ABSTRACT
BACKGROUND: Two recent experimental studies evaluated the influence of shoulder rotation on neck-shaft angle, with conflicting results. However, there have been no clinical studies of whether this angle varies in different shoulder positions. The present study aimed to determine whether shoulder rotation affects neck-shaft angle on standard radiographs in patients with complaints of shoulder pain. HYPOTHESIS: Shoulder rotation does not affect neck-shaft angle. MATERIALS AND METHODS: A prospective study was conducted in selected patients with shoulder pain. Three true anterior-posterior radiographic views were obtained: in neutral rotation, 30° external rotation, and internal rotation with patient's arm in a sling. The X-rays were evaluated by three shoulder and elbow surgeons. Inter- and intra-observer reliability was evaluated by intraclass correlation coefficient (ICC). RESULTS: Neck-shaft angle on true AP view did not differ between neutral rotation and 30° external rotation: 132±6° and 130±9°, respectively (P>0.999). In internal rotation with the hand resting on the abdomen, neck-shaft angle was 145±6°: i.e., significantly different (P<0.001) to the other two positions. Intra- and inter-observer correlation demonstrated excellent reliability. CONCLUSIONS: Radiographic neck-shaft angle was significantly different in internal rotation with the patient's arm in a sling, compared with views in neutral or 30° external rotation. Intra- and inter-observer correlation showed excellent reliability. LEVEL OF EVIDENCE: II, comparative prospective study.
Subject(s)
Patient Positioning/methods , Rotation , Shoulder Pain/diagnostic imaging , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Observer Variation , Prospective Studies , Radiography , Reproducibility of Results , Shoulder Joint/surgery , Shoulder Pain/pathology , Young AdultABSTRACT
Osteoid osteoma is a benign tumor that is rarely found in the scapula. We report a clinical case involving a 36-year-old female patient who suffered from progressive pain in her right shoulder for 1 year. This patient was initially diagnosed with impingement syndrome and was treated unsuccessfully with medication and physical therapy for approximately 2 months. Based on imaging exams, a juxta-articular osteoid osteoma of the glenoid was identified. The patient underwent a shoulder arthroscopy that included tumor removal and treatment of the resulting chondral lesion. At 6-, 12- and 36-month assessments, the patient was asymptomatic, with a normal range of motion and experienced a pain intensity corresponding to 0 points on the Visual Analog Scale (VAS) and 35 points on the University of California, Los Angeles (UCLA) Scale. A postoperative MRI indicated the absence of any residual tumor tissue or inflammatory signs. We believe that the approach described in this paper allows juxta-articular osteoid osteomas to be accessed in a minimally invasive manner and permits not only adequate resection but also the treatment of chondral lesions that could remain after tumor resection.
Subject(s)
Arthroscopy/methods , Bone Neoplasms/surgery , Osteoma, Osteoid/surgery , Scapula , Adult , Bone Neoplasms/complications , Female , Humans , Magnetic Resonance Imaging , Osteoma, Osteoid/complications , Pain , Pain Measurement , Physical Therapy Modalities , Scapula/surgery , Shoulder Pain/etiologyABSTRACT
BACKGROUND: Few biomechanical studies have assessed the resistance of the ligamentous structures of the sternoclavicular joint, and none have reproduced the physiological movements of the joint. Determining the structures that are injured in sternoclavicular dislocations is important for the surgical planning of acute or chronic ligament reconstruction. METHODS: Forty-eight joints from 24 human cadavers were studied, and they were divided into 4 groups of 12 joints each (retraction, protraction, depression and elevation). Biomechanical testing assessed primary and secondary failures. The mechanical resistance parameters between movements that occurred on the same plane (depression versus elevation, protraction versus retraction) were compared. RESULTS: The posterior sternoclavicular ligament was the most injured structure during the protraction test, but it was not injured during retraction. The anterior sternoclavicular ligament was the most affected structure during retraction and depression. The costoclavicular ligament was the most affected structure during elevation. Joint resistance was significantly greater during protraction movements when compared to retraction (P<0.05). CONCLUSION: The anterior sternoclavicular ligament was the most affected structure during retraction and depression movements. During protraction, lesions of the posterior sternoclavicular ligament were most frequent during elevation, and the costoclavicular ligament was the most frequently injured ligament. The resistance of the sternoclavicular joint was significantly greater during protraction movement when compared to retraction. LEVEL OF EVIDENCE: IV, basic science, biomechanics, cadaver model.
