Applications of Latissimus Dorsi Grafts in Reverse Shoulder Arthroplasty.

The shoulder joint is a multiaxial joint in the upper body known for its high degree of motion. It is also infamously known for recurrent dislocations compared to other joints. These dislocations are mainly fixed by closed reduction methods like the Hippocrates technique, Stimpson's gravity technique, and the most commonly used modified Kocher's technique. The modified Kocher's technique uses traction followed by external rotation, adduction, and internal rotation. Rotator cuff tears are associated with shoulder joint dislocations. Rotator cuff tears slowly heal and persist for 10-20 years, irrespective of their etiology. When left untreated, fibrosis can set in the joint. After fibrosis, it is repaired with a reverse shoulder arthroplasty. Reverse shoulder arthroplasty allows a greater degree of movement compared to the conventional arthroplasty. In reverse shoulder arthroplasty, the latissimus dorsi tendon is removed from its original insertion and attached to the humerus around the insertion of the deltoid muscle. This change increases the torque and external rotation of the joint and provides better results than the surgeries where the tendon transfer is not done. This article compiles the various etiologies of shoulder dislocation and its treatment, shoulder arthroplasty. It discusses the indications and contraindications of total and reverse total arthroplasty. This article aims to compare conventional shoulder arthroplasty and reverse shoulder arthroplasty. It highlights the advantages of using latissimus dorsi grafts in reverse shoulder arthroplasty in shoulder joint dislocations.

Incidence of Facial Nerve Palsy in Pregnancy.

The facial nerve is cranial nerve number seven. A facial nerve palsy is a form of severe weakness of muscles of the face or paralysis due to swelling or any other kind of injury to the seventh nerve. Bell's palsy is the most common reason for facial nerve palsy in both pregnant and non-pregnant women, as well as in men and children. Palsy of the facial nerve is increased in conditions like pregnancy, diabetes, myasthenia gravis, Lyme disease, and multiple sclerosis, among others. The frequency of Bell's palsy in pregnant women is about three times that of an average person. There are several theories that have not been proven as to why this is the case. They are elevation of clotting factors in the blood, total body water causing compression and swelling of the facial nerve, increased level of female hormones like estrogen and progesterone, and the weakening of immune system in the third trimester of pregnancy, leading to reactivation of many viruses. Also, Bell's palsy during pregnancy has been linked to pre-eclampsia, which is also referred to as pregnancy-induced high blood pressure. Other associated factors are hemolysis, low platelets, which is a variant of pre-eclampsia, and elevated liver enzymes. Women are also susceptible to paralysis after childbirth. Most of the women who develop Bell's palsy after pregnancy start showing signs and symptoms seven to 10 days after the date of delivery.