The Porcellini test: a novel test for accurate diagnosis of posterior labral tears of the shoulder: comparative analysis with the established tests.

QUESTIONS/PURPOSES: Although the posterior labral tears of the shoulder are known for their disabling clinical course, especially in overhead athletes, no clinical test used in isolation can diagnose it accurately in the preoperative period. We wanted to: (1) introduce "Porcellini test" with its radiological verification furnishing the anatomical basis of its mechanism; (2) determine its accuracy; and (3) compare its accuracy with that of the other established tests for diagnosing posterior labral tears of the shoulder. METHODS: To determine the anatomical basis, we initially performed radiological verification of our test. Then, we evaluated its accuracy in a retrospective case-controlled study on 310 consecutive patients who underwent shoulder arthroscopic procedures at our hospital between January 2013 and December 2013. All patients were examined preoperatively for Porcellini test, and the presence of posterior labral tear was confirmed on arthroscopy. Later, in a cohort study on 91 consecutive patients who underwent shoulder arthroscopic procedures, we compared its accuracy with O'Brien's test, the Kim test, the Jerk test, and the Load and Shift test. The accuracy was interpreted in terms of sensitivity, specificity, and predictive values. RESULTS: The radiological verification conferred the anatomical basis for the mechanism of the Porcellini test. This new test showed high accuracy for posterior labral tears with sensitivity of 100 %, specificity of 99.3 %, the positive and negative predictive values of 92.6 and 100 %, respectively. Also, it had superior accuracy results than every other test. The interexaminer reliability for all test results was found to be >0.80. CONCLUSIONS: We propose "Porcellini test" as a simple, accurate, reproducible, and reliable test for the preoperative diagnosis of posterior labral tears of shoulder.

Scapular and rotator cuff muscle activity during arm elevation: a review of normal function and alterations with shoulder impingement: [review] / Atividade dos músculos escapulares e do manguito rotator durante a elevação do braço: uma revisão da função normal e das alterações na síndrome do impacto: [revisão]

OBJECTIVE: The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. RESULTS: The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. CONCLUSION: These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients.

OBJETIVO: O objetivo deste manuscrito é revisar o conhecimento atual sobre como a ativação muscular e a produção de força contribuem para a cinemática do ombro em indivíduos saudáveis e em pessoas com síndrome do impacto. RESULTADOS: As porções média e inferior do músculo serrátil anterior produzem rotação para cima, inclinação posterior e rotação externa na escápula. O trapézio superior produz elevação e retração da clavícula. O trapézio médio é principalmente um estabilizador medial da escápula. O trapézio inferior auxilia na estabilização medial e rotação para cima da escápula. O músculo peitoral menor está alinhado para resistir às rotações normais da escápula durante a elevação do braço. O manguito rotador é crucial para a estabilização e prevenção do excesso de translação superior da cabeça do úmero, assim como para a produção de rotação externa na glenoumeral durante a elevação do braço. Foram identificadas alterações na amplitude ou no tempo de ativação em diversas investigações que compararam sujeitos portadores de síndrome do impacto com controles saudáveis. As alterações incluem ativação reduzida do músculo serrátil anterior médio ou inferior e do manguito rotador, ativação retardada do trapézio médio e inferior, assim como maior ativação do trapézio superior e do deltóide médio em sujeitos com síndrome do impacto. Além disso, sujeitos com o músculo peitoral menor com curto comprimento de repouso apresentam padrões alterados de cinemática escapular semelhantes aos encontrados em pessoas com síndrome do impacto. CONCLUSÃO: Estas capacidades musculares funcionais normais e alterações nas populações de pacientes devem ser consideradas no planejamento de programas de exercícios para a reabilitação destes pacientes.

Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement.

OBJECTIVE: The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. RESULTS: The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. CONCLUSION: These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients.

Cryptophthalmos.

