Asymptomatic HyperCKemia: A Diagnostic Trap.

Elevated creatine kinase (CK) levels are the most sensitive indicator of muscle injury. Levels >5000 U/L warns physicians to initiate aggressive hydration and prevent renal failure. We present a rare case of asymptomatic hyperCkemia with levels >80 times the upper limit of normal (ULN), refractory to fluid resuscitation. Our patient was found to have elevated macroenzymes- macroCkemia, causing decreased clearance of CK. The objective of this case report is to bring to attention a rare and benign cause of CK elevation which can lead to diagnostic and therapeutic errors.

Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review.

BACKGROUND: The benefits of acromioplasty in treating rotator cuff disease have been debated. We systematically reviewed the literature regarding whether acromioplasty with concomitant coracoacromial (CA) release is necessary for the successful treatment of full-thickness rotator cuff tears. MATERIALS AND METHODS: We identified randomized controlled trials that reported on patients who underwent rotator cuff repair with or without acromioplasty and used descriptive statistics to summarize the findings. RESULTS: Four studies fulfilled the inclusion criteria. They reported on 354 patients (mean age, 59 years; range 3-81 years) with a mean follow-up of 22 months (range 12-24 months). There were two level-I and two level-II studies. Two studies compared rotator cuff repair with versus without acromioplasty, and two studies compared rotator cuff repair with versus without subacromial decompression (acromioplasty, CA ligament resection, and bursectomy). The procedures were performed arthroscopically, and the CA ligament was released in all four studies. There were no statistically significant differences in clinical outcomes between patients treated with acromioplasty compared with those treated without acromioplasty. CONCLUSIONS: This systematic review of the literature does not support the routine use of partial acromioplasty or CA ligament release in the surgical treatment of rotator cuff disease. In some instances, partial acromioplasty and release of the CA ligament can result in anterior escape and worsening symptoms. Further research is needed to determine the optimum method for the operative treatment of full-thickness rotator cuff tears. LEVEL OF EVIDENCE: Level I, systematic review of level I and II studies.

Stress reaction of the humerus in a high school baseball player.

The patient was an 18-year-old high school baseball pitcher with a chief complaint of right (dominant) arm pain in the region of his right distal humerus that began 8 weeks earlier. Conventional radiographs were obtained, which were interpreted as normal. As a result, magnetic resonance imaging was obtained, which showed a hyperintense bone marrow signal in the distal humerus on fluid-sensitive sequences, which was consistent with a stress reaction of the distal humerus.

Scapula fracture and os acromiale after reverse total shoulder arthroplasty.

An 80-year-old woman underwent a right reverse total shoulder arthroplasty for cuff tear arthropathy with no complications. She was discharged 3 days after surgery with well-controlled pain. However, 6 days postoperatively, she reported the onset of excruciating pain in her right shoulder, and conventional radiographs, including an axillary radiograph, were obtained.