Transient postoperative inferior subluxation of the shoulder after surgical stabilization of recurrent anterior dislocation in a patient with myasthenia gravis: a case report

The authors present a case of transient postoperative inferior subluxation of the shoulder after arthroscopic surgical stabilization for recurrent anterior dislocation. The patient was a 61-year-old woman with myasthenia gravis (MG). The first anterior shoulder dislocation occurred because of a fall to the ground. Despite a successful closed reduction, two more dislocations occurred in 3 weeks. Magnetic resonance imaging revealed an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion, an engaging Hill-Sachs lesion, and large tears of the supraspinatus and infraspinatus tendons. The patient underwent arthroscopic rotator cuff repair and ALPSA repair with a remplissage procedure. Intraoperatively, no tendency for instability was found; however, a widened glenohumeral joint space and inferior subluxation of the humeral head without functional compromise was observed on the day after surgery and disappeared spontaneously on radiographs 2 weeks later. To the authors’ knowledge, this is the first report documenting the occurrence of transient postoperative inferior subluxation of the shoulder in a patient with MG.

Can a Two Simple Stitches Method Provide Secure Fixation Strength in Biceps Tenodesis?:Biomechanical Evaluation of Various Suture Techniques

Background@#The purpose of this study was to compare the initial fixation strength between four different suture methods for the long head of the biceps. @*Methods@#Forty-eight fresh frozen porcine flexor hallucis longus tendons (mean width at suture site, 8.5 ± 0.9 mm) and phalanx bones were randomly assigned to one of the four arthroscopic biceps tenodesis techniques: simple stitch (SS), mattress suture (MS), lasso-loop (LL), and two simple stitches (2SS). A biceps tenodesis was performed according to the four techniques using all-suture type suture anchors (1.9-mm SUTUREFIX anchor with No. 1 ULTRABRAID sutures). Biomechanical evaluations were performed to test load to failure (N), stiffness (N/mm), stress (N/m 2 ), and mode of failure. @*Results@#As for the SS, MS, LL, and 2SS, the mean load to failure was 50.9 ± 14.61 N, 82.3 ± 24.8 N, 116.2 ± 26.7 N, and 130.8 ± 22.5 N (p < 0.001), respectively; mean stiffness was 6.1 ± 1.3 N/mm, 6.7 ± 2.6 N/mm, 7.8 ± 1.4 N/mm, and 8.1 ± 4.2 N/mm, respectively (p = 0.258); and mean stress was 0.7 ± 0.3 N/m 2 , 1.4 ± 0.8 N/m 2 , 2.9 ± 0.7 N/m 2 , and 2.7 ± 0.8 N/m 2 , respectively (p < 0.001). All the failures happened by the suture cutting through the tendon along its longitudinal fibers. @*Conclusions@#Neither the SS nor the MS method was enough to securely fix the biceps tendon with a significantly lower mechanical strength; however, the 2SS method showed similar initial fixation strength as the LL technique.

Metastasis of renal cell carcinoma around suture anchor implants

We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.

Metastasis of renal cell carcinoma around suture anchor implants

We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.

Changes in Shoulder Muscle Activities Depending on Static and Dynamic Body Positions during Shoulder External Rotation Exercises Using Kinetic Chain Concept / 대한스포츠의학회지

Purpose@#We aimed to evaluate shoulder muscle activities during shoulder external rotation exercises using an elastic band with the arm at the side or at 90° of abduction in static and dynamic body positions. @*Methods@#In 2017, a total of 19 right-handed male subjects were included in this study. Surface electromyography signals were recorded from the anterior deltoid, middle deltoid, upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscles. The subjects underwent maximal voluntary isometric contraction testing of each muscle in the W position or 90/90 position. Subjects performed the exercise in the sitting, static squat, static rotational squat, dynamic squat to standing (DSS), and dynamic squat to standing and trunk rotation (DSSR) positions. @*Results@#The main finding of this study was that shoulder external rotation exercises in the DSSR position were effective in reducing shoulder muscle activities except in the serratus anterior compared with static rotational squat position. @*Conclusion@#DSSR enabled effective control of scapular motion with less shoulder muscle activation. Therefore, the kinetic chain exercises incorporated with lower extremity, hip, or trunk would be beneficial for shoulder muscle exercises, which is required for patients with weak periscapular muscles, in whom the lower trapezius activities were found to be frequently decreased.

Surgical Resection of Intermetatarsal Coalition of the Fourth and Fifth Founded in Long Distance Running / 대한스포츠의학회지

Intermetatarsal coalition (IC) is very rare; although few cases have been reported in foreign orthopedic journals, these have not originated in our country. We report the case of a 20-year-old man who complained of pain in the left forefoot only during long distance running (3 km). On examination, his foot shape, skin appearance, and gait were normal, with no plantar keratosis; however, the radiograph revealed coalition between the fourth and fifth metatarsals. Surgical excision was performed. In the histopathologic study, fibrous coalition was confirmed. This paper reports an uncommon case involving surgical excision of IC in the military service, involving active sport activity.

