Epithelioid Sarcoma in the Median Nerve of the Hand: A Case Report.

Epithelioid sarcoma of the peripheral nerves is extremely rare. We present a case concerning the median nerve of the right hand in a 35-year-old woman who was treated with radical resection, reconstructive surgery, and chemotherapy. After 2 years of follow-up, there is no evidence of local recurrence or metastatic dissemination.

Arthroscopic superior capsule reconstruction using semitendinosus tendon autograft for irreparable rotator cuff tears: Preliminary results.

BACKGROUND: To examine prospectively the functional and structural results of arthroscopic superior capsule reconstruction using semitendinosus tendon autograft for irreparable superior rotator cuff tears. METHODS: 5 patients (40.8 months average follow-up) were evaluated clinical preoperatively and at the end of the follow-up. Magnetic resonance imaging (MRI) was used preoperatively and at 12 months. RESULTS: The mean ASES and the Constant scores increased from 56.2 to 92 and 46.8 to 82.8. The MRI showed continuity of the ligamentoplasty. CONCLUSIONS: Given the small number of cases, few conclusions can be drawn. Nonetheless, the results regarding this technique may be considered promising. LEVEL OF EVIDENCE: Level IV; Case series; Treatment Study.

Lack of elevation and external rotation in the shoulder: Reverse total shoulder arthroplasty combined with latissimus dorsi transfer to the humerus versus the greater tuberosity.

BACKGROUND: The purpose of this study was to prospectively compare clinical outcomes of reverse total shoulder arthroplasty (RTSA) combined with latissimus dorsi transfer by modified L'Episcopo (Group I) versus the greater tuberosity (Group II) in patients with lack of elevation and external rotation in the shoulder. MATERIALS AND METHODS: Eighteen patients participated in the study. They were placed randomly into two groups of nine patients in each group. The results were evaluated prior to surgery and at the end follow-up. RESULTS: The average follow-up was 33.2 months. The mean ASES scores improved from 13 points to 79 in Group I and from 15 to 73 in Group II. The mean Constant shoulder scores improved from 19 to 66 in Group I and from 18 to 67 in Group II. Mean active elevation increased from 59° to 147° in Group I and from 58° to 148° in Group II. The mean external rotation scores increased from -43° to 7° in Group I and from -41° to 23° in Group II. CONCLUSION: Comparing clinical outcomes and active elevation, there were no significant differences. The latissimus dorsi transfer to the greater tuberosity provided greater external rotation than did the modified L'Episcopo transfer.

Treatment of static scapholunate dissociation using a slip of the flexor carpi radialis.

The purpose of this paper is to examine the results of reconstruction of the dorsal and palmar limbs of the scapholunate interosseous ligament in flexible static scapholunate instability using a slip of flexor carpi radialis tendon. Between June 2012 and August 2018, 13 patients with flexible static scapholunate instability underwent with this surgical technique. Mean patient age at surgery was 42 years. Average follow-up was 52, 8 months. The functional outcome postoperative according to Green and O'Brien was excellent in 1, good in 9 and regular in 3 patients. Postoperative disabilities of the arm, shoulder and hand and modified Mayo scores averaged were 9.02 and 80, respectively. At final follow-up, the radiographic findings demonstrated a significant decrease in scapholunate gap from 5 mm to 2, 5 mm and a significant improvement in scapholunate angle from 65° to 50°. Of the 13 patients, 10 were pain free and 3 had mild pain. Given the small number of cases, few conclusions can be drawn. However, results may be regarded as promising for this technique.

Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study.

BACKGROUND: The purpose of this prospective study was to compare the clinical and structural findings following the arthroscopic repair of partial-thickness (exceeding 50%) articular-sided rotator cuff tears using either a single-row or a double-row suture bridge fixation. MATERIALS AND METHODS: Fifty patients were included in this study. The patients were randomly placed into two groups: 25 underwent the single-row (Group I) and 25 a double-row suture bridge fixation (Group II). The clinical outcomes were assessed using ASES and Constant shoulder scores, both preoperatively and at the end of follow-up. The pain level was evaluated using the visual analogue scale (VAS), preoperatively, at 6 months and at the end of follow-up. All patients underwent preoperative MRI to identify the rotator cuff tear, and postoperatively at 12 months to evaluate tendon integrity. RESULTS: The average follow-up was 32.5 months. The mean ASES scores increased from 35.9 to 96.7 in Group I and from 35.3 to 93.4 in Group II; the mean Constant shoulder scores increased from 55.6 to 97.8 in Group I and from 57.5 to 97.3 in Group II. There were no significant differences between the two groups. The average preoperative pain level decreased from 7.4 to 3 at 6 months and to 0.4 at the end of the Group I; and from 7.6 to 3 at 6 months and 0.8 in Group II. There was no significant difference between the two groups. At 12 months, the MRI assessments showed two retears in Group I (8%) and one retear in Group II (4%). CONCLUSION: Arthroscopic repair of partial-thickness articular rotator cuff tears that exceed 50% of tendon thickness with a single-row transtendon repair or double-row suture bridge provides functional improvement and pain relief regardless of the repair technique used. There were no differences in clinical results between both techniques. LEVEL OF EVIDENCE: Level II; prospective comparative study.

