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Objective: To evaluate the long-term effectiveness of patients received surgical treatment under the guidance of "West China Classification" of desmoid-type fibromatosis (DTF) in the shoulder girdle. Methods: The clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed, including 14 males and 18 females, aged 14-56 years with an average age of 36.8 years. The maximum diameter of the tumor was 7-19 cm, with an average of 11.1 cm. According to the "West China Classification" of DTF in the shoulder girdle, there were 4 cases of region Ⅰ, 3 cases of region Ⅱ, 6 cases of region Ⅲ, 3 cases of region Ⅳ, 5 cases of regions Ⅰ+Ⅱ, 5 cases of regions Ⅱ+Ⅲ, and 6 cases of regions Ⅰ+Ⅱ+Ⅲ. In addition, the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach. Finally, 12 cases were operated via anteroposterior approach (group A), 14 via posterior approach (group B), and 6 via combined anterior-posterior approach (group C). The 1993 Musculoskeletal Tumor Society (MSTS93) score (including pain, limb function, satisfaction, hand position, hand flexibility, and lifting ability), Japanese Orthopedic Association (JOA) score, range of motion (ROM) of shoulder joint (including flexion, extension, abduction, and adduction), and complications of patients in the 3 groups were recorded and compared. Results: All the 32 patients were followed up 30-190 months, with an average of 94.6 months. At last follow-up, complications occurred in 5 cases (15.6%), including 2 cases (16.6%) in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. There was no significant difference in the incidence of complications among the 3 groups ( P=1.000). Tumor recurrence occurred in 5 (15.6%) cases, including 1 (8.3%) case in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. No significant difference was found in the recurrence rate among the 3 groups ( P=1.000). At last follow-up, MSTS93 score of pain, limb function, satisfaction, hand flexibility, and hand position in groups A and B were significantly better than those in group C ( P0.05). The lifting ability score in group C was significantly lower than in group A ( P0.05). The JOA score and flexion, extension, abduction, and adduction activities of shoulder in groups A and B were significantly better than those in group C ( P0.05). Conclusion: Taking a rational approach to fully expose and completely remove the tumor is the key point of surgical treatment for patients with DTF in the shoulder girdle. At the same time, preservation of vital structures and reconstruction of soft tissues should also be taken into consideration. Overall, surgical treatment under the guidance of "West China Classification" of DTF in the shoulder girdle has achieved satisfactory long-term effectiveness.
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Abstract Introduction: Few activities of daily living (ADLs) in chronic obstructive pulmonary disease (COPD) are tolerated because they are associated with ventilatory and metabolic changes. Simply lifting the upper limb muscle requires changes, resulting in thoracic abdominal asynchrony, increased dyspnea, and can interfere with quality of life (QoL). Objective: to relate the muscle strength of the shoulder girdle, trunk and hand grip with the degree of dyspnea in ADLs and secondarily correlate them with QoL in individuals with chronic obstructive pulmonary disease. Materials and Methods: Nine male subjects with chronic obstructive pulmonary disease III and IV (COPDG) and nine healthy, sedentary male individuals - control group (CG) were evaluated. All patients underwent the following evaluations: Pulmonary function, muscle strength of shoulder girdle, trunk and hand grip, and questionnaires. Results: In the intergroup analysis found that the spirometric variables of the COPDG were significantly lower compared to the CG. Intragroup analysis for measures of muscle strength, found significant difference for shoulder girdle, trunk and hand grip between both groups (COPDG) with lower mean (CG). Only the shoulder girdle had a positive correlation with ADL's and QoL. Conclusion: COPDG individuals, in addition to having pulmonary compromise, showed a significant decrease in muscle strength of the shoulder girdle, trunk and hand grip when compared to the CG. Only the shoulder girdle strength was positively correlated with the level of dyspnea in ADL's in QoL. Thus, pulmonary rehabilitation is an important tool for strengthening these muscles, possibly providing a positive impact on the degree of dyspnea during ADLs and reflecting on QoL.
Resumo Introdução: As atividades da vida diária (AVD's) na doença pulmonar obstrutiva crônica(DPOC) são poucas toleradas pelo fato de estarem associadas a alterações ventilatórias e metabólicas. A simples elevação dos membros superiores altera o recrutamento muscular, resultando em assincronia toracoabdominal, aumento da dispneia, podendo interferir na sua qualidade de vida (QV). Objetivo: relacionar as forças musculares da cintura escapular(CE), tronco(T) e preensão palmar(PP) com os graus de dispneia nas AVD´s e secundariamente correlacioná-las com a QV em indivíduos com DPOC. Materiais e Métodos: Foram avaliados 09 indivíduos com DPOC (III e IV) do sexo masculino - grupo DPOC (GDPOC) e 09 indivíduos saudáveis sedentários - grupo controle (GC). Todos foram submetidos às seguintes avaliações: prova de função pulmonar, forças musculares da CE, T, PP e questionários. Resultados: Na análise intergrupos constatou que as variáveis espirométricas do GDPOC foram significativamente menores comparados aos do GC. Na análise intragrupo, para as medidas das forças musculares, observou-se diferença significativa para PP, T e CE entre ambos os grupos (GDPOC com média menor que GC). Somente na força da CE houve correlação positiva com as AVD´s e QQV. Conclusão: Concluímos que indivíduos do GDPOC possuem, além do comprometimento pulmonar, apresentam diminuição significativa da força muscular da CE, T e PP quando comparado ao GC. Somente na força da CE houve correlação positiva com os graus de dispneia nas AVD´s e na QV. Sendo assim, a reabilitação pulmonar é um importante instrumento para o fortalecimento dessa musculatura proporcionando possivelmente um impacto positivo nos graus de dispneia durante as AVD´s e refletindo na QV. [K].
