The prevalence and characteristics of shoulder pain after traumatic brain injury

OBJECTIVE: To determine the prevalence and characteristics of shoulder pain in people with traumatic brain injury participating in inpatient rehabilitation and to compare the clinical presentation with that of people with stroke. DESIGN: A prospective comparative study. SETTING: Six metropolitan rehabilitation units. SUBJECTS: Eighty-seven people with traumatic brain injury and 52 people with stroke took part in the study. MAIN MEASURES: Assessment of shoulder pain, range of motion, strength and function was conducted on admission and, for the subjects with traumatic brain injury, at discharge if rehabilitation exceeded two weeks. RESULTS: The prevalence of shoulder pain in people with traumatic brain injury was 62%, which was comparable with the 69% of subjects with stroke that experienced shoulder pain (odds ratio 0.72, 95% confidence interval 0.34 -1.5). Fracture in the shoulder complex and passive shoulder external rotation range of motion were the best predictors for shoulder pain after traumatic brain injury. This was different from the subjects with stroke for which the best predictors were passive shoulder flexion range of motion and length of acute hospital stay. CONCLUSION: There is a relatively high prevalence of shoulder pain after traumatic brain injury. Trauma to the shoulder complex contributes to shoulder pain after traumatic brain injury, making clinical presentation different from people with stroke. The findings support the need for greater attention in the management of shoulder pain after traumatic brain injury.     

Scoliosis circa 2000: radiologic imaging perspective

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. Advances in CT and MR imaging have greatly improved the ability to detect or confirming nonidiopathic causes of scoliosis, including abnormalities within the spinal canal. Three-dimensional thinking has become more important in evaluating and understanding scoliosis.     

Systematic evaluation of bone dysplasias by the paediatric radiologist

A bone dysplasia is often a difficult diagnosis for the radiologist to achieve. However, principles of interpretation can make the task both interesting and often straightforward. In general, one of the factors of bone growth is in some way impaired, yielding an abnormal skeleton. To analyse what is impaired may greatly assist in narrowing the diagnostic possibilities. In most dysplasias, the affected growth factor is either one of enchondral or membranous bone growth. When interpreting bone radiographs for dysplasia one should be aware that aberrant positioning, that may lead to foreshortening in space, may simulate impaired growth in time. Dysplasia diagnosis for the paediatric radiologist is an art, but it can also be a science (as well as a pattern recognition challenge).     

Prevalence of reduced bone mass in children and adults with spastic quadriplegia

This study was designed to test the hypothesis that non-ambulatory patients with spastic quadriplegia will have reduced bone mass which worsens with increasing age. Forty-eight patients (age 5 to 48 years, median age 15 years; 19 females and 29 males) were studied. Anticonvulsants were used in 29 patients (60.4%). Lumbar spine bone mineral density (LS-BMD) was markedly reduced compared with age-and sex-matched control individuals with a z score of -2.37 +/- 0.21. Twenty-eight (58%) had z scores of less than -2. A history of documented previous fracture was present in 19 patients (39%). Patients with a history of fracture had significantly lower (p = 0.05) LS-BMD z scores (-2.81 +/- 0.29) compared with those without a history of fracture (-2.11 +/- 0.26). Mean serum 25-OH vitamin D was 29.6 +/- 1.9ng/mL (normal 9 to 37.6ng/mL) with three patients having serum 25-OH vitamin D levels less than 15ng/mL. These findings indicate that BMD is markedly reduced in non-ambulatory children and adults with neuromuscular disease. Reductions in bone mass put them at greater risk for non-traumatic fractures.     

Seltene akute Krankheitsbilder der oberen Atemwege bei Kindern

The radiologist should recognize dangerous uncommon conditions such as epiglottitis and membranous croup by their pattern on conventional images. Subglottic narrowing, as from croup, is recognizable on lateral images by loss of the superior interface of trachea and vocal cords. A lateral image is important when an upper esophageal foreign body is seen on a frontal view.