[Shoulder pain due to suprascapular neuropathy]. / Schouderpijn door suprascapularisneuropathie.

BACKGROUND: Shoulder complaints are caused by suprascapular neuropathy in 1-2% of patients. This rare condition is characterised by slowly progressing shoulder pain, which has as a consequence restriction of movement and loss of strength. The most frequent causes are tear of the rotator cuff or a space occupying lesion. CASE DESCRIPTION: A 30-year-old man presented with slowly arising shoulder pain with subsequent also loss of strength and atrophy of the shoulder. A MRI scan of the shoulder showed a cyst in the glenoid cavity. Using EMG suprascapular neuropathy was diagnosed. The cyst was removed by operation and the patient recovered well. CONCLUSION: The diagnosis 'suprascapular neuropathy' was made using EMG. Space occupying lesions of the shoulder can be excluded by X-ray and MRI. The treatment is primarily conservative, with physiotherapy and pain management.

Molecular systematics of the endemic Leptaxini (Gastropoda: Pulmonata) on the Azores islands.

The Azorean representatives of the Leptaxini (Pulmonata) are single island endemics, where a high-spired shell distinguishes the monotypic genus Helixena from two slightly different low-spired forms within Leptaxis (azorica and caldeirarum type). We studied the evolutionary history of putative taxa and the three shell-types using 12 allozyme loci and sequences of nuclear (ITS-1 and ITS-2) and mitochondrial DNA (COI and 16S rRNA). While little variation was found in both ITS genes, allozyme and mtDNA divergence was among the highest reported for pulmonate land snails. Generally, phylogeographic patterns are indicative of allopatric differentiation via the successive colonization of (younger) islands, while a major role for adaptive evolution is not supported. The azorica shell-type is monophyletic and has no common history with other sympatric shell-types on the same islands. The (ambiguous) position of Helixena sanctaemariae makes Leptaxis paraphyletic on the Azores and possibly also the caldeirarum shell-type. Helixena can therefore not be distinguished as a separate genus on the Azores. Following a lineage-based concept, representatives on all (ancient) islands should be considered distinct species.

The anterior ankle impingement syndrome: diagnostic value of oblique radiographs.

BACKGROUND: The diagnostic value of an oblique radiograph, in addition to a lateral radiograph, for detecting osteophytes in the anterior ankle impingement syndrome was evaluated in a prospective study. The hypothesis was that the application of a lateral radiograph is insufficient to detect osteophytes that are located in the anteromedial aspect of the ankle joint. Oblique anteromedial impingement (AMI) radiographs were hypothesized to be a relevant adjunct, because of their utility to detect these anteromedially located osteophytes. METHODS: Presence or absence of tibial and talar osteophytes on both radiographs was compared with the combined findings of CT, MRI scan, and arthroscopic surgery. Estimates of test characteristics were obtained for 60 consecutive patients with an anterior ankle impingement syndrome. RESULTS: It was shown that the sensitivity of lateral radiographs for detecting anterior tibial and talar osteophytes was 40% and 32%, respectively (specificity, 70% and 82%). When the lateral radiograph was combined with an oblique AMI radiograph, these figures increased to 85% and 73%, respectively (specificity decreased to 45% and 68%). This increase was due to the high sensitivity of the oblique AMI radiographs for detecting anteromedial osteophytes (93% for tibial and 67% for talar osteophytes). CONCLUSION: A lateral radiograph is insufficient to detect all anteriorly located osteophytes. An oblique AMI radiograph is a useful adjunct to routine radiographs and is recommended to detect anteromedial tibial and talar osteophytes.

Systematic review of treatment strategies for osteochondral defects of the talar dome.

The aim of this study was to summarize all eligible studies to compare the effectiveness of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from January 1966 to June 2000 were systematically screened. Based on our inclusion criteria, 39 studies describing the results of treatment strategies for OCD of the talus were included. No randomized clinical trials (RCT) were identified. Fourteen studies described the results of nonoperative treatment (NT); 4: the results of excision alone; 10: the results of excision and curettage (EC); 21: the results of excision, curettage, and drilling (ECD); 2: the results of cancellous bone grafting after EC; 1: the results of osteorchondral transplantation; 3: the results of fixation; and 1: the results of retrograde drilling. The average success rate of NT was 45%. Comparison of different surgical procedures showed that the highest average success rate is reached by excision, curettage, and drilling (ECD; 86%), followed by excision and curettage (EC; 78%) and excision alone (38%). On the basis of this systematic review, we conclude that NT and excision alone are not to be recommended in treating talar OCD. Both EC and ECD have been shown to lead to a high percentage good/excellent results. At the present time, ECD seems to be the most effective treatment strategy for osteochondral defect of the talus. Due to great diversity in the articles and variability in treatment results, however, no definitive conclusions can be drawn. Sufficiently powered randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus.

Technical note: Resterilizable noninvasive ankle distraction device.

Arthroscopic ankle surgery can be performed effectively and satisfactorily in the majority of procedures without distraction. However, there are cases in which joint distraction eases access to the pathology and, therefore, improves execution of the surgical procedure. We developed a simple resterilizable noninvasive distraction device that is cheap, gives reproducible results, and is easy to apply. The main advantage of the device is that the choice to perform distraction can be made at any moment during the arthroscopic procedure. Thus, the operation can start without distraction in the dorsiflexed position and, if needed at any time, the distraction device can be applied and vice versa. The effectiveness was assessed in a consecutive series of 25 patients. The average force of distraction was 115 N, while the average joint distraction was 4.5 mm on the medial and 4.3 mm on the lateral side.