Deltoid contracture: a radiographic survey of bone and joint abnormalities.

We performed a radiographic survey on 12 shoulders in 11 patients with a contracture of the deltoid present since childhood (juvenile) but left untreated until adulthood and on 14 shoulders in 10 patients with the same disorder first developed in adulthood (adult type). The greater tuberosity was located either under or near the acromion in all but 1 shoulder. Flattening of the humeral head, a high-positioned greater tuberosity, posterior rotation and vertical disposition of the acromion, inferior angulation of the lateral clavicle, and anterosuperior subluxation of the humeral head were noted in 58%, 33%, 75%, 67%, and 8% of the juvenile cases, respectively. Scoliosis and narrowing of the thoracic cage were each detected in 36% of the patients with juvenile deltoid contracture. Six of the juvenile cases were treated surgically and followed-up for a lengthy period. In these cases, however, the abnormalities persisted, except for subluxation of the humeral head and abnormal proximity of the acromion and greater tuberosity. In the adult-type cases no abnormalities were observed except for scoliosis in 4 patients and anterosuperior subluxation of the humeral head in 1 shoulder. We conclude that treatment by surgical intervention should be performed at an age when spontaneous correction of the bone deformity can prevent future development of secondary arthrosis.

Posterior shoulder dislocation associated with fracture of the humeral anatomic neck: treatment guidelines and long-term outcome.

OBJECTIVE: We describe here 10 cases of posterior shoulder dislocation associated with fracture of the humeral anatomic neck. METHODS: Patients were treated according to our uniform treatment guidelines, in which only the dislocated humeral head (closed, if possible) was reduced, without any concomitant repositioning or internal fixation for fractures. RESULTS: Reduction resulted in an acceptable repositioning of the fractured fragments in all but one case. Anatomic neck fractures were impacted by applying longitudinal pressure for stabilization. Although early physiotherapy was initiated, redisplacement of the bone fragments did not occur. Of nine patients who were followed for more than 2 years, complete recovery of function was achieved in all but two patients. The completely detached humeral head became avascular necrotic accompanied by subchondral collapse in one case, and in the other case the displaced lesser tuberosity caused a decreased range of movement. CONCLUSION: We recommend initially treating such patients by either open or closed reduction of the dislocated humeral head and impaction of the fracture, with neither repositioning nor internal fixation of any of the fractured fragments. A completely detached humeral head or bone fragments displaced more than 10 mm after reduction of the dislocated humeral head contraindicate the use of this method.

Magnetic resonance imaging of suprascapular nerve palsy.

In magnetic resonance imaging of peripheral nerve palsy, changes of signal intensity are often found in paralyzed muscles. The purpose of this report is to clarify the relation between magnetic resonance imaging findings and clinical examination in suprascapular nerve palsy. The subjects were 12 patients with suprascapular nerve palsy who underwent magnetic resonance imaging examinations. In 9 of 12 cases ganglion cysts were found at the spinoglenoid notches. On T1-weighted images the signal intensity of infraspinatus muscle was high in four cases but normal in the supraspinatus muscle in all cases. On T2-weighted images the signal intensity of infraspinatus muscle was high in six cases, and that for supraspinatus muscle was high in one case. In two cases the high intensity of palsied muscles became normal after the palsy recovered. Magnetic resonance imaging is a useful examination of peripheral nerve palsy not only for the detection of ganglion cysts but also for assessing the stage of paralysis.

The relation between the position of the glenohumeral joint and the intraarticular pressure: an experimental study.

Intraarticular pressures of the glenohumeral joint were measured in 15 cadaveric shoulders during passive movement of the humerus and under various inferiorly directed loads on the humerus. With a fiber-optic transducer-tipped catheter and an airtight connector, the basic intraarticular pressure was measured directly without injection of any physiological saline solution into the joint before measurement. The initial intraarticular pressures were all negative with a mean value of -67.8mm Hg. During abduction-adduction movement the minimal intraarticular pressure was measured at 20 degrees of humeral abduction. During rotation the minimal intraarticular pressure was observed at neutral humeral rotation. The intraarticular pressure decreased nearly linearly with increasing inferior load on the humerus. These results indicate that the intraarticular pressure takes part in stabilization of the glenohumeral joint, and the negative intraarticular pressure of the glenohumeral joint induces the maximal stabilizing effect at 20 degrees of humeral abduction and neutral humeral rotation.