[Diagnosis and therapy of fresh and neglected ligament injuries in the shoulder-joint area].
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We report a case of successful percutaneous retrieval of a broken Kirschner's wire that had entered the venous system and the right atrium and later migrated to the left pulmonary artery. The management of a long, rigid, nail-like foreign body within the heart and/or the pulmonary artery is discussed.
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Stress fracture is a rarely reported late complication of radical neck dissection. The condition should be recognised as its clinical and radiological differentiation from avascular necrosis or bony metastasis may be difficult.
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The sterno-clavicular joint covers one remarkable importance in the complex of the shoulder girdle. This review investigates the anatomy, biomechanics, main affections and involvement of this joint in the pathological processes of the shoulder girdle in its complex. Moreover, it focuses on the opportunities offered from the conservative treatment, using in particular the manual therapy. Active and passive, as well as against isometric resistance movements, are discussed. In particular, the passive mobilization is demonstrated effective in the restoration of joint mobility. The sterno-clavicular joint is not structured in order to complete great work loads and has the tendency to become hypermotile or unstable, if subordinate to overload works, becoming painful. In this case, the techniques of passive mobilization and of modulation of the pain turn out effective.
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Bacteria and crystals were simultaneously recovered from the synovial fluid of two patients with acutely inflamed joints. The bacteria were initially identified on Gram stain and subsequently grown on supplemented peptone broth, and the crystals were readily identified by polarizing microscopy. Although cause-and-effect relationship between these two types of arthritis cannot be established, the need for thorough examination of synovial fluid is evident.
Scapulothoracic dissociation (SCTD) is a rare clinical entity with fewer than 70 cases reported in English literature. The mechanism of injury is severe rotational force, which causes disruption of the shoulder girdle from the rest of chest wall. Frequently, SCTD produces massive blood loss as it involves major fractures of the upper extremity, disruption of muscle, brachial plexus, and vascular damage. This case report demonstrates classical radiological findings of SCTD with brachial plexus injury but with no associated vascular damage.
Skeletal scintigraphy was performed in patients with pustulosis palmo-plantaris. There was an increased isotope uptake in the sterno-costo-clavicular area in 16 of 73 patients (22%). The skeletal involvement was further studied by computer tomography showing seven characteristics (including unilaterality) typical of the disease. Clinically, the arthritis is aseptic and benign, and only 9 of 16 patients with a positive scintigraphy complained of juxta-sternal arthralgia.
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Manubriosternal joint involvement in rheumatoid arthritis is not rare and may be evidenced by erosion, reactive sclerosis and ankylosis. Frequent reports of such involvements appear in the radiological literature but only 3 cases where this had been associated with clinically evident subluxation of the joint have been reported previously. It is, nonetheless, our observation that clinical deformity of this joint is common and careful review at our clinic has revealed the 10 cases reported here. Chronic or recurrent chest infections have been incriminated in the production of this deformity. However, the evidence seen in our series suggests rather, that this deformity is closely associated with severe cervicodorsal spinal erosion and deformity and that its presence should alert clinicians to potential problems of cervical cord compression.