Clinical and radiological outcomes of ultrasound-guided barbotage using a spinal needle and subacromial steroid injection for calcific tendinitis of the shoulder

Methods@#Thirty-six patients with calcific tendinitis of the shoulder treated by US-guided barbotage with a spinal needle and subacromial steroid injection were included in the study. We evaluated clinical outcomes based on American Shoulder and Elbow Surgeons (ASES) score, Constant score, and visual analog scale (VAS) for pain score. Radiological outcomes were assessed by X-ray imaging at each visit. @*Results@#Our results showed that US-guided barbotage and subacromial steroid injection produced good clinical and radiological outcomes in patients with calcific tendinitis of the shoulder. Of the 36 patients, only one required surgical treatment, while the others showed improvement without any complications. Compared to values before the procedure, calcific deposit size and VAS, ASES, and Constant scores showed significant improvement 6 weeks after the procedure. No significant correlation was found between the initial calcific deposit size and clinical outcomes at each time point. @*Conclusions@#In patients with calcific tendinitis of the shoulder, US-guided barbotage using a spinal needle and subacromial steroid injection can yield satisfactory clinical and radiological results.

Comparison of Anterior Translation among Three Sternoclavicular Reconstruction Methods in Cadaver Study / 대한정형외과학회잡지

PURPOSE: Currently, biomechanics and function comparison of the reconstruction of structures play important roles in the sternoclavicular joint stability is not much. In order to confirm the improvement in the functional aspects of the sternoclavicular joint after the three most widely used reconstruction methods, we measured the degree of anterior translation of the sternoclavicular joint after the operation using cadavers. MATERIALS AND METHODS: We studied 24 sternoclavicular joints in the cadavers. First, we measured the anterior translation of the clavicle, which was compared with the sternum in 24 normal sternoclavicular joints. We divided the cadaver into three groups and performed each of the three current operations: figure of eight hamastring tendon reconstruction operation (Group 1), subclavius tendon reconstruction operation (Group 2), and hamstring tendon reconstruction operation (Group 3); then we compared the degree of anterior translation in each group. We did the measurement by adding 10 degrees to the glenohumeral joint each time from 0 degrees to 90 degrees. RESULTS: In the normal joint, the clavicle was significantly ascended compared with the sternum. The Group 1 had a 1.68±0.25 mm anterior translation while the Group 2 had 1.81±0.23 mm and Group 3 had 2.8±0.58 mm (Group 1: p=0.004, Group 2: p=0.001, Group 3: p=0.002). The Group 1 showed a low ascending rate of up to 60 degrees, which showed no significant difference with that of the normal joint. However, after 60 degrees, the ascending rate showed a significant increase. In the case of Group 2, there was no significant difference with normal joint of up to 50 degrees. Group 3 showed significant anterior ascending from 20 degree. CONCLUSION: Through measuring the anterior translation of subjects that underwent three representative sternoclavicular joint reconstructions, we found that the result from the Group 1 was most comparable normal translation of the sternoclavicular joint.

Comparison of Distal Radius Fractures with or without Scaphoid Fractures

PURPOSE: Distal radius fracture is one of the most common factures, but incidence of concomitant scaphoid fracture is rare. The rarity makes diagnosing the concomitant scaphoid fracture often delayed. Thus, in this study, the authors examined the frequency of concomitant scaphoid injury in distal radius fracture and the type of distal radius fracture that is more commonly associated with simultaneous scaphoid fracture. METHODS: We examined a total of 212 patients who had received treatment for the fracture in our institution. They were divided into two groups, isolated distal radius fracture group and distal radius fracture group with simultaneous scaphoid fracture, and their age, gender, body mass index and distal radius fracture type in accordance with AO classification were compared between the two groups. RESULTS: Concomitant scaphoid fractures were found in 12 (5%) patients, and among them 10 cases were associated with type C distal radius fracture. Statistical comparison between the group with isolated distal radius fracture and the group with both distal radius and scaphoid fractures was made, and only comparison of distal radius fracture types showed statistical significance. CONCLUSION: It is imperative to make timely and appropriate diagnosis of accompanying scaphoid fracture, since delay in making the diagnosis usually lead to many complications. We conclude that further diagnostic imaging such as computed tomography is necessary to make the correct diagnosis of concomitant scaphoid fracture, especially in type C distal radius fractures.