Measuring Needle Angle and Depth for Lumbar Medial Branch Block Using Ultrasonography: An Evaluation of Efficiency Compared with Magnetic Resonance Imaging / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare accuracy of proper needle insertion angle between magnetic resonance imaging (MRI) and ultrasonography during lumbar medial branch nerve block procedure. MATERIALS AND METHODS: Between January 2015 and June 2016, 80 people who underwent MRI in the past 3 months with improved lumbar pain after sono-guided medial branch nerve block were enrolled for analysis (male, 39; female, 41; average age, 63.3 years). The insertion angle and depth between the spinous process and needle at each target points were measured at various levels (superior, inferior segment of each facet joints from L2–3 to L5–S1). The needle was positioned 1 cm apart from both lateral sides of the probe, locating spinous process in the middle. A comparative analysis was performed between an ultrasonography and an MRI. We determined the statistical correlation between the two methods. RESULTS: The average differences with respect to the distance between each level on a sono-guided medial branch nerve block were 1.28±1.07 mm in L2 (7 cases), 1.27±4.26 mm in L3 (25 cases), 1.63±5.89 mm in L4 (93 cases), 1.99±4.12 mm in L5 (141 cases), and 1.51±3.87 mm in S1 (66 cases). The average differences regarding the angle of each level were 1.69°±1.34° in L2 (7 cases), 2.03°±5.35° in L3 (25 cases), 1.49°±3.42° in L4 (93 cases), −1.55°±3.67° in L5 (141 cases), and 1.86°±4.83° in S1 (66 cases). All measurements followed a normal distribution (p < 0.05), showing statistical correlation without significant difference (p < 0.05). CONCLUSION: After measuring each level using an MRI prior to performing the procedure, a sono-guided lumbar medial branch nerve block can be performed with greater safety and efficacy, especially for beginners.

Clinical Efficacy and Safety of Radiofrequency Ablation Therapy with Cement Augmentation for a Metastatic Spine Tumor

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical efficacy and safety of radiofrequency (RF) ablation therapy followed by a bone cement augmentation procedure in treating and managing pain among metastatic spine tumor patients. SUMMARY OF LITERATURE REVIEW: As a metastatic spine tumor is unresectable, this procedure was performed. Results showed an increase in the necrosis rate, and a decrease in local recurrence and secondary vertebral stability. MATERIALS AND METHODS: From March 2007 to April 2016, 26 patients who were treated with RF ablation with a bone cement augmentation procedure and the same number of patients treated with radiotherapy for metastatic spine lesions were included in this study. Pain relief and functional quality of life were evaluated using a visual analogue scale (VAS) and Roland Morris Questionnaire (RMQ). RESULTS: VAS scores preoperatively and at 1, 4, and 12 weeks follow-up were 7.45, 3.01, 3.78, and 2.97 in the procedure group, and 7.04, 6.65, 5.87, and 3.03 in the radiotherapy group. The procedure group had significantly better average outcomes than the radiotherapy group for pain relief at 4 weeks but showed no difference at 12 weeks. The RMQ score improved from 13.92 to 7.21 in the procedure group, and from 15.33 to 9.75 in the radiotherapy group. Two patients who had a metastatic tumor near the vertebral body posterior cortex showed cement leakage into the disc space, that is, intraforaminal and intracanal space; therefore, operations were performed (7.69% nerve injury). CONCLUSIONS: RF ablation therapy with cement augmentation in treatment of metastatic spine tumor shows effectiveness in early pain relief and brings immediate vertebral stability, helping patients return to normal life. However, it carries a risk of nerve injury due to cement leakage.

Prevalence and Clinical Characteristics of Neurogenic Thoracic Outlet Syndrome in Specific Industrial Field

PURPOSE: The aim of this study was to analyze the multiple factors as a cause of thoracic outlet syndrome (TOS) in specific industrial field which is a South Korea company manufacturing rolling stock, defense products and plant equipment. METHODS: We analyzed questionnaire survey of 30 patients diagnosed as TOS at outpatient department from January 2005 to October 2015 retrospectively. We reviewed clinical records and questionnaire about repetitive task related to microtrauma. Questionnaire was established to analyze the correlation between occupational history and TOS. Statistical test was done with multiple regression analysis. RESULTS: Incidence rate was 9%, all of 30 patients engaged in heavy workload with symptoms of pain in neck and shoulder. A multiple regression was run to predict arm visual analogue scale (VAS) score from age, force of work, time of work and career. The model of analysis for arm VAS was statistically significant, p<0.001, adjusted r²=0.489. Only force of work variable added was statistically significantly to the prediction, p<0.001. CONCLUSION: Prevalence of TOS in highly loaded industrial field is higher than typically known, appropriate diagnosis is important for early comeback to work. Aggressive diagnosis and treatment is important since non-operative treatment can have satisfying result for patient and help early comeback to work.

A Comparison of Clinical Results and Second-Look Arthroscopic Findings between Early and Delayed Reconstruction in Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

PURPOSE: This study was conducted for comparison of clinical and second look arthroscopic results between early and delayed reconstruction of acute anterior cruciate ligament (ACL) injuries. MATERIALS AND METHODS: Thirty-six patients who underwent ACL reconstruction between March 2008 and October 2011 were enrolled in this study. We divided the patients into two groups, those in the early reconstruction group underwent surgery before one week, and those in the delayed reconstruction group underwent surgery after three weeks, before six weeks. We checked clinical results and second look arthroscopic results and analyzed correlation of clinical and second look arthroscopic results. RESULTS: At the final follow up, the Lysholm, International Knee Documentation Committee, and Tegner score were not statistically different between the two groups (p=0.173, p=0.154, p=0.109). No difference for the range of motion (p=0.808, p=0.680), Lachman test (p=0.377), and pivot shift test (p=0.894) was observed between the groups. In the results of second look arthroscopy, there was no difference in graft continuity (p=0.936), tension (p=0.944) and synovial coverage (p=0.789). No statistical clinical correlation was observed between clinical and second look arthroscopic results (p>0.05). CONCLUSION: We obtained satisfactory clinical and second look arthroscopic results in both the early and delayed ACL reconstruction groups. Therefore, early reconstruction of ACL performed before one week could be a treatment options for acute ACL injury.