Irreducible anterior shoulder dislocation with interposition of the lesser tuberosity and subscapularis.

Anterior shoulder dislocation is the most common joint dislocation, unreducible dislocations however are a rare occurrence. The causes of the irreducibility vary, with interposition of soft tissues or bony fragments within the glenohumeral joint being the usual culprits. We present the case of an irreducible anterior shoulder dislocation with concomitant greater and lesser tuberosity fractures, with interposition of the subscapularis and lesser tuberosity thereby preventing reduction. We present the case of a 54-year-old female presenting with a left shoulder fracture dislocation after a fall from a 1.8-meter ladder. Patient was taken to the operating room after undergoing a CT scan. Attempts of closed reduction after administration of general anesthesia were unsuccessful. Open reduction and internal fixation with plate and screws was done through a deltopectoral approach. Intra-operatively, the lesser tuberosity and the subscapularis were found to be the cause of the irreducibility of the dislocation. At the latest follow up at 6 months post-op, the patient had regained a normal ROM with a good function. The vast majority of shoulder fracture dislocations are easily reducible, with only a limited number of case reports discussing irreducible fracture-dislocations. The causes of the irreducibility comprise interposition of soft tissue or bony fragments within the glenohumeral joint such as avulsed labrum or tendons, glenoid or humeral bony fragments interposition, and tensioning of nerves or tendons such as the biceps or subscapularis around the humeral head. CT scans are in our opinion very important for proper surgical planning when needed and for possible identification of an irreducible dislocation. Orthopedic surgeons should be aware that difficult closed reductions of the glenohumeral joint, whenever encountered, should raise the possibility of interposition of bony fragments or soft tissues where surgical treatment might be mandatory.

A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons.

The long head of the biceps tendon is stabilized in the intertubercular groove by several anatomical structures. Dislocation or identification of the biceps tendon into or within the subscapularis tendon is very rarely mentioned in the literature. This is the first reported case of bilateral identification of the long head of the biceps tendons within the lateral subscapularis tendon. This report presents the case of a 51-year-old male patient who presented for bilateral shoulder pain. After failure of conservative treatment, MRIs were done which identified bilateral biceps tendons within the subscapularis tendons, with a concomitant supraspinatus tear on the right side. He underwent right shoulder arthroscopic biceps tenotomy, with supraspinatus repair. The symptoms of the left shoulder diminished as a result of the continuation of conservative treatment. The long head of the biceps tendon normally travels through the intertubercular groove and is stabilized by soft tissue and bony structures. Medial dislocation of the tendon is affected by the medial wall angle and by the integrity of the soft tissue stabilizers; most importantly the coracohumeral ligament in the proximal part of the groove. Dislocation of the biceps tendon into the substance of the subscapularis has been rarely mentioned in the literature; and as far as we know, bilateral occurrence without any identifiable subscapularis tears has never been previously mentioned. The bilateral occurrence with the absence of subscapularis lesions indicates that this is a congenital anomaly.

New trends in the management of hepatic Echinococcus granulosus.

The liver is the most commonly involved organ in the body by cystic echinococcosis (CE) secondary to infection with Echinococcus granulosus. In this article, the authors discuss the classification, recent advances in magnetic resonance (MR) imaging for the diagnosis of hepatic CE, and approaches for management of hepatic CE using five therapeutic options that include: antihelminthic chemotherapy, surgery, percutaneous treatment, endoscopic approach, and the "watch and wait" approach.

Abdominal complications of chemotherapy in pediatric malignancies: imaging findings.

OBJECTIVE: To describe the imaging findings of abdominal complications caused by chemotherapy in pediatric cancer patients. SUBJECTS AND METHODS: Radiology studies of 243 patients treated in our Children Cancer Center were reviewed, 164 of whom had abdominal studies. Medical records of 54 patients with abnormal imaging findings were studied. RESULTS: Ultrasound and/or CT findings showed the following complications: (1) gallbladder sludge/crystals (n=13), gallstones (n=8), cholecystitis (n=3); (2) liver steatosis (n=23), siderosis (n=1), veno-occlusive disease (n=2); (3) pancreatitis (n=7); (4) typhlitis (n=12), esophagitis (n=2). CONCLUSION: Awareness of these complications is essential for appropriate management, decreasing their mortality and morbidity.