RESUMO
Nonunion of humerus fractures is an extensively reviewed topic in orthopedic literature. The current case describes the successful outcome of a hypertrophic nonunion in a patient who chose not to undergo any intervention when the nonunion was identified and the treatment options were discussed with him. Hence this case report is a good example of the transition of the medical world to the concept of patient-centered decision making having a successful outcome.
Assuntos
Fixação Intramedular de Fraturas/efeitos adversos , Fraturas não Consolidadas/complicações , Fraturas do Úmero/cirurgia , Pseudoartrose/etiologia , Pinos Ortopédicos/efeitos adversos , Síndrome do Túnel Carpal/complicações , Síndrome do Túnel Carpal/cirurgia , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Pseudoartrose/diagnóstico por imagem , Radiografia , Falha de TratamentoRESUMO
Patients with chronic rotator cuff tears frequently have anterior shoulder pain attributed to the long head of the biceps brachii (LHBB) tendon. In this study, tenodesis or tenotomy samples and cadaveric controls were assessed by use of immunohistochemical and histologic methods to quantify inflammation, vascularity, and neuronal plasticity. Patients had moderate pain and positive results on at least 1 clinical test of shoulder function. The number of axons in the distal LHBB was significantly less in patients with biceps tendinitis. Calcitonin gene-related peptide and substance P immunostaining was predominantly within nerve roots and blood vessels. A moderate correlation (R = 0.5) was identified between LHBB vascularity and pain scores. On the basis of these results, we conclude that, in the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity.
