Lipomatous lesions around the shoulder: Recent experience in a Nigerian hospital

We present four cases of shoulder lipomas in two females and two males in their fourth to fifth decades of life. All four lipomas were big. Three were subcutaneous and one was intermuscular. None of them were associated with any functional limitation of the affected shoulder. Subcutaneous or intermuscular lipomas around the shoulder do not appear to affect shoulder functions. Complete surgical excision is rewarding and was achieved under local anesthesia in all our patients with no incidence of recurrence.     

肩关节融合术治疗连枷肩的远期疗效

本文报告采用肩关节融合术治疗连枷肩的远期疗效。１２例采用本法治疗，平均随访１０年１１月的远期疗效满意，人武部病例均于术扣３月获得骨性愈合，患肢功能满意，作者认为，本法是治疗连枷肩的一种安全、简单有效方法。     

Real‐time pressure monitoring of intraarticular hydraulic distension for painful stiff shoulders

Intraarticular hydraulic distension (IHD) has been utilized to treat painful stiff shoulders by distending and then rupturing the joint capsules. However, no attempts have been made to optimize the capsule distension, which might give a better clinical outcome. To set up a prerequisite technique for a maximal distension without rupturing the capsule, real‐time pressure monitoring of IHD procedures was performed in 16 patients, which revealed triphasic pressure‐volume profiles in 10 patients and biphasic in 6 patients. The IHD procedures were terminated without rupturing the capsule by observing the real‐time pressure‐volume curves (N = 10) or by pain (N = 3). The pressure profiles of the 13 patients who had the infusion stopped without rupture demonstrated stress–relaxation curves of the capsules. The biphasic group showed a steeper slope of the second phase of linearly increasing pressure (p = 0.017) and higher pressure (p = 0.005) with slightly larger volume (p = 0.095) at the termination of fluid infusion than did the triphasic group. The stiffness of the glenohumeral joint capsule had a close correlation with the limitation in range of motion. Real‐time pressure monitoring would be helpful to develop a novel IHD technique that could distend the glenohumeral joint as much as possible without rupturing it. The biomechanical parameters derived from the pressure‐volume profiles would also be useful to characterize the properties of the joints of painful stiff shoulder patients. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:965–970, 2008     

Arthroscopic Capsular Plication in the Treatment of Shoulder Pain in Competitive Swimmers

Shoulder pain is a common and difficult problem in competitive swimmers due to cumulative loads from repetitive overhead motion. Capsular laxity has been implicated as a potential etiology for shoulder pain in competitive swimmers. No study has examined the role of capsular plication in addressing recurrent shoulder pain in competitive swimmers. The purpose of this study is to retrospectively describe our series of competitive swimmers treated with arthroscopic capsular plication with a primary outcome of return to competitive swimming. Eighteen shoulders in 15 patients underwent arthroscopic capsular plication from 2003 to 2007. Patients were contacted at an average follow-up of 29 months (range, 8–42) and a swimming history, American Shoulder and Elbow (ASES) scores, and L''Insalata scores were obtained. At time of surgery, all patients demonstrated laxity under examination under anesthesia. All patients had a positive drive-through sign. Eighty percent (12/15) of patients returned to competitive swimming although only 20% (3/15) were able to return to their pre-injury training regimen volume. All patients subjectively reported improved pain after surgery. The average ASES score was 78 ± 16 (average, standard deviation). The average L''Insalata score was 82 ± 11. Although our results demonstrate that arthroscopic capsular plication has utility in the treatment of shoulder pain in swimmers who have failed non-operative treatment, the inability of some athletes to return to pre-injury training volume illustrates the difficult nature of shoulder pain in swimmers.Level of Evidence: Retrospective case series, Level IV     

肩关节后脱位的诊断与治疗

目的 探讨肩关节后脱位相关诊断方法的意义和治疗效果。方法 对5例漏珍的肩关节后脱闰进行创伤系列X线检查和CT扫描检查。根据伤后延误时间、临床症状和影像学检查结果选择治疗方法。3例行早期闭合复位,2例陈旧脱位中,1例行切开复位内固定,1例放弃复位。结果 CT、MRI和肩关节侧位、腋窝位、Velpeau腋窝位X线片分别显示5例、1例、2例、5例肩关节后脱位;CT和腋位X线检查同时显示伴随骨折。随访2－5年,闭合复位者UCLA评分32－35分;切开复位者UCLA评分14分;未予复位者UCLA评分22分。结论 临床上对该症认识不足是造成漏诊的主要原因,早期闭合复位可取得良好功能恢复。     

Reverse shoulder arthroplasty for proximal humerus fractures

A reverse shoulder arthroplasty is a consideration for the treatment of comminuted four-part proximal humerus fractures in elderly patients. While a reverse TSA should not replace other treatment modalities, it is indicated in elderly patients with fractures that are not amenable to fixation. Immediate stability and relative independence from tuberosity healing are clear advantages, but the complication rate is substantially higher. Larger studies are necessary to clarify appropriate indications.     

反Hill-Sachs损伤合并肱骨近端骨折1例

正患者,男,42岁,工作时受电击后被倒下的电线杆砸中肩部,当即感左肩部肿痛,肩关节活动明显受限而就诊。查体:左侧肩部稍肿胀,未见明显"方肩"畸形,局部压痛,关节腔空虚感存在,肩关节外旋、外展活动受限,Dugas征阴性,其余关节活动正常,肢端感觉、血供正常。急诊摄肩关节正位CR片,显示     

Bristow-Latarjet Procedure for Recurrent Anterior Dislocation of the Shoulder: A 2-5 Year Follow-up Study on the Results of 112 Cases

A follow-up study of 111 out of 112 patients operated on for shoulder joint dislocation according to the Bristow-Latarjet procedure during the years 1975 through 1979 in four Swedish hospitals is presented. the average follow-up time was 30 months (range 24-60 months).

There were seven cases of significant recurrences (6 per cent). During follow-up, further surgery had been performed on four of these. Another eight patients (7 per cent) had experienced occasional insignificant subluxations. in one case neurolysis of the musculocutaneous nerve was undertaken because of postoperative paresis of elbow flexors.

The average limitation of outward rotation as compared with the nonoperated side was 19^o in adduction and 21^o in abduction. There was a measurable difference in strength between the operated and nonoperated shoulders.

The results were considered excellent or good by 101 of the patients (90 per cent), fair by eight and bad by three. of 12 cases with failed surgery before the Bristow-Latarjet procedure 10 regarded the result as good or excellent.     

Surgical management of shoulder arthritis

Shoulder arthritis is a painful and functionally limiting condition. Importantly, the overarching diagnosis of shoulder arthritis encompasses a cascade of pathologies affecting the bony and soft tissue structures of the shoulder. Although many surgical and non-surgical management options are available, effective utilization of these treatments is dependent upon careful diagnosis and consideration of the complex anatomy of the glenohumeral joint. This review considers what is known about this increasingly common condition and the spectrum of treatments available.