Glenohumeral joint translation and muscle activity in patients with symptomatic rotator cuff pathology: An ultrasonographic and electromyographic study with age-matched controls.

OBJECTIVES: To determine whether patients with symptomatic rotator cuff pathology had more glenohumeral joint translation and different patterns of rotator cuff muscle activity compared to controls. DESIGN: Repeated measurements of glenohumeral translation and muscle activity in two positions and six testing conditions in two groups. METHODS: Twenty participants with a symptomatic and diagnosed rotator cuff tear and 20 age, and gender matched controls were included. Neuromuscular activity was tested by inserting intramuscular electrodes in the rotator cuff muscles. Anterior and posterior glenohumeral translations were measured using real time ultrasound in testing conditions (with and without translation force, with and without isometric internal and external rotation), in two positions (shoulder neutral, 90° of abduction) and two force directions (anterior, posterior). RESULTS: Symptomatic pathology group demonstrated increased passive glenohumeral translation with posterior translation force (p<0.05). Overall, rotator cuff muscle contraction in the pathology group limited joint translation in a similar manner to the control group, but they did not show the normal direction specific pattern in the neutral posterior position (p<0.03). The pathology group demonstrated reduced EMG activity in the upper infraspinatus muscle relative to the reference position (p<0.02) with anterior translation force and in the supraspinatus (p<0.05) muscle with anterior and posterior translation force in the abducted position. CONCLUSIONS: Symptomatic pathology resulted in increased passive glenohumeral joint translation. Although there were some reductions in muscle activity with injury, their rotator cuff still controlled glenohumeral translation. These results highlight the need to consider joint translation in the assessment and management of patients with rotator cuff injury.

Surgical outcome in patients treated for hemangioma during infancy, childhood, and adolescence: a retrospective review of 44 consecutive patients.

BACKGROUND: Hemangiomas are the most common tumors in infancy and childhood and account for 7% of benign soft tissue tumors. Diagnosis is usually made in infancy or childhood. There are only a few reports on the surgical treatment of these lesions, likely because the lesions are quite vascular, have a tendency to infiltrate into the muscle and other tissues, and the recurrence rate is quite high. METHODS: We reviewed the outcome of surgical treatment on 44 consecutive children and adolescents with 47 surgically treated hemangiomas. Hemangiomas involving the face and the head were excluded. RESULTS: Eleven lesions were surgically treated before the age of 5 years, 20 lesions between the ages of 5 and 12 years, and 16 lesions were treated after the age of 12 years. Eleven lesions had intralesional resection, 33 lesions underwent marginal resection, 2 lesions were managed with wide resection, and 1 lesion underwent radical resection. The overall recurrence rate was 22.2%. CONCLUSIONS: In the pediatric population, it is desirable to perform definitive treatment whenever possible, thereby minimizing morbidity, both functional and psychological. Asymptomatic lesions should be monitored to confirm the diagnosis and to look for signs of progression. Symptomatic lesions can be treated with surgical excision if this does not result in significant functional impairment. A marginal resection may be used to treat most superficial soft tissue tumors. Intramuscular hemangiomas pose a more difficult therapeutic problem. When the lesion is limited in size, it may be treated with wide local excision. However, if the lesion is more diffusely spread into the muscle unit, the morbidity created by extensive muscle resection has to be weighed against the morbidity of the condition or alternative treatment methods. Whenever possible, a wide marginal resection should be carried out to minimize the risk of recurrence and avoid further surgical procedures. We recommend prolonged follow-up of these patients because 7% of the patients included in this study required late review due to multiple recurrences of these lesions. LEVEL OF EVIDENCE: Level IV (case series).

Hip displacement in cerebral palsy.

BACKGROUND: Hip displacement is considered to be common in children with cerebral palsy but the reported incidence and the proposed risk factors vary widely. Knowledge regarding its overall incidence and associated risk factors can facilitate treatment of these children. METHODS: An inception cohort was generated from the Victorian Cerebral Palsy Register for the birth years 1990 through 1992, inclusive, and multiple data sources pertaining to the cohort were reviewed during 2004. Gross motor function was assessed for each child and was graded according to the Gross Motor Function Classification System (GMFCS), which is a valid, reliable, five-level ordinal grading system. Hip displacement, defined as a migration percentage of >30%, was measured on an anteroposterior radiograph of the pelvis with use of a reliable technique. RESULTS: A full data set was obtained for 323 (86%) of 374 children in the Register for the birth years 1990 through 1992. The mean duration of follow-up was eleven years and eight months. The incidence of hip displacement for the entire birth cohort was 35%, and it showed a linear relationship with the level of gross motor function. The incidence of hip displacement was 0% for children with GMFCS level I and 90% for those with GMFCS level V. Compared with children with GMFCS level II, those with levels III, IV, and V had significantly higher relative risks of hip displacement (2.7, 4.6, and 5.9, respectively). CONCLUSIONS: Hip displacement is common in children with cerebral palsy, with an overall incidence of 35% found in this study. The risk of hip displacement is directly related to gross motor function as graded with the Gross Motor Function Classification System. This information may be important when assessing the risk of hip displacement for an individual child who has cerebral palsy, for counseling parents, and in the design of screening programs and resource allocation.

Cerebral palsy in Victoria: motor types, topography and gross motor function.

OBJECTIVES: To study the relationships between motor type, topographical distribution and gross motor function in a large, population-based cohort of children with cerebral palsy (CP), from the State of Victoria, and compare this cohort to similar cohorts from other countries. METHODS: An inception cohort was generated from the Victorian Cerebral Palsy Register (VCPR) for the birth years 1990-1992. Demographic information, motor types and topographical distribution were obtained from the register and supplemented by grading gross motor function according to the Gross Motor Function Classification System (GMFCS). RESULTS: Complete data were obtained on 323 (86%) of 374 children in the cohort. Gross motor function varied from GMFCS level I (35%) to GMFCS level V (18%) and was similar in distribution to a contemporaneous Swedish cohort. There was a fairly even distribution across the topographical distributions of hemiplegia (35%), diplegia (28%) and quadriplegia (37%) with a large majority of young people having the spastic motor type (86%). CONCLUSIONS: The VCPR is ideal for population-based studies of gross motor function in children with CP. Gross motor function is similar in populations of children with CP in developed countries but the comparison of motor types and topographical distribution is difficult because of lack of consensus with classification systems. Use of the GMFCS provides a valid and reproducible method for clinicians to describe gross motor function in children with CP using a universal language.