1/3. acromion reconstruction after total arthroscopic acromionectomy: Salvage procedure using a bone graft.We report 2 cases of acromion reconstruction with a bone graft as a salvage procedure after total arthroscopic acromionectomy. Complete removal of the acromion had produced severe shoulder abnormality with pain and joint stiffness. We present the operative technique of acromion reconstruction using a corticocancellous bone graft from the iliac crest. recreation of the acromion as a fulcrum of the shoulder joint as well as an important physiological insertion area for the deltoid muscle markedly improved pain and range of motion in these patients. In conclusion, based on these cases, we believe that total acromionectomy is an inadequate procedure for treatment of shoulder impingement syndrome. acromion reconstruction with a bone graft is an alternative that may lead to improvement of clinical symptoms.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/3. Articular impingement in malunited fracture of the humeral head.We report on the case of a fracture of the humeral metaepiphysis, surgical neck, and greater tuberosity treated conservatively. Malunion of a fracture of the greater tuberosity developed an impingement on the glenoid surface, causing an articular locking in internal rotation that resolved with slight pressure and a painful "click." The impinging bone was removed arthroscopically. Its extreme posterior position required opening a second, novel portal close to the posterior edge of the acromion for instrument access. Complete removal of the impinging bone restored free internal rotation without signs of impingement on the glenoid surface. Passive motion was initiated immediately postoperatively, and active motion in a water pool was initiated after 2 weeks. After 1 year, the patient has no pain, has maintained complete range of motion, and experiences no limitations in daily or sports activities. The peculiar features of this case are the absence of soft tissue scar stiffness and deficiency of the rotator cuff, because malunion of the bone fragment to the posterior edge of the humeral head produced a mechanical block of internal rotation, and the arthroscopic treatment of the impingement through an atypical superoposterior portal, which has not been described in the literature before.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
3/3. rotator cuff impingement.OBJECTIVE: To present a case of shoulder impingement syndrome managed with a conservative multimodal treatment approach. CLINICAL FEATURES: A patient had anterior shoulder pain and a diffuse ache in the right upper arm, with tenderness in the shoulder region on palpation. Shoulder range of motion was limited with pain and catching, coupled with limited and painful cervical motion. After physical and orthopedic examination, a clinical diagnosis of shoulder impingement syndrome was made. INTERVENTIONS AND OUTCOME: The patient underwent a multimodal treatment protocol including soft tissue therapy, phonophoresis, diversified manipulation; and rotator cuff and shoulder girdle muscle exercises. Outcomes included pain measurement; range of motion of the shoulder, and return to normal daily, work, and sporting activities. At the end of the treatment protocol the patient was symptom free with all outcome measures normal. The patient was followed up at 4 and 12 weeks and continued to be symptom free with full range of motion and complete return to normal daily and pre-treatment activities. CONCLUSION: This case report shows the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with shoulder impingement syndrome.- - - - - - - - - - ranking = 4keywords = motion (Clic here for more details about this article) |