Outcome of subacromial steroid injection in management of shoulder impingement syndrome

Objective: to evaluate the outcome of subacromial steroid injection in subacromial impingement syndrome in our racial group population

Material and Methods: 150 cases having clinical diagnosis of SIS of age >16 years were included from outpatient department of Orthopedic Surgery, Services Hospital Lahore during 12- 03-09 to 14-12-09. Patient having constant gradeA[less than 70 constant score] and grade B [70- 79 constant score] were included while those having full thickness tears of rotator cuff, internal rotation contracture, previous open shoulder surgery or gleno-humeral instability were excluded from study. Methyl Prednisolone Acetate 40 mgs along with 5 ml of 0.5 % Bupivacaine injection were given administered in subacromial space to all patients under aseptic conditions. Patients were follow-up at one week; three weeks, and six weeks and outcome was assessed by Constant scoring system. Improvement was labeled by the achievement of grade C [80-89], D [90-100] on constant score

Results: the mean age was 50 years+/- 2.50 [range 35-65], 38.7% were of 30-40 years, and 38.7% were 40-50 years and 22. 7 % were >50 years of age. 134 [89.3%] were male patients and male to female ratio was 9:1. Right shoulder involvement was 76.7% and left sided was 22.7%. Outcome at first week was grade A in 14.0%, grade Bin 84.7% and grade C in 1.3%. Outcome at third week was grade B in 10.0%, grade C in 88% and grade D in 2.0% and there was no patient in grade A. Outcome at end of six week was grade A in 1.3%, grade B in 13.3% and grade C in 53.3% and grade Din 31.3%. Final outcome was 85.3% improvement [CSS grade C and D] and 14.7% nonimprovement [CSS grade A and B]

Conclusion: subacromial steroid injection shows early decrease in morbidity of the patient. It has low complication rate and is cost effective

Fatal intra-operative disseminated intravascular coagulation; extensive Surgery: a case report

Authors present a case of 26 years old female who was having Esophagectomy done due to esophageal perforation secondary to severe corrosive intake strictures. Pre-operative course was uneventful, but during 5 hours of extensive surgery, she developed fulminant disseminated intravascular coagulation [DIG] which was initially managed, but proved to be fatal after 4 hours of ICU stay. Surgeons should be alert that hypercoaguable state can develop in unprepared patients having extensive surgery