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Background: To recognize different pathologies affecting the shoulder joint with the help ultrasound and MRI scans and to evaluate the features, pattern and extension of the different pathologies affecting the shoulder joint with help of ultrasound and MRI scans so as to help the clinician for further management. Aim: To estimate role of ultrasound and MRI in examination of shoulder joint. Material and methods: Study comprised of an observational hospital based study. Out of 65patients, 20 underwent only ultrasound investigation, 25 underwent only MRI scans whereas 20 patients were evaluated by ultrasound and MRI. These were performed by 3-5 MHZ curvilinear probe and 8-10 MHZ linear probe on HD 7 and HD 9 Philips ultrasound machines and 1.5 T Philips MRI machine. MR arthrography was performed as a follow up in some of the patients in outside centre. Results: USG study also showed that the most commonly occurring rotator cuff tears were supraspinatus tears whereas alone infrspinatus and subscapularis tears were very rare. MRI study showed supraspinatus tears Were the most frequently occurring in the rotator cuff whereas subscapularis and infraspinatus tears were the most commonly occurring rotator cuff tears were supraspinatus tears whereas alone infraspinatus and subscapularis tears were very rare. MRI study showed supraspinatus tears were the most frequently occurring in the rotator cuff whereas subscapularies and infraspinatus tears were rare. MRI is 100% confirmative in almost all cases of Rotator cuff tears but may sometimes need extra imaging by MR arthrography in partial bursal tears. Conclusion: Rotator cuff tears are the most common pathologies affecting the shoulder joint according to this study. It was proved that, there is no evident difference in the accuracy of ultrasound and MRI in detecting this pathology, even though MRI has proved to be more accurate in evaluating almost all other pathologies as compared to ultrasound.
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@# ObjectiveTo explore the classification, limb salvage strategy and treatmental results following resection of malignant bone tumors around the shoulder girdle. Methods28 patients with malignant bone tumors of the shoulder girdle underwent a limb-sparing resection according to Malawer's surgical classification system of shoulder girdle. Various limb-salvage procedures were performed for all patients. They were evaluated with survival, recrudesce, and metastasis. The function outcome was assesssed with Enneking Function Evaluation System. Results25 patients were followed-up with a mean time of 54 months (ranged 9～96 months)．6 patients recrudesced, 11 patients died．According to Enneking Function Evaluation System, the mean score of the upper extremity was 23 in reimplantation of tumor-bearing bone after alcohol devitalization group, 24 in osteoarticular allograft group, 24 in free periosteum vascularized clavicle group, 26 point in endoprosthesis group, 25 in the total scapulectomies and the head of humerus slinging group, 28.5 in the partial scapulectomies group respectively. ConclusionThe malignant bone tumors around the shoulder girdle can be resected completely. There were a variety of limb-salvage procedures following tumors resection, with which hand function can be preserved in the majority of patients with relieved pain and good function shoulder.
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Between 1987 and 1994, the authors analysed 29 patients who underwent limb sparing resection for shoulder girdle neoplasms. Follow up averaged 24 months. Primary bone and soft tissue malignancy were 23 cases, metastatic carcinoma 3, aggressive giant cell tumor 2, aneurysmal bone cyst 1. By Enneking's criteria, stage IIB 23 cases, stage III 3, stage I 2. The surgical margins were: wide(20), marginal(7), and intralesional(2). In 4 cases with S2345B resections(by Musculoskeletal Tumor Society classification), shoulder fusion were done with Ender nail and bone cement. Among twenty patients with S345A(3), S34A(6), S345B(11) resections, arthroplasty with Ender nail and bone cement were done in 11 cases, endoprothesis and its combination with bone cement in 4, vascu- larized fibula graft in I, shoulder fusion with fibula graft in 1, combination of autoclaved bone and endoprothesis were done in 3 cases. Four patients with S12B, no reconstruction were done. For one patient with S45A, segmental resection and reconstruction with autogenous pasteurized bone were done. Oncologic results are CDF 14, DOD 5, NED 3, AWD 7 cases. Complications were local recur- rence 3(10.3%), distal fragment loosening 1, subluxation of humeral head 1, graft site fracture 1, and infection in 1 case. MSTS functional scores for the whole 29 cases were 22.5(75% of normal). S2345B with fusion was 20(67%). For S345A(3) and S34A(6) score was 23.2(77%). For S345B(11), score was 21.7(72%). For S12B(4) and S45A(1), score was 25.8(86%). Although functional results are depend on the extent of bone and soft tissue resection, reconstruction of soft tissue seems to be important. The options for reconstruction of bony defect(endoprothesis complex, living fibula graft or IM nail and cement as a prothesis) did not affect functional outcome.