Chronic Irreducible Anterior Dislocation of the Shoulder without Significant Functional Deficit

Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment.

Comparison of Image Quality of Shoulder CT Arthrography Conducted Using 120 kVp and 140 kVp Protocols

OBJECTIVE: To compare the image quality of shoulder CT arthrography performed using 120 kVp and 140 kVp protocols. MATERIALS AND METHODS: Fifty-four CT examinations were prospectively included. CT scans were performed on each patient at 120 kVp and 140 kVp; other scanning parameters were kept constant. Image qualities were qualitatively and quantitatively compared with respect to noise, contrast, and diagnostic acceptability. Diagnostic acceptabilities were graded using a one to five scale as follows: 1, suboptimal; 2, below average; 3, acceptable; 4, above average; and 5, superior. Radiation doses were also compared. RESULTS: Contrast was better at 120 kVp, but noise was greater. No significant differences were observed between the 120 kVp and 140 kVp protocols in terms of diagnostic acceptability, signal-to-noise ratio, or contrast-to-noise ratio. Lowering tube voltage from 140 kVp to 120 kVp reduced the radiation dose by 33%. CONCLUSION: The use of 120 kVp during shoulder CT arthrography reduces radiation dose versus 140 kVp without significant loss of image quality.

Anatomical, histological and radiological study of the rotator cuff interval of the shoulder

The Rotator cuff interval [RCI] is the triangular capsular space between the insertion of tendons of supraspinatus and subscapularis muscles. This RCI is supposed to be reinforced superficially by the coracohumeral ligament and deeply by the superior glenohumeral ligament SGHL. In addition to the ligamentous structures, the participation of the supraspinatus and subscapularis muscles tendons in the composition of the RCI has been pointed out. The aim of the present work was to study RCI, its boundaries and components, macroscopically and microscopically in correlation to MRI. Fourteen adult human cadaveric shoulder regions [5 right and 9 left] obtained from the Anatomy Department, Faculty of Medicine, Ain Shams University, were used in the present study. Specimens with gross pathology, trauma or previous surgery were excluded. Retrospectively the normal MRI findings were examined in 19 volunteers [10 right and 9 left shoulders, after obtaining consents] to demonstrate the boundaries and contents of the RCI using 1.5 tesla [General Electric Medical System [Milwaukee]. Results gross dissection at the apex of RCI revealed extension of fibers from subscapularis and supraspinatus tendons across the location of the RCI. They merge together in this region forming a confluence of fibers amalgamating with the capsule from outside. The long bicipital tendon was supported anteriorly by the suspension sling formed by the SGHL which seems to stabilize the long head of biceps in the RCI. The subscapularis tendon and the middle glenohumeral [GH] ligament, supported the antero-medial wall of the RCI. Sections taken from the lateral part of the roof, near the apex of the RCI and the superomedial part showed three distinct layers of connective tissue bundles. In sections taken in close proximity to the tendinous insertions into the tuberosities showed a zone of fibrocartilage. Sections from antero-medial part of the roof of RCI showed a meshwork of loose connective tissue. The RCI is best demonstrated in sagittal cuts. However, coronal and axial cuts can be helpful in identification of the relationship and contents. The coracohumeral [CHL] is always well identified in the mid portion of the RCI and is visualized in all planes, but sagittal images are the most useful for analysis of this structure. In conclusion studying the anatomy of RCI and determining [RCI] at MR imaging is important as it will provide a scientific background to the surgeon to repair any interval tear to stabilize the shoulder and may explain to some extent the superior instability observed in shoulders with rotator cuff tears

Métodos de avaliação dos movimentos escapulares durante a elevação dos membros superiores: uma revisão crítica da literatura / Methods of assessment of scapular movements during upper limb elevations: literature review

Realizar uma revisão crítica da literatura sobre os métodos utilizados para avaliar os movimentos escapulares durante a elevação dos membros superiores (MMSS) e apontar as vantagens, desvantagens e limitações associadas a cada um deles. Método: Foram realizadas buscas nas bases de dados MEDLINE, SCIELO, LILACS e PEDro com combinação de palavras-chave relacionadas ao assunto. Os critérios de inclusão para os estudos foram: estar publicado nos idiomas português/espanhol/inglês/francês até o último dia do ano de 2005 e realizar a avaliação dos movimentos escapulares durante a elevação dos MMSS. Foi considerado como critério de exclusão a avaliação dos movimentos escapulares na posição de decúbito. Resultados: Foram encontrados 181 estudos diferentes e, após a verificação dos critérios estabelecidos, selecionaram-se 29 para análise, os quais foram agrupados em 4 categorias distintas: medidas bidimensionais estáticas, bidimensionais dinâmicas, tridimensionais estáticas e tridimensionais dinâmicas. Apesar da diversidade de métodos empregados na avaliação dos movimentos escapulares, ainda não existe um que tenha aplicabilidade clínica e seja capaz de fornecer medidas relacionadas à real cinemática escapular. Outro problema encontrado foi a ausência de padronização na nomenclatura utilizada para descrever os movimentos, planos e eixos. Além disso, os métodos tridimensionais dinâmicos com aplicabilidade em estudos científicos ainda apresentam importantes limitações, como elevado custo, treinamento de pessoal e erros de medidas que podem ser significativos na determinação de alterações da cinemática escapular. Conclusão: é essencial a padronização da nomenclatura dos movimentos e dos planos e eixos em que eles ocorrem e o desenvolvimento de métodos de análises funcionais completas com aplicabilidade clínica, confiáveis e válidos.

To carry out a literature review on methods to assess scapular movements during upper limb elevation and point out their advantages, disadvantages, and limitations. Methods: The search was performed assessing MEDLINE, SCIELO, LILACS e PEDro databases with key words related to the subject. To be included, the studies would have to be published in Portuguese/English/Spanish/French until the last day of 2005 and have assessed scapular movement during upper limb elevation. The exclusion criterion included assessments in the decubitus position. Results: one hundred eighty-one different studies were found and after the verification of the established criteria, 29 were selected for the analysis, which were divided into four groups: bidimensional static, bidimensional dynamic, three-dimensional static and three-dimensional dynamic assessment methods. Despite the variety of assessment techniques, a method that shows clinical applicability and is able to carry out measurements related to the functional movements of the scapula is yet to be developed. Another problem found was the lack of standardization of the terminology regarding movements, planes and axes. Furthermore, the three-dimensional methods applicable to scientific studies showed important limitations, such as high cost, need for specialized human resources, and measurement errors, which could be significant when determining changes in scapular kinematics. Conclusion: It is essential to standardize the terminology used to describe scapular movements, planes and axes and to develop complete functional assessment methods with clinical applicability, reliability and validity.