Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine - a prospective study with ultrasound-based motion analysis

<p>Abstract</p> <p>Background</p> <p>Shoulder complaints, and especially the outlet-impingement syndrome, are a common condition. Among other things, poor posture has been discussed as a cause. A correlation between impingement syndrome and restricted mobility of the thoracic spine (T) has been described earlier, but there has been no motion analysis of the thoracic spine to show these correlations. In the present prospective study, we intended to find out whether there is a significant difference in the thoracic sagittal range of motion (ROM) between patients with a shoulder outlet impingement syndrome and a group of patients who had no shoulder pathology. Secondly, we wanted to clarify whether Ott's sign correlates with ultrasound topometric measurements.</p> <p>Methods</p> <p>Two sex- and age-matched groups (2 × n = 39) underwent a clinical and an ultrasound topometric examination. The postures examined were sitting up straight, sitting in maximal flexion and sitting in maximal extension. The disabilities of the arm, shoulder and hand (DASH) score (obtained by means of a self-assessment questionnaire) and the Constant score were calculated. Lengthening and shortening of the dorsal projections of the spine in functional positions was measured by tape with Ott's sign.</p> <p>Results</p> <p>On examination of the thoracic kyphosis in the erect seated posture there were no significant differences between the two groups (p = 0.66). With ultrasound topometric measurement it was possible to show a significantly restricted segmental mobility of the thoracic spine in the study group compared with the control group (p = 0.01). An in-depth look at the mobility of the subsegments T1-4, T5-8 and T9-12 revealed that differences between the groups in the mobility in the lower two sections of the thoracic spine were significant (T5-8: p = 0.03; T9-12: p = 0.02). The study group had an average Constant score of 35.1 points and the control group, 85.5 (p < 0.001). On the DASH score the patient group reached 34.2 points and the control group, 1.4 (p < 0.001). The results of Ott's sign differed significantly between the two collectives (p = 0.0018), but showed a weak correlation with the ultrasound topometric measurements (study group flexion/extension: r = 0.36/0.43, control group flexion/extension: r = 0.29/0.26).</p> <p>Conclusion</p> <p>The mobility of the thoracic spine should receive more attention in the diagnosis and therapy of patients with shoulder outlet impingement syndrome.</p

Intra-articular hemangioma of the knee

Intra-articular hemangioma of the knee is a rare cause of pain and spontaneous hemarthrosis, often seen as an internal derangement of the joint in children and young adults. The tumor is observed in two different forms: the synovial hemangioma or the arteriovenous malformation named also as hemangiohamartomas. They may, cause hemorrhagic synovitis and arthropathy, probably as a result of recurrent episodes of intra-articular bleeding and mechanical irritation. Four cases of intra-articular hemangioma of the knee are presented in this study. Two of our cases were diagnosed as synovial hemangioma with the lesions localized inside the knee and the other 2 were intermediate type with the tumor extending to the muscle group and the skin. After magnetic resonance imaging and angiographic assessment, arthroscopic excision was performed in the localized type of the tumor. The other 2 cases received only diagnostic arthroscopy and biopsy followed by conservative treatment due to the extensive localization of the tumors and the serious chondral lesions. The decision of the treatment modality is very difficult in intra-articular hemangioma of the knee because, when combined with chondral degeneration, the incidence of local recurrence is high

Arthroscopic meniscectomy for discoid laternal meniscus in children and adolescents: 4.5 year follow-up

We retrospectively reviewed the 4.5 year (range, 21-88 months) follow-up results of arthroscopic partial meniscectomies performed in 11 knees between 1994 and 2000 to treat a symptomatic discoid lateral meniscus. The average age at surgery was 11.5 years (range, 5-17 years). All except one of the discoid menisci were of a complete type, and all except three were torn menisci. At the latest follow-up examination, the result was excellent for nine knees, and good for two; no degenerative changes were evident on the roentgenograms. Arthroscopic partial meniscectomy should be the treatment of choice for the complete type symptomatic lateral discoid meniscus, even if it is intact. Preoperative lack of the knee extension requires a gentle rehabilitation program post-operatively. (C) 2003 Lippincott Williams Wilkins

Calcification of the patellar tendon after ACL reconstruction - A case report with long-term follow-up

(E)xtensive calcification of the patellar tendon following ACL reconstruction with central-third bone-patellar tendon-bone autograft is a rarely seen complication. A 45-year-old male patient underwent combined intraarticular reconstruction of ACL with 1/3 central patellar bone-tendon-bone graft and extraarticular reconstruction with modified MacIntosh technique. Two cm of calcification of the patellar tendon was observed incidentally when he underwent a high tibial osteotomy due to medial compartment degeneration, secondary to varus malalignment, 18 months after the ACL surgery. The calcification, being painless, was left untouched during the surgery. At the final examination, 136 months postoperatively, the patient still had no complaint relating to the patellar tendon

Localized pigmented villonodular synovitis of the knee

Eight patients with localized pigmented villonodular synovitis (LPVNS) of the knee were treated with arthroscopic and open techniques, with diagnosis confirmed by histological examination. Average patient age was 29 years (range: 13-50 years). At arthroscopy, all lesions except one were in the anterior compartment of the involved knee. Treatment consisted of complete local excision with partial synovectomy. This procedure was completed arthroscopically in seven patients. No recurrence was reported at average 24-month follow-up (range: 12-33 months). Arthroscopy is a valuable tool in the diagnosis and treatment of LPVNS

Myositis ossificans in early childhood

A 5-year-old boy underwent arthroscopic surgery because of a lateral discoid meniscus, which was followed by an overly strenuous rehabilitation program. At 6-week follow-up, a painful mass at the distal part of the thigh and a flexion restriction of the operated knee were detected, caused by myositis ossificans inside the vastus medialis muscle. The symptoms disappeared with an appropriate rehabilitation program and the patient recovered