Subtraction osteotomy of the humeral head in posterior shoulder dislocation: a case report.

Locked posterior dislocations of the shoulder with an impacted fracture of the humeral head and an articular surface defect greater than 35-40% are generally treated with a femoral head bone graft or prosthesis. We present a case in which a subtraction osteotomy with osteoclasia on the impacted zone was performed to try to make the articular surface of the humeral head congruent and continuous. With a 42-month follow-up, the clinical outcome, in terms of mobility and pain, was very good; X-rays show there was no avascular necrosis of the humeral head nor signs of articular arthrosis. The aim of this work is to present a detailed description of our procedure, which can be a therapeutic option for this type of pathology.

Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff.

The objective of this paper was to determine the outcome of the transfer of the latissimus dorsi tendon in patients with massive irreparable rotator cuff tears. Eighteen patients of mean age 54 years (range 37-72 years) with massive irreparable rotator cuff tears were studied. The mean follow-up was 28 months (range 12-58 months). The postoperative Constant score was higher by an average of 21.15 points compared to the preoperative score (P=0.002); 88.8% of patients reported significant pain relief and improved mobility, particularly on external rotation. Postoperative resting antero-posterior radiography in neutral rotation revealed a mean 3.2-mm depression of the humeral head, due to the tenodesis effect of tendon transfer, thus, increasing the deltoid lever arm. These clinical results suggest that latissimus dorsi transfer is a useful surgical technique for treating massive irreparable postero-superior tears of the rotator cuff in young and/or active patients, providing significant pain relief and improved shoulder strength.

Vascularised bone graft and osteotomy of the radius in Kienböck's disease.

Treatment of stage IIIA and III B avascular necrosis of the lunate bone remains controversial. We present a series of 5 cases in young patients treated with a vascularised bone graft from the second metacarpal, combined with a lateral shortening and closing wedge osteotomy of the radius. Good clinical and radiographic results were obtained and disease progression was halted with the combination of these two surgical procedures.

Chronic rupture of the pectoralis major muscle: report of two cases.

Rupture of the pectoralis major muscle is relatively rare. The authors present two cases of chronic rupture in which direct suturing was not possible; reconstruction was possible using a bone-patellar tendon autograft. They conclude that this surgical technique may be useful in some cases of chronic ruptures of the pectoralis major muscle in which direct tendon suturing is impossible.

Osteonecrosis of the trapezium treated with a vascularized distal radius bone graft.

A 20-year-old man presented with early stage osteonecrosis of the trapezium, diagnosed by magnetic resonance imaging. A vascularized distal radius bone graft was performed, with good clinical and radiologic results over a 1-year follow-up period. The authors believe that a vascularized distal radius bone graft is an ideal treatment for early stage carpal bone necrosis.

Fractures of osteochondroma during physical exercise.

BACKGROUND: The mechanism responsible and the best form of treatment for fractures of osteochondromas remain unclear. PURPOSE: We studied the incidence, cause, treatment, and outcome of fractures of osteochondroma over a 17-year period. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively reviewed all cases of osteochondroma at one institution over 17 years (1985 to 2002) to identify cases of fractures. These patients were then contacted for follow-up. RESULTS: Seven cases of fracture through the stalk of a pedunculated osteochondroma were identified. All fractures were sustained during physical exercise. One fracture was due to a direct blow, and the others to indirect muscle or tendon injury. Five patients were treated surgically with excision of the osteochondroma, and the other two received nonoperative treatment consisting of restriction of physical activity and observation. In all cases, patients were able to resume sporting activity within 4 to 8 weeks. The recovery period was shorter for patients who received surgical treatment. CONCLUSIONS: Surgical excision of the fractured osteochondroma may be preferable for patients engaging in sport.