Multiple Rice Body Formation in Subacromial and Subdeltoid Bursal Spaces

We encountered a rare condition of rice body in subacromial and subdeltoid spaces in a patient with unremarkable medical history. Although it is uncommon, there have been continued reports on its formation in certain type of infective and inflammatory arthritis. However, except for a traumatic event, evaluation yielded no known and conceivable cause for his chronic inflammatory bursitis. Relatively typical findings for rice body on magnetic resonance imaging have been described, and in our case the imaging prompted us to schedule early removal, which is generally accepted as the management of choice to prevent further progression of symptoms. The symptoms of the shoulder showed significant improvement, and a close follow-up schedule has been recommended for observation of recurrence and development of any foreseeable underlying cause.

Multiple Rice Body Formation in Subacromial and Subdeltoid Bursal Spaces

We encountered a rare condition of rice body in subacromial and subdeltoid spaces in a patient with unremarkable medical history. Although it is uncommon, there have been continued reports on its formation in certain type of infective and inflammatory arthritis. However, except for a traumatic event, evaluation yielded no known and conceivable cause for his chronic inflammatory bursitis. Relatively typical findings for rice body on magnetic resonance imaging have been described, and in our case the imaging prompted us to schedule early removal, which is generally accepted as the management of choice to prevent further progression of symptoms. The symptoms of the shoulder showed significant improvement, and a close follow-up schedule has been recommended for observation of recurrence and development of any foreseeable underlying cause.

Fracture in a Young Male Patient Leading to the Diagnosis of Wilson's Disease: A Case Report

Wilson's disease is a rare genetic disorder that has abnormal copper metabolism. Although the disease's main problems are found in liver and brain, some studies revealed manifestation of various musculoskeletal problems in the patients. In this report, we encountered a young patient who had fracture in the forearm bone. Initially, exception to a previous history of fracture from a motorcycle accident, the patient did not have any medical or drug use history, and laboratory work-ups were insignificant. However, with suspicion on his bone's integrity, bone densitometry was recommended and revealed osteopenic change. To disclose a cause for the change, questions were made to recall any particular history or event, and his complaint of recent vision loss led to ophthalmologic consultation where under slit-lamp test found Kayser-Fleischer ring. Further laboratory work-up found low levels of serum copper and ceruloplasmin and high copper level in 24-hr urine sample that led to the diagnosis of Wilson's disease. Although Wilson's disease has been frequently noticed with considerable musculoskeletal manifestation, it rarity makes the diagnosis illusive to a physician. Hence, despite of its rarity, it is imperative to remember the disease's bony manifestation, and it should be suspected in young patients with demineralized bone when the reason for brittle bone cannot be answered with other better known conditions.

The Efficacy of Ultrasound-Guided Brachial Plexus Block in Trauma Patients

PURPOSE: We evaluated the efficacy of brachial plexus block under the guide of ultrasonography for immediate management of open wound in patients with multiple trauma. METHODS: From July 2012 to April 2013, 34 patients with multiple trauma had brachial plexus block for immediate management of open wound in the upper extremity. We evaluated the patient satisfaction of the anesthesia and any complications related to the block. RESULTS: During the brachial plexus block, intravascular injection of lidocaine occurred in one patient. Except this, all patients who received brachial plexus replied they would choose brachial plexus block if they had to undergo the same surgery. CONCLUSION: Brachial plexus block is an effective anesthesia technique in the immediate management of open wound in upper extremities.