Rotator cuff lesions: signal patterns at MR imaging.

The signal intensity patterns of rotator cuff lesions at magnetic resonance (MR) imaging were evaluated in 80 patients who had surgical correlation and in 13 asymptomatic individuals (14 shoulders). Six cadaver shoulders were examined with MR, and histologic correlation was obtained in four. All studies were performed at 1.5 T with a flexible circular surface coil. The accuracy of MR imaging in detection of full-thickness cuff tears (31 patients) was 0.95 and of partial thickness tears (16 patients), 0.84. The most common and accurate pattern for full-thickness cuff tears (22 of 31 tears) was a region of intense signal seen on T2-weighted images. Less often the torn region consisted of an extremely degenerated and attenuated tendon with moderate signal intensity or was obscured by low-signal-intensity scar. The intense signal pattern on T2-weighted images was also accurate, although a less common finding (seven of 16 cases), in the diagnosis of partial tears. Tendinitis was recognized as focal or diffuse regions of increased signal intensity or a nonhomogeneous pattern of increased signal often associated with tendinous enlargement. In some patients, manifestations of subacromial-subdeltoid bursitis was present. Tendon degeneration was also manifested as regions of increased signal intensity. Some similarity and overlap of signal patterns of partial interstitial tears, tendinitis, and tendon degeneration are observed.

Rotator cuff injuries in the throwing athlete.

Injuries to the rotator cuff have often been attributed to a progressive, degenerative process seen in the older patient. Traditionally, impingement has been implicated as the major etiologic factor. This paper will review the recent literature regarding rotator cuff injuries in the throwing athlete and examine the current thoughts on etiology and treatment.

Shoulder arthroscopy in the throwing athlete: perspectives and prognosis.

The efficacy of arthroscopy of the shoulder has been demonstrated as both a diagnostic and an operative tool. The throwing athlete has benefited greatly from this procedure. Intra-articular pathology resulting from throwing motion overuse can be visualized and treated, with relatively little morbidity and a rapid rehabilitation phase.

Vascularized bone transfer for limb salvage and reconstruction after resection of aggressive bone lesions.

At our institution from 1980 to 1985, 30 patients underwent resection of malignant or locally aggressive bone tumors, with limb salvage and reconstruction by free vascularized bone grafts. Of the 26 patients followed up for at least four months (average, 21 months), four had complications. In these four, there were three nonunions, two infections, and one stress fracture. The average duration of immobilization was 7.6 months in the lower extremity, five months in the pelvis, and 3.8 months in the upper extremity. The average time to union was 6.3 months in the lower extremity, five months in the pelvis, and five months in the upper extremity. Although the technique of oncologic reconstruction must be individualized, our experience indicates that vascularized bone grafts offer significant advantages over conventional methods in selected patients.

Functional evaluation of nonsensate free flaps to the sole of the foot.

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.

Calcaneal osteomyelitis following steroid injection: a case report.

A 71-year-old male presented with unremitting heel pain in the region of his calcaneal tuberosity. He had been previously treated with steroid injections for plantar fasciitis. Diagnostic workup revealed a calcaneal osteomyelitis which was treated with a partial calcanectomy. This case underlines the need to rule out this expected but previously unreported complication.