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Four cases of brachial plexus lesions caused by anterior fracture-dislocation of the shoulder are reported. The incidence, mechanism of injury and prognosis are reviewed.
The rapid development of arthroscopic techniques has raised questions on the treatment of first shoulder dislocations. Primary arthroscopic or even open labral repair have been recommended. However, the available prospective studies demonstrate a recurrence rate of not more than 50% in the global population. This number increases steeply if certain risk factors are present: young age (under 25 years), shoulder sports, adequate trauma with acute unidirectional instability. For this selected group, arthroscopic labral repair should be proposed and should be performed by a surgeon specifically trained in this advanced arthroscopic technique. Repair of the labrum is feasible with various arthroscopic techniques, whereas the shortening of redundant capsular areas still poses problems. The efficiency of laser- or heat-shrinking of the shoulder capsule must yet be proven.
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AIM OF STUDY: It is the aim of this investigation to describe the normal ultrasonographical appearance of the glenohumeral joint in childhood. METHODS: Ultrasound investigation was performed in 20 healthy children aged between 6 weeks and 19 years (median: 6 years) using 12 MHz linear probes. A dynamic examination of both shoulders was carried out. Probe positions according to standard planes were used, and attention was paid to visualise the growth regions. RESULTS: Ultrasound images of the periarticular soft tissue in children do not differ markedly from those in adults. However, there are basic structural differences of the epiphyseal and apophyseal regions. In the newborn period the proximal humeral epiphysis mainly consists of cartilage and changes to the adult shape after the appearance of three secondary ossification centers and growth plates. Interestingly, the chondral buds of the acromion or coracoid process offer additional imaging facilities for ultrasound examination in children. CONCLUSIONS: Ultrasound examination of the glenohumeral joint in children offers a more precise evaluation when compared to adults, due to the presence of additional ultrasonographical "windows" and depiction of parts of the humeral epiphysis. This imaging technique is well tolerated by children.
Injuries and degenerative alterations of the shoulder predominantly affect the soft tissue. To investigate this area we use a multitude of diagnostic examinations: apart from clinical and functional diagnosis also the image reproductive methods of arthrography, ultrasound and computer tomography in addition to the classical X-ray. To ascertain pathological changes to shoulder soft tissue the simplest and quickest, least dangerous and most straightforward examination is the sonograph as it includes dynamic movement procedures. Warning: a high degree of experience and anatomical knowledge is a must! Computer- and especially nuclear spin tomography--being static examining forms a comprehensive picture of every anatomic structure and its pathology--may well represent a valuable addition to shoulder diagnostics. Nevertheless, as yet the clinical and material requirements are still enormous.
BACKGROUND: To evaluate the per-operative process of shoulderjoint replacement, time-action analysis can be used. MATERIAL/METHODS: Forty procedures performed by 7 surgeons with different experience using 5 different prostheses and 3 different surgical approaches were analyzed. RESULTS: The surgical procedures showed a large variation in, for example, duration, tasks of team members, and protocol used. The surgical procedure was influenced by several factors, such as the prosthesis used, the surgical approach, the patient's condition, and the experience of the surgeon. Exposure of the glenoid was difficult and several retractors were needed, which were held by an extra assistant or clamped to the table or the surgeon. Two main limitations were seen in all procedures: repeated actions and waiting. Also, five errors could be identified. None of the alignment instruments was completely reliable and they allowed the surgeon to make major errors. CONCLUSIONS: Better alignment instruments, pre-operative planning techniques, and operation protocols are needed for shoulder prostheses. The training of resident surgeons should be focused on the exposure phase, the alignment of the humeral head, the exposure of the glenoid, and the alignment of the glenoid. Evaluating the surgical process using time-action analysis can be used to determine the limitations during surgical procedures. Furthermore, it shows the large variation in factors affecting surgical performance, indicating that a system approach is needed to improve surgical outcome.
The 3D visual presentation of biodynamic events of human joints is a challenging task. Although the 3D reconstruction of high contrast structures from CT data has been widely explored, then there is much less experience in reconstructing the small low contrast soft tissue structures from inhomogeneous and sometimes noisy MR data. Further, there are no algorithms for tracking the motion of moving anatomic structures through MR data. We represent a comprehensive approach to 3D musculoskeletal imagery that addresses these challenges. Specific imaging protocols, segmentation algorithms and rendering techniques are developed and applied to render complex 3D musculoskeletal systems for their 4D visual presentation. Applications of our approach include analysis of rotational motion of the shoulder, the knee flexion, and other complex musculoskeletal motions, and the development of interactive virtual human joints.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Diagnostic error possibility and non-adequate surgical treatment by shoulder injury lead to non-adequate rehabilitation program. Authors show the case with diagnostic error and discuss the reasons for incomplete functional answer after rehabilitation-program. It is given the recommendation for solving these problems.
It is known that hyaluronic acid can protect against damage to articular cartilage and helps to lessen friction between joint surfaces. Furthermore, it is reported that hyaluronic acid is effective for pain relief and for the risk of adhesion, and contractures of joints. The injection of hyaluronic acid is useful for the treatment of frozen shoulder, osteoarthritis, and rheumatoid arthritis. The risk of infection is a rare, though important, possibility, however this method is relatively safe.
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