Posterior shoulder instability managed by arthroscopic acromial pediculated bone-block. Technique

In posterior shoulder instability (recurrent dislocation, involuntary posterior subluxation or voluntary subluxation that has become involuntary), surgery may be considered in case of failure of functional treatment if there are no psychological contraindications. Acromial bone-block with pediculated deltoid flap, as described by Kouvalchouk, is an alternative to iliac bone-block, enabling triple shoulder locking by the blocking effect, the retention hammock provided by the deltoid flap and posterior capsule repair. Arthroscopy allows shoulder joint exploration and diagnosis of associated lesions, with opening and conservation of the posterior capsule; it greatly facilitates bone-block positioning and capsule reinsertion. The present report describes the procedure in detail

Anatomical, Clinical and Electrical Observations in Piriformis Syndrome

<p>Abstract</p> <p>Background</p> <p>We provided clinical and electrical descriptions of the piriformis syndrome, contributing to better understanding of the pathogenesis and further diagnostic criteria.</p> <p>Methods</p> <p>Between 3550 patients complaining of sciatica, we concluded 26 cases of piriformis syndrome, 15 females, 11 males, mean age 35.37 year-old. We operated 9 patients, 2 to 19 years after the onset of symptoms, 5 had piriformis steroids injection. A dorsolumbar MRI were performed in all cases and a pelvic MRI in 7 patients. The electro-diagnostic test was performed in 13 cases, between them the H reflex of the peroneal nerve was tested 7 times.</p> <p>Results</p> <p>After a followup 1 to 11 years, for the 17 non operated patients, 3 patients responded to conservative treatment. 6 of the operated had an excellent result, 2 residual minor pain and one failed. 3 new anatomical observations were described with atypical compression of the sciatic nerve by the piriformis muscle.</p> <p>Conclusion</p> <p>While the H reflex test of the tibial nerve did not give common satisfaction in the literature for diagnosis, the H reflex of the peroneal nerve should be given more importance, because it demonstrated in our study more specific sign, with six clinical criteria it contributed to improve the method of diagnosis. The cause of this particular syndrome does not only depend on the relation sciatic nerve-piriformis muscle, but the environmental conditions should be considered with the series of the anatomical anomalies to explain the real cause of this pain.</p

The clinical features of the piriformis syndrome: a systematic review

Piriformis syndrome, sciatica caused by compression of the sciatic nerve by the piriformis muscle, has been described for over 70 years; yet, it remains controversial. The literature consists mainly of case series and narrative reviews. The objectives of the study were: first, to make the best use of existing evidence to estimate the frequencies of clinical features in patients reported to have PS; second, to identify future research questions. A systematic review was conducted of any study type that reported extractable data relevant to diagnosis. The search included all studies up to 1 March 2008 in four databases: AMED, CINAHL, Embase and Medline. Screening, data extraction and analysis were all performed independently by two reviewers. A total of 55 studies were included: 51 individual and 3 aggregated data studies, and 1 combined study. The most common features found were: buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with manoeuvres that increase piriformis muscle tension. Future research could start with comparing the frequencies of these features in sciatica patients with and without disc herniation or spinal stenosis

Treatment of osteochondral lesions of the talus: a systematic review

The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from January 1966 to December 2006 were systematically screened. The proportion of the patient population treated successfully was noted, and percentages were calculated. For each treatment strategy, study size weighted success rates were calculated. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. One randomized clinical trial was identified. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Retrograde drilling and fixation scored 88 and 89%, respectively. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus

Les séquelles des entorses latérales de la cheville

Pathologie chronique de la cheville du sportif et séquelles d'une entorse. La cheville 'douloureuse' : les fibroses périarticulaires, le conflit astragalien antérieur, les corps étrangers, la cheville dite 'du sportif', les lésions ostéochondrales du dôme du talus, le syndrome du carrefour postérieur, le syndrome du sinus du tarse, les pathologies des tendons fibulaires, les séquelles neurologiques. La cheville 'instable'. L'arthrose tibiotarsienn

La tendinopathie du corps du tendon d'Achille : une lésion à bien connaître

Editorial : distinction entre lésions dégénératives, tendinoses ou tendinopathies nodulaires, et lésions inflammatoires plus rares : les péritendinites. Etiologie, anatomopathologie, diagnostic, traitement

La souffrance du compartiment fémoro-tibial interne : la prothèse unicompartimentale

Trabalho final de mestrado integrado em Medicina (Geriatria), apresentado á Faculdade de Medicina da Universidade de CoimbraA Síndrome da Apneia Obstrutiva do sono (SAOS) encontra-se inserida no espetro dos distúrbios respiratórios relacionados com o sono e, apresenta-se como uma síndrome clínica prevalente, embora frequentemente sub-diagnosticada. Carateriza-se pela obstrução transitória e recorrente das vias aéreas superiores durante o sono, conduzindo a períodos de apneia e hipopneia, hipóxia intermitente e fragmentação do sono. A SAOS acompanha-se de diminuição da qualidade de vida e de inúmeras complicações, incluindo doenças cardiovasculares. Evidências substanciais reconhecem a SAOS como um factor de risco independente para o desenvolvimento e/ou exacerbação de diversas condições cardiovasculares, designadamente hipertensão arterial, insuficiência cardíaca, doença vascular cerebral, arritmias e doença coronária. Neste contexto, a SAOS coaduna-se com o aumento da morbilidade e mortalidade neste grupo de indivíduos. Os mecanismos fisiopatológicos implicados na etiologia da doença cardiovascular associada a SAOS não se encontram completamente esclarecidos, contudo serão provavelmente multifatoriais. O tratamento do distúrbio respiratório relacionado com o sono tem demonstrado efeitos benéficos, sobretudo na morbilidade e a nível da redução do risco cardiovascular. Considerando que as doenças cardiovasculares constituem a maior causa de morbilidade e mortalidade a nível mundial, a determinação de fatores de risco controláveis e o seu tratamento, como a SAOS, torna-se fundamental na prevenção e abordagem de eventos cardiovasculares.Obstructive sleep apnea (OSA) is included in the sleep-related respiratory pathologies category, and is a prevalent clinical syndrome, frequently underdiagnosed. It is caracterized by transitory and recurrent obstruction of the upper respiratory tract during the sleep, leading to periods of apnea and hipopnea, intermitente hypoxia and sleep fragmentation. OSA is associated with life quality impairment and with multiple complications, such as cardiovascular diseases. OSA has been recognized as an independent factor for development and/or exacerbation of different cardiovascular conditions, including arterial hypertension, heart failure, cerebrovascular disease, arrytmias and coronary arterial disease. Within the previous context, OSA increases the mortality and morbility in groups previously refered. The physiopathological processes involved in cardiovascular disease are not completely understood, but most probably are multifactorial. The treatment of sleep-related disease has demonstrated benefits, particularly on morbility and reduction of cardiovascular risk. Being the cardiovascular diseases the main cause of morbility e mortality worldwide, identification of controlable risk factor and their properly treatment are critical to prevent and manage cardiovascular events