Atypical Ulcerative Necrobiosis Lipoidica Diabeticorum: A Case Study.

Necrobiosis lipoidica is a granulomatous skin condition commonly associated with diabetes. When associated with diabetes mellitus, the name expands to necrobiosis lipoidica diabeticorum (NLD). In these patients, this rare condition has an incidence rate of 0.3% to 1.6%. The cause of NLD remains unknown even though many speculations exist in the medical literature. The treatment of this condition has most researchers agreeing on the use of topical steroids for the anti-inflammatory effect on NLD; however, the role of glucose control in the treatment of this disorder has been debatable. The following case presents a patient who, despite better glucose control, did not improve until the introduction of doxycycline.

The Oblique Mattress Lasso-Loop Stitch for Arthroscopic Capsulolabral Repair.

Arthroscopic capsulolabral repair during shoulder stabilization surgery requires the use of suture anchors. Several arthroscopic suturing techniques for capsulolabral repair have been described, and each carries very specific advantages and disadvantages with regard to risk, patient satisfaction, and functional outcomes. The purpose of this report is to describe the oblique mattress lasso-loop stitch. This stitch (1) provides strong initial fixation of the labrum, (2) establishes labral height and allows for larger capsular plication if needed, (3) prevents the suture from cutting through the radial fibers of the glenoid labrum, (4) prevents knot migration to the articular side and loosening of the knot, and (5) requires fewer implants and preserves glenoid bone stock by increasing the amount of labrum and capsule that can be reattached to the glenoid with a single-loaded suture anchor.

Arthroscopic Repair of Inferior Labrum Anterior to Posterior Lesions of the Shoulder Using a Combined "Double-Pulley" Simple Knot Technique.

Inferior labrum anterior to posterior lesions as an isolated injury or as part of an extensive traumatic labral tear are uncommon and may present as multidirectional instability of the shoulder. These lesions are hard to visualize radiographically and many times are diagnosed only during surgery. Arthroscopic repair of these lesions requires advanced arthroscopic skills and is required for restoration of glenohumeral stability. We report a combined double-pulley simple knot technique that anatomically reconstructs the inferior labrum while overcoming the typical technical challenges, providing a large footprint for healing along the inferior glenoid rim and minimizing the amount of suture material in direct contact with the articular cartilage and the risk of knot migration.

Atypical Pectoralis Major Muscle Wasting in a Recreational Weight Lifter.

Pectoralis major injuries are relatively uncommon and can pose a diagnostic challenge. Deformity and weakness of this muscle in weight lifters is typically due to traumatic tendon rupture and often requires surgical repair. However, there are other less common etiologies that can mimic the clinical presentation of pectoralis major wasting and weakness that require different treatment approaches. This article describes a case of a 48-year-old recreational weight lifter who presented with severe pectoralis major wasting and weakness secondary to isolated mononeuropathy of the lateral pectoral nerve possibly due to Parsonage Turner syndrome. The patient was treated nonoperatively and achieved full recovery 18 months after onset. Parsonage Turner syndrome should be included in the differential diagnosis of patients with atraumatic weakness and wasting of the pectoralis major muscle and dysfunction. [Orthopedics. 2016; 39(4):e756-e759.].

Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Coracoid Cerclage Technique.

This technical note discusses the arthroscopic coracoid cerclage technique for double-bundle coracoclavicular ligament reconstruction in patients with nonacute symptomatic high-grade acromioclavicular separation injuries. This technique allows for an anatomic graft reconstruction of the coracoclavicular ligaments through an arthroscopic approach without the requirement to drill into the coracoid process. Early results are promising with high patient satisfaction and excellent reported clinical and radiographic outcomes. We believe this technique to be an anatomic, less invasive alternative to a complex shoulder procedure while sparing the structural integrity of the coracoid process and also allowing the surgeon to convert easily to a more traditional open surgical technique as necessary.