Cryptophthalmos, a very rare congenital anomaly of the eye, is characterised by skin passing continuously from the forehead to the cheek over a malformed eye. It may be isolated or more commonly as a part of Fraser syndrome. Cryptophthalmos is classified into three types: complete, incomplete and abortive. Surgical reconstruction is the modality of treatment available. We present a case of bilateral, complete, isolated cryptophthalmos, who has undergone stage 1 of reconstructive surgery.

A comparison of systemic photochemotherapy with 8-methoxypsoralen (8-MOP) and with trimethylpsoralen (TMP) in vitiligo.

Oral 8-MOP and TMP were compared in the PUVA therapy for vitiligo. Group A (25 cases) was initiated on 0.3 mg/kg of 8-MOP with 1/2 Joule/cm2 of UVA and weekly increments of 1/2 Joule/ cm2 and Group B was started on 0.6 mg/kg of TMP with 1 Joule/cm2 of UVA and weekly increments of 1 Joule/cm2. Therapy was given thrice a week. Repigmentation was evaluated by using a 0-6 scale. At the end of 60 sittings, on acceptable cosmetic response was seen over the face, neck and upper extremities in both groups, while trunk and lower extremities showed lesser response. 8-MOP gave earlier response, needing a lower cumulative UVA dose i.e. 75 J/cm2 as compared to TMP i.e. 106 J/cm2. Phototoxicity was seen more often with 8-MOP. In conclusion, in Indians, 8-MOP is the drug of choice in PUVA therapy of vitiligo provided precautions against phototoxicity are adequate.

Proteus syndrome.

A 2½-year-old male child born of a nonconsanguineous marriage with high parental age presented with macrodactyly, dysmorphic features, large disfiguring lipomas, small fibromas, a linear verrucous epidermal naevus and lymphangioma circumscriptum. X-ray of hand revealed macrodystrophia lipomatosa progressiva. A lipoma and lymphangioma circumscriptum were confirmed by histopathology. The cosmetically disfiguring lipomas were excised. This is the first case report from India with the characteristic macrodactyly. This could possibly be the first case of report of a mutational disorder following intake of carbimazole during pregnancy.

Disseminate and persistent infundibulo-folliculitis.

An 18-year-old girl presented with a persistent skin eruption of 6 years duration. She had skin-coloured follicular papules involving the trunk, proximal extremities, neck and face. Histopathology revealed spongiosis of the follicular infundibulum and infiltration with lymphocytes and neutrophils. Treatment with oral vitamin A and topical retinoic acid was ineffective.

Cutaneous vasculitis with peripheral neuropathy.

a 40-year-old male patient presented with cutaneous vasculitis affecting both lower legs without any evidence of systemic involvement and a bilateral sensory neuropathy affecting both lateral popliteal nerves. Treatment with oral prednisolone resulted in healing of the cutaneous lesions but the sensory loss persisted.

Comparison of topical methenamine, glutaraldehyde and tap water Iontophoresis for palmoplantar hyperhidrosis.

Sixty patients with palmo-plantar hyperhidrosis were studied to compare the efficacy and safety of topical methenamine in the treatment of palmo-plantar hyperhidrosis with established therapies like glutaraldehyde and tap water iontophoresis. Patients were randomly allocated to 3 treatment groups: topical Methenamine (10%) solution, topical Glutaraldehyde (5% for palms and 10% for soles) and tap water iontophoresis. Hyperhidrosis was graded into 4 grades. The total duration of therapy was 4 weeks for all the 3 groups. Patients were followed up weekly for 4 weeks and 2 weeks after completion of therapy. Response to therapy was evaluated by the change in the grade of hyperhidrosis. Side-effects like irritation and pigmentation were looked for at every follow up. Wilcoxon's rank sum test was used for comparison between changes in grading of 2 groups. It showed that methenamine is superior to tap water iontophoresis and acts faster than glutaraldehyde. Fewer side effects were noted with mether amine.