Subject(s)
Joint Dislocations/surgery , Ligaments, Articular/physiopathology , Orthopedic Procedures , Plastic Surgery Procedures/methods , Range of Motion, Articular/physiology , Sternoclavicular Joint/physiopathology , Cadaver , Humans , Joint Dislocations/physiopathology , Ligaments, Articular/surgery , Sternoclavicular Joint/surgeryABSTRACT
Quinze pacientes (um caso bilateral - 16 escápulas), com crepitaçao escapulotorácica sintomática rebelde aos tratamentos conservadores, foram operados de junho de 1983 a maio de 1994. Dez eram do sexo masculino e cinco, do feminino; a idade mínima foi de nove anos, a máxima, de 53 anos (média de 20 anos e seis meses); o tempo de evoluçäo foi de três meses e dez anos. O RX simples mostrou osteocondroma em três, margem superior e medial da escápula salientes em um, escápula alta em um, hipoplásica em um e, em nove, ausência de alteraçöes. A TAC feita em oito mostrou osteocondroma em três, irregularidade do ângulo e margens superior e medial da escápula em um, assimetria muscular do serrátil em dois e, em dois, foi normal. As indicaçöes para o tratamento cirúrgico foram dor e desconforto. Na operaçäo, foram identificadas alteraçoes ósseas escapulares relacionadas com a crepitaçäo somente em oito escápulas (irregularidade do ângulo e margem superior e medial em quatro, osteocondroma em três, neoarticulaçäo escapulocostal em um). Foi feita exérese dos três osteocondromas, ressecçäo do ângulo superior e de toda a margem medial da escápula em oito e só do ângulo e parte superior da margem medial em cinco. O resultado foi bom em 15 escápulas (ausência de dor e funçäo normal), incluindo o caso bilateral; mau em um (dor residual persistente).
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Bone Neoplasms/surgery , Osteochondroma/surgery , Respiratory Sounds/physiopathology , Follow-Up Studies , Treatment OutcomeABSTRACT
We concur with the idea that congenital muscular dystrophy (CMD) is a distinct clinical entity, and report 17 patients (2 negroes and 15 whites; 12 M and 5 F; median age 6 years, range 1 to 24 years) with genetic, clinical, laboratorial, electrophysiological and histochemical studies. All our cases have an inheritance compatible with an autosomal recessive pattern. A decrease in fetal movements was reported by 57% of the mothers, generalized hypotonia at birth was present in 82%, limb girdle and neck weakness, absent or decreased deep tendon reflexes, and limb contractures were present in all. Severe muscular wasting was found in 41%. Calf pseudo-hypertrophy was observed in one patient. A patient was severely mentally retarded and another was borderline. During a 30-month follow-up, the muscle weakness of the majority remained essentially unchanged but the degree of motor activity deteriorated and was proportional to the worsening of the limb contractures. Serum CK levels were normal or increased to a maximum of 8 times. The electromyogram was myopathic in 74%, neurogenic in 13% and normal in 13%. CT scans showed a symmetrical white matter hypodensity in the hemispheres in 8 cases. All but 5 patients were operated upon to release the limb contractures and all were submitted to physical therapy. The contractures recurred in 4 patients submitted to surgery and were probably related to the cessation of physical therapy.
