ABSTRACT
Unilateral adrenal hemorrhage is a rare but deadly complication that can occur secondary to causes such as trauma and metastasis. A 55-year-old male with a history of metastatic lung adenocarcinoma and deep vein thrombosis managed with rivaroxaban presented with acute right abdominal and flank pain. A CT angiogram of the abdomen showed a retroperitoneal hematoma around the right adrenal gland, consistent with a unilateral adrenal hemorrhage. An MRI showed no signs of adrenal metastasis and the patient had no history of trauma. The volume of the hematoma did not change in size and the patient was hemodynamically stable, which only prompted supportive management. Anticoagulant use is a known risk factor for bilateral adrenal hemorrhage. However, this case demonstrates that unilateral adrenal hemorrhage can also be a complication, one that usually appears subclinically. It can present non-specifically but may progress to a more fatal bilateral hemorrhage. Hence, it demands a high index of suspicion for patients on systemic anticoagulation.
ABSTRACT
BACKGROUND: Capsulectomy is performed during hip arthroscopic surgery in young adult patients with hip pain to improve intraoperative visualization. The stability of the hip joint after anterior capsulectomy is relatively unknown. PURPOSE: To evaluate anterior hip stability in capsular sectioned states with a labral injury to test whether the load required for anterior translation would decrease with greater capsular injuries. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen hips from 8 of 10 human cadaveric pelvises (mean age, 54.25 years) were prepared/mounted onto a custom-built fixture and tested in 5 states: intact capsule, intact labrum (all intact); sutured capsule, intact labrum (sutured intact); sutured capsule, 1-cm partial labrectomy (sutured labrectomy); partial capsulectomy, 1-cm partial labrectomy (partial capsulectomy); and total capsulectomy, 1-cm partial labrectomy (total capsulectomy). Each hip was tested in a neutral position with a 20-N compressive force. The load at 12 mm of anterior translation was recorded for each state after 2 preconditioning trials. RESULTS: A repeated-measures analysis of variance with Bonferroni adjustment showed no difference between the all-intact versus sutured-intact states and demonstrated no significant difference between the sutured-intact and sutured-labrectomy states. There were significant differences between the sutured-labrectomy and partial capsulectomy (P = .01), sutured-labrectomy and total capsulectomy (P < .001), and partial capsulectomy and total capsulectomy (P = .04) states. CONCLUSION: The findings demonstrate that the capsule/labrum plays an important role in anterior hip stability and that the iliofemoral ligament is crucial for preventing anterior translation in labral-injured states. In addition, the ischiofemoral and pubofemoral ligaments provide resistance to anterior translation in iliofemoral- and labral-deficient states. Intraoperative capsulectomy should be avoided in patients with large, irreparable labral tears to prevent postoperative anterior hip instability. CLINICAL RELEVANCE: This study quantifies the roles of the capsulolabral structures in anterior hip stability and demonstrates the importance of maintaining/repairing them during hip arthroscopic surgery.
ABSTRACT
PURPOSE: This study compared the amount of glenohumeral abduction during arm abduction in the affected and unaffected shoulders of 3 groups of patients with shoulder instability: failed surgical stabilization, successful surgical stabilization, and unstable shoulder with no prior surgical intervention. METHODS: All patients underwent bilateral shoulder computed tomography scans in 3 positions: 0° of abduction and 0° of external rotation (0-0 position), 30° of abduction and 30° of external rotation (30-30 position), and arms maximally abducted (overhead position). Three-dimensional computed tomography reconstruction was performed for both shoulders in all 3 positions. A specialized coordinate system marked specific points and directions on the humerus and glenoid of each model. These coordinates were used to calculate the glenohumeral abduction for the normal and affected sides in the 0-0, 30-30, and overhead positions. RESULTS: Thirty-nine patients with shoulder instability were included, of whom 14 had failed surgical repairs, 10 had successful surgical repairs, and 15 had unstable shoulders with no prior surgical intervention. In the overhead position, patients with failed surgical intervention had significantly less glenohumeral abduction in the failed shoulder (95.6° ± 12.7°) compared with the normal shoulder (101.5° ± 12.4°, P = .02). Patients with successfully stabilized shoulders had significantly less glenohumeral abduction in the successfully stabilized shoulder (93.6° ± 10.8°) compared with the normal shoulder (102.1° ± 12.5°, P = .03). Unstable shoulders with no prior surgical intervention (102.1° ± 10.3°) did not differ when compared with the normal shoulders (101.9° ± 10.9°, P = .95). CONCLUSIONS: Surgical intervention, regardless of its success, limits the amount of abduction at the glenohumeral joint. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
