Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography.

OBJECTIVE: To study the correlation between improvement of shoulder motion and shoulder joint space capacity determinated by arthrography. DESIGN: Case series. SETTING: General community hospital. PATIENTS: Twelve patients with clinically diagnosed frozen shoulder without rotator cuff tear. All subjects were divided as "primary" and "secondary" according to spontaneous onset or not, and "acute" or "chronic" depending on whether duration of disease was less than 2 months or longer. INTERVENTIONS: Outpatient rehabilitation programs, including physical modalities, exercise intervention, and regular weekly outpatient clinic follow-up. MAIN OUTCOME MEASURES: Shoulder range of motion (ROM) and joint space capacity in shoulder arthrography. RESULTS: In acute patients, the joint space capacity increased significantly after treatment (t = 2.82; p < .05). Increased joint space capacity was most significantly correlated with improvement in external rotation (r = .77, p < .05), followed by abduction (r = .43, p > .05), but was poorly correlated with flexion and internal rotation. In chronic patients, both primary and secondary groups, there was no obvious joint space capacity increase despite significant shoulder motion improvement. Follow-up arthrograms showed the reappearance and/or enlargement of the axillary recess and smoother capular margins in all the patients except one chronic case (disease duration for 1 year). These findings were more obvious in acute than in chronic patients. CONCLUSIONS: For frozen shoulder, generally described as "adhesive capsulitis," the adhesion was reversible in the acute stage. The increase of joint space capacity was significant and was correlated with improvement of external rotation. In chronic patients, ROM restoration occurred independent of change in joint space capacity, which increased slightly. The stretching of other contracted soft tissues around the shoulder, in addition to the adhesive capsule, may contribute to the recovery of chronic frozen shoulder.

Evaluation of iliopsoas compartment disorders by computed tomography.

BACKGROUND: Iliopsoas compartment lesion frequently goes undiagnosed at clinical presentation. Therefore, even delayed diagnosis may depend on radiographic techniques. Computed tomography (CT) can play an important role in the identification and localization of these lesions. This report concerns the experience of using CT to evaluate the iliopsoas compartment disorder. METHODS: Retrospective review of CT scans for 42 patients who had abnormalities of the iliopsoas compartment revealed that inflammation was responsible in 20, hemorrhage in 8, and tumor in 14 patients. Diagnoses were proven by surgery or biopsy/aspiration in all cases except in five cases whose CT findings correlated with their clinical pictures. A comparison was made among the surgical data, the CT and plain abdominal films. In addition, a comparative evaluation of CT features was also made. RESULTS: By using a hypodense area for the diagnosis of psoas abscess, the sensitivity, specificity and accuracy of CT were 100%, 77%, and 88%, respectively. By using a diffuse involvement of the entire muscle for the diagnosis of hemorrhage, the sensitivity, specificity and accuracy of CT were 63%, 62%, and 62% respectively. By using a bone destruction for the diagnosis of tumors, the sensitivity, specificity and accuracy of CT were 79%, 39%, and 69%, respectively. Evaluation of the iliopsoas compartment lesions was 91% sensitive by CT and 40% sensitive by plain X-ray film. CONCLUSIONS: It is difficult to differentiate iliopsoas abscesses, hematomas and neoplasms without knowing the clinical history. However, when coupled with percutaneous aspiration biopsy, CT has proved to be an effective, rapid means to diagnose and guide the therapy of psoas lesions.

Brain abscesses in children--a cooperative study of 83 cases.

This study reviews our experience in 83 cases of brain abscesses in children diagnosed at seven teaching hospitals during the 10-year period from June 1978 to July 1987. The average age of the patients was 7 years, with 12% of them less than 1 year old. The male-to-female ratio was 1.7:1. Of the brain abscesses, 90.4% were detected by CT brain scan. A total of 50.6% patients had congenital heart disease, and 20.4% patients had sepsis and/or meningitis. Only 6% cases had ear, nose, and throat infection. Sixty-eight (81.9%) patients received a combination of antibiotics and surgical treatment. The cerebral abscesses were totally excised in 26 cases, aspirated and partially excised in 6, and aspirated in 32. Sixty patients had pus cultures from the cerebral abscesses. Organisms were isolated in 29 (49.2%) of them. Streptococcus was by far the most common organism. The overall outcome was: 49 (59%) alive; 16 (19.3%) dead; 18 (21.7%) lost to follow-up. Among the 16 mortalities, the causes of death were due to failure to treat the diseases causing the brain abscesses. We had a better outcome in patients whose cerebral abscesses were totally excised or whose abscesses were aspirated, and in patients who were older than 1 year of age.