CT Scan

High rates of nonunion have recently been reported for midcarpal fusions. Due to curvature and overlap of carpal interfaces, two dimensional films are not reliable in determining union of a midcarpal fusion. Computed tomography is the most reliable radiographic method of evaluating osseous union. Initiating motion as soon as fusion has occurred is a priority with the goal of maximizing final range. Cost control in healthcare makes obtaining serial scans unreasonable. The single optimal time point for a computed tomography scan to determine union of a midcarpal fusion remains to be determined. A prospective protocol selected 8 weeks post operative as the point in time to obtain the single determining scan. Forty-six consecutive midcarpal fusions with scaphoidectomy were retrospectively analyzed for the reliability of this time point. All fusions had achieved union by 8 weeks and only this one scan was clinically necessary to advance the patients on to full range of motion without a splint at that time