Isometric evaluation of rotator cuff muscles in volleyball athletes.

AIM: The aim of the present study was to evaluate, in a group of semi-professional volleyball players, the function of the rotator cuff muscles with a new specific device. METHODS: We have studied 30 asymptomatic volleyball players, 15 females and 15 males, all right handed central or lateral spikers, with some specific functional tests. Every subject was evaluated by some common clinical tests to detect shoulder range of motion (ROM) and rotator cuff muscles strength in both sides. Athletes were also submitted to an isometric bilateral shoulder strength test, with a specific upper limb dynamometer (Dynatorq), in three different positions: 1) arm 0° abducted; 2) arm 90° abducted and 90° external rotation, to try to reproduce the spike gesture; 3) arm behind the thorax, as a simulation of clinical lift-off test. All clinical and instrumental data were collected in male and female groups and, in each group, comparisons between dominant and non dominant shoulders. RESULTS: Our data show in all athletes an initial postero-superior impingement with significant weakness of the subscapularis muscle in the dominant shoulder. CONCLUSION: In all overhead athletes, and in particular in volleyball spikers, a pre-clinical diagnosis of lack of strength of the subscapularis muscle in the dominant side, before the occurrence of pain or discomfort signs, could be an important diagnostic aspect to avoid or delay the back-retraction of the joint capsule of the shoulder.

Conservative treatment vs prosthetic replacement surgery to treat 3- and 4-fragment fractures of the proximal epiphysis of humerus in the elderly patient.

Several previous studies have revealed a significant difference in the functional results obtained between conservative treatment and prosthetic replacement surgery to treat complex fractures of the proximal end of the humerus. Thus, prosthesis is the gold standard in treatment of such fractures. It is the purpose of this study to analyze the functional results obtained with the conservative treatment of 18 consecutive patients, mean age 78 years, affected with 3- and 4-fragment fractures of the proximal epiphysis of humerus. A comparison of functional results that may be obtained when prosthetic replacement is performed does not show significant differences in this category of patients. Thus, in order to limit complications, when the patient is elderly, complex fracture of the proximal epiphysis of humerus should be treated conservatively.

Compression hip screw nail-plate system for intertrochanteric fractures.

BACKGROUND: The worldwide increased incidence in fractures of the proximal end of the femur is increasing with the parallel increase in the average age of the population. The advanced age and poor physical condition of these patients render surgery necessary. METHODS: In 1999, at the Orthopaedic Clinic of the University of Siena, 56 patients were treated with the compression hip nail-plate system, a new synthesis device for the treatment of peritrochanteric fractures. The system consists of a new dynamic cephalic screw that could be combined with a plate or a femoral nail. The dynamic cephalic screw of the BCM system has a limited sliding method, impeding excursions greater than 10 mm and preventing excessive collapse of the fracture fragments that can evolve into a shortening of the limb. The canulated nail has a diameter of only 9 mm, which permits insertion into the shaft canal without reaming. RESULTS: Four patients with a follow-up of less than 3 months, 2 patients lost to control, and 1 patient who died were excluded from the study. All 49 remaining patients healed clinically and radiographically within 3 months. CONCLUSIONS: The possibility of the double combination of the screw with a plate or with an intramedullary nail permits the surgeon to have a double solution with a single instrument at hand, and offers the opportunity of changing the choice of synthesis method to implant even during surgery.

Pneumococcal septic arthritis of the shoulder. Case report and literature review.

Septic arthritis due to Streptococcus Pneumoniae appears to be relatively uncommon. Single- or clustered-case histories constitute the majority of reports on pneumococcal septic arthritis. A 70-year-old man presented with a 7-day history of pain, erythema and swelling of the left shoulder. Physical examination of the left shoulder revealed a warm, swollen, erythematous, and markedly tender to light palpation. The patient was unable to elevate his arm more than 30 degrees without pain. Arthrocentesis performed on admission produced 30 cc of grossly purulent fluid whose culture demonstrated S. Pneumoniae. The septic arthritis was treated with intravenous vancomycin and imipenem. The antibiotics were substituted when the sensitivities were known with oral ciprofloxacin and rifampycin to complete 8 weeks' total treatment. On follow-up examination 1 year later, the patient has remained afebrile and asymptomatic without evidence of increasing joint effusion or acute joint inflammation. Pneumococcal arthritis is classically described as a painful monoarticular arthritis complicating an active pneumococcal infection, generally a primary pulmonary infection. Pneumococcal arthritis appears to be predominantly a disease affecting the elderly. Clinical presentation ranges from septicemia to indolent infection with few systemic symptoms. With adequate antibiotic therapy and aspiration or drainage of the joint, the prognosis for return of normal joint function appears to be excellent. Although pneumococcal organisms are not likely causes, this bacteria should certainly be considered as a possible cause of arthritis or prosthetic infection.

Use of a modified IMHS for unstable intertrochanteric fractures.

The treatment of unstable intertrochanteric fractures in elderly osteopenic patients, especially those who cannot follow limited weight bearing instructions, is controversial. Recent publications indicate concern with excessive sliding of telescoping nail or sliding screw devices when used in these unstable intertrochanteric fractures. In our experience with the use of intramedullary hip screw (IMHS) in these fracture patterns, we have observed excessive sliding and collapse of the fracture in some patients. We modified the keyed centering sleeve by threading its internal distal third and substituted the compression screw with a custom bolt to obtain restricted sliding or rigid fixation depending on the gap between the lag screw and custom bolt. We used this modified system in static configuration to treat five patients who had an unstable intertrochanteric fracture of the femur. The length of the involved limb measured at the time of consolidation showed no shortening. In view of these results, intertrochanteric hip fractures that are unstable in patients with poor bone-stock can be fixed using the modified IMHS in a static or controlled sliding configuration.

[Osteochondroma. Report of a case with atypical localization and symptomatology]. / Osteocondroma. Presentazione di un caso a localizzazione e sintomatologia atipica.

Osteochondroma, the most common benign bone tumor, represents 10-15% of all bone tumors. It can occur frequently as solitary osteocartilagineous exostosis or rarely as hereditary multiple lesions. The most common sites of occurrence are long bones of the lower arm (50%), usually the lower end of the femur and upper end of the tibia. However, involvement of the small hand and foot bones occurs in 10% of cases, pelvis in 5%, scapulae in 4%, and spine in 2%. Symptoms are not very specific. The authors present an atypical case of osteochondroma.

Preliminary experience with a new osteosynthesis device for intertrochanteric fractures.

From 1999, at the Orthopaedic Clinic of the University of Siena, 56 patients were treated with the compression hip nail-plate system, a new synthesis device for the treatment of peritrochanteric fractures. The system consists in a new dynamic cephalic screw that could be combined with a plate or a femoral nail. The dynamic cephalic screw of the BCM system has a limited sliding method, impeding excursion greater than 10 mm and preventing excessive collapse of the fracture fragments that can evolve into a shortening of the limb. The canulated nail has a diameter of only 9 mm, which permits insertion into the shaft canal without reaming. The possibility of the double combination of the screw with a plate or with an intramedullary nail permits the surgeon to have a double solution with a single instrument at hand, and offers the opportunity of changing the choice of synthesis method to implant even during surgery.