Subject(s)
Muscular Dystrophies/congenital , Adolescent , Adult , Child , Child, Preschool , Female , Fetal Movement , Humans , Infant , Male , Motor Activity , Muscular Dystrophies/physiopathology , Muscular Dystrophies/therapy , Physical Therapy Modalities , PrognosisABSTRACT
Descrevemos 17 pacientes (12m, 5f) com idades que variaram de 1 a 24 anos (mediana 6 anos) com distrofia muscular congênita (DMC), que foram estudados do ponto de vista genético, clínico, laboratorial, eletrofisiológico e anátomo-patológico. A apresentaçäo segundo a herança foi a forma esporádica (76,5%) ou possivelmente autossômica recessiva (23,5%). A diminuiçäo da movimentaçäo fetal intra-uterina foi referida em 57% dos casos, hipotomia neonatal em 82% e retardo no desenvolvimento motor em 88,2%. Fraqueza muscular, diminuiçäo dos reflexos profundos e contraturas articulares estavam presentes em todos os casos. A piora na funçäo motora estava muito relacionada ao aumento ou aparecimento de novas retraçöes articulares. A CK nuna ultrapassou valores acima de 8 vezes o normal. O EN MG foi de padräo miopático em 73,3%, neuropático em 13,3% e normal em 13,3% dos casos. Aspectos tomográficos com hipodensidade da substância branca subcortical foram vistos em 8 casos. Ao tratamento impôs-se fisioterapia adequada e cirurgia corretiva das deformidades articulares. Novas contraturas desenvolveram-se mais tarde e estavam relacionadas freqüêntemente a fisioterapia insuficiente
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Adult , Humans , Male , Female , Muscular Dystrophies/congenital , Fetal Movement , Motor Activity , Muscular Dystrophies/genetics , Muscular Dystrophies/physiopathology , Muscular Dystrophies/therapy , Physical Therapy Modalities , PrognosisABSTRACT
A thorough histological description of 17 patients with congenital muscular dystrophy (CMD) is presented. The biopsies were performed in the left superficial deltoid muscle and processed with histochemical techniques. All samples showed connective tissue proliferation, changes in the internal architecture, necrosis, increase of adipose tissue, macrophagia, fiber regeneration and segmentation, central nuclei, and type I fiber predominance. The histological hallmarks of this entity are the marked endomysial connective tissue proliferation that frames one fiber from the other, and the important changes in the fiber's internal architecture. Those two abnormalities are extremely helpful to differentiate, on histological grounds, CMD from limb girdle muscular dystrophy and Duchenne/Becker muscular dystrophy. CMD presents a particular natural course and should be individualized apart from other muscular dystrophies.
Subject(s)
Muscular Dystrophies/congenital , Muscular Dystrophies/pathology , Diagnosis, Differential , Humans , Muscles/innervation , Muscles/pathology , Nerve Fibers/pathologyABSTRACT
Twenty-two chronic alcoholic patients were assessed by neurologic examination and muscle biopsy. The patients manifested proximal muscular weakness to a variable extent. One case presented as an acute bout of myopathy, according to the Manual Muscle Test, MMT. The most prominent histologic feature observed was muscle atrophy (95.3%) better evidenced through the ATPase stain with the predominance of type II A fibers (71.4%). Lack of the mosaic pattern (type grouping) seen in 76% of the cases and an important mitochondrial proliferation with intrasarcoplasmatic lipid accumulation in 63% of the patients. In case of acute presentation of muscle weakness the pathological substrate is quite different, i.e. presence of myositis mainly interstitial characterized by lymphoplasmocytic infiltrate and several spots of necrosis like Zencker degeneration. Based on histologic criteria, our data suggest that: the main determinant of muscle weakness seen in chronic alcoholic patients is neurogenic in origin (alcoholic polyneuropathy); the direct toxic action of ethanol under the skeletal muscle is closely related to the mitochondrial metabolism; the so-called acute alcoholic myopathy has probably viral etiology.
Subject(s)
Alcoholism/pathology , Muscles/pathology , Muscular Diseases/pathology , Adult , Ethanol/adverse effects , Female , Humans , Male , Middle Aged , Muscular Diseases/etiology , Necrosis , Staining and LabelingABSTRACT
Vinte e dois pacientes alcoólatras crônicos foram submetidos a exame clínico neurológico e biópsia muscular. Eles apresentavam graus variáveis de fraqueza muscular proximal (cinturas escapular e pélvica), tendo um deles evoluído com quadro agudo de miopatia (avaliaçäo pelo 'Manual Muscle Test', MMT). A principal alteraçäo histológica observada é melhor evidenciada pela coloraçäo da ATPase: atrofia muscular (95,3%), predominando nas fibras do tipo II A (71,4%) e, em 76% dos casos, alteraçäo da imagem em mosaico à custa de agrupamentos de fibras musculares de mesmo tipo histoquímico ('type-grouping'). Secundariamente, em 63% dos casos, observa-se proliferaçäo mitocondrial e conseqüente acúmulo lipídico intra-sarcoplasmático. No caso de instalaçäo aguda da fraqueza muscular, o substrato anátomo-patológico é completamente diferente: presença de miosite, predominantemente intersticial, caracterizada por infiltrado linfoplasmocitário e numerosas imagens de necrose tipo degeneraçäo cérea de Zencker. Baseando-se em critérios histológicos, nossos dados sugerem que: a principal gênese da fraqueza muscular observada em pacientes alcoólatras crônicos tem natureza neurogência (polineuropatia alcoólica); a atuaçäo tóxica direta do etanol sobre o músculo esquelético está intimamente relacionada ao metabolismo mitocondrial; a chamada miopatia aguda alcoólica tenha etiologia inflamatória, do tipo viral
