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PubMed1991

The shoulder: facts, confusions and myths.

The purpose of this paper is to address some of the myths, facts and confusions about the shoulder. Myth: Recurrent subluxation or dislocation of the shoulder requires surgery. Fact: The most important shoulder muscle is the anterior deltoid. Myth: You can diagnose shoulder problems with two anterior/posterior x-rays. Fact: You must keep track of the pins you insert for shoulder problems. Confusion: The position of the shoulder for arthrodesis: which to choose? Confusion: What if the arthrodesis is painful? Myth: You don't need the clavicle and can resect it without any problems. Fact: All sternoclavicular dislocations are not dislocations. Fact: Do not repair or reconstruct spontaneous sternoclavicular dislocations in children and young adults. Confusion: What is the role of the arthroscope in the diagnosis and treatment of shoulder problems? Fact: There are more than just Type I, II and III injuries to the acromioclavicular joint. Fact: Total shoulder arthroplasty is not an experimental operation. Myth: All patients with a sore shoulder need an arthrogram. All patients with positive arthrograms need an operation. All rotator cuffs must be repaired.

Acromioclavicular Joint↗

PubMed1981

The importance of soft tissues in certain skeletal traumatic lesions.

Soft tissue aspects of skeletal trauma are discussed according to two categories: (1) those injuries in which the significance of the soft tissue in the pathophysiology of the skeletal lesion is indicated by the characteristics of the skeletal injury (such as extension teardrop fracture, little leaguer's elbow, "baseball fracture," and Bennett's fracture); and (2) those injuries in which the associated soft tissue injury, or complication, may be reasonably inferred by the location and nature of the skeletal injury (such as major facial fractures, posterior sternoclavicular dislocations, fractures of the lower rib and lumbar transverse processes, and pelvic disruptions).

Ankle Injuries↗

PubMed2004

[Sternoclavicular dislocations: clinical and therapeutic study. A report of 9 cases].

Sterno-clavicular dislocations represent an uncommon pathology in shoulder trauma. The authors describe the anatomical and clinical forms observed between January 1999 and December 2002, and evaluate the treatment process. The retrospective study addressed 9 patients (men only) with an average age of 26.6. Based on the duration of the consulting period, one could distinguish old forms from more recent ones. Diagnosis would help to see anterior forms from posterior forms. Evaluation criteria were: pain, mobility of the shoulder, visibility of the deformation of the sterno-clavicular joint. Six types of anterior dislocations were listed, including 4 recent and 2 old ones. There were 3 recent posterior forms. The anterior recent forms, which were treated in orthopedics, showed a positive evolution. As there was no functional disability, it was wiser to refrain from any treatment of the anterior old forms. The posterior forms, two of them were operated (osteosynthesis) revealed no functional deficit after treatment. However, one of the patients had a broken implant. Scanner facilitated the diagnosis of sterno-clavicular dislocations. The anterior forms, which are more frequent and benign, are different from the posterior forms, which are emergency cases due to the proximity of the aero-digestive and cardiovascular elements. Their surgical stabilization requires techniques related to ligamentoplasty rather than using osteo-synthesis equipment which may move away or break off.

Adolescent↗

PubMed1990

Muscle activity and coordination in the normal shoulder. An electromyographic study.

Muscle activity and coordination in ten shoulders were studied in five healthy subjects using electromyography (EMG) recorded during standardized loaded movements, i.e., flexion, extension, abduction, external rotation, and internal rotation at 0 degrees, 45 degrees, and 90 degrees of abduction. Bipolar surface and intramuscular fine-wire electrodes were used, and the EMG signal was low-pass filtered, full-wave rectified, and time-averaged. Activity from the subscapularis, supraspinatus, infraspinatus, pectoralis major (sternoclavicular part), the anterior, middle, and posterior parts of the deltoid, and the latissimus dorsi was recorded in parallel. In order to allow a comparison of the activity in a subject's different muscles and the activity in specific muscles between different individuals, the EMG was normalized. Muscle activity occurred simultaneously in muscles producing the movement and in antagonistic muscles. Coordination due to muscle contractions plays a significant role in stabilizing the shoulder joint. The infraspinatus, subscapularis, and latissimus dorsi acted as stabilizers during flexion; the subscapularis acted as a stabilizer during external rotation and with the supraspinatus during extension.

Adult↗

PubMed1995

The unstable shoulder girdle: early functional treatment utilizing open reduction and internal fixation.

The unstable shoulder girdle--a combination of a scapular neck fracture with a clavicular fracture, acromioclavicular dislocation, or sternoclavicular dislocation--represents a rare and often underestimated injury. Sufficient treatment to permit early function is necessary to avoid a frozen shoulder as well as to treat concomitant thoracic injuries. This is possible only by open reduction and internal fixation. In most cases this can be achieved by a sole osteosynthesis of the clavicular injury. We retrospectively analyzed 12 cases and classified the results according to the Constant Score. This analysis showed excellent functional results in nearly all cases.

Acromioclavicular Joint↗

PubMed2005

Complications of the minimally invasive repair of pectus excavatum.

BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) has become widely popular since its introduction in the late 1990s by Nuss. We describe 1 unusual complication after MIRPE and 1 life-threatening bleeding during removal of the pectus bar. METHODS: We report the cases of 2 patients in a single institution, more than 100 MIRPE procedures performed so far, and review of literature. CASES: A 14-year-old girl presented 6 months after MIRPE in another institution. During removal of the pectus bar, a massive hemorrhage from both chest wounds occurred, requiring emergency sternotomy. Arrosion of a pulmonary vessel close to the metal bar had led to the bleeding. The second case was a bilateral sternoclavicular dislocation after MIRPE, which has not caused symptoms so far, in a 13-year-old girl. CONCLUSIONS: Numerous operative and postoperative complications after MIRPE are feasible. This is the first report of a life-threatening bleeding during removal of the pectus bar. Minimally invasive repair of pectus excavatum procedure and removal of the pectus bar should only occur in specialized institutions with wide experience in thoracic surgery.

Adolescent↗

PubMedDate not supplied

[Synovial sarcoma of the head and neck: a case report of parapharyngeal region and review of the literature].

Synovial sarcoma is a clinically and morphologically well defined entity that has been described extensively in Literature. It occurs primarily in the para-articular regions, usually in close association with tendon sheaths, bursae and joint capsules. On rare occasions it is also encountered in areas without any apparent relationship to synovial structures, as in the parapharyngeal region or the abdominal wall. It is considered the fourth most common type of sarcoma (7-10%) after malignant fibrous histiocytoma, liposarcoma and rhabdomyosarcoma. There are three histological variants: the classical biphasic, the monophasic fibrous type and the monophasic epithelial type (the biphasic and monophasic fibrous type are equally common). Clinical sign complaints are subtle and at times noted 20 years before diagnosis. The course of the disease is slow and insidious. The most typical presentation is that of a palpable deep-seated swelling or mass associated with pain or tenderness. Patients with synovial sarcoma in the head and neck (10%) tend to have difficulties in swallowing and breathing and not infrequently have alteration or loss of voice. Head and neck synovial sarcoma seem to originate from the paravertebral connective tissue spaces and manifest themselves as solitary retropharyngeal or parapharyngeal masses near the forking of the carotid. Additional cases in this general area have been reported in the soft palate, tongue, maxillofacial region, mandible corner, sternoclavicular region, scapular region and the cervical oesophagus. As in other types of sarcoma, the principal sites of metastases are the lung, but many make their appearance many years after the initial diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