1/8. brachial plexus injury caused by impalement.Open injuries of the brachial plexus are rare. One such case, that of a 68-year-old impaled on a fence spike, is presented here. Certain principles to guide evaluation and treatment are discussed. Concomitant injury to the pleura or to vascular structures requires immediate attention; the extent and type of plexus damage may be determined from physical findings and the nature of injury. The results of plexus reconstruction are variable and routine exploration may be detrimental. The Brooks classification is reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Arthroscopic reconstruction of an isolated avulsion fracture of the lesser tuberosity.Isolated avulsion fracture of the lesser tuberosity represents an extremely rare injury that occurs mainly in younger patients. This report outlines the case of a 35-year-old healthy man who sustained a bony avulsion of the subscapularis tendon during an abduction external rotation trauma to his left shoulder. The injury was diagnosed by physical examination, standard radiographs, and magnetic resonance imaging. An arthroscopic reconstruction including closed reduction and internal fixation using suture anchors was performed. After a follow-up of 6 months, the patient's Constant Score increased from 62.4 points preoperatively to 91.3 points. At the latest follow-up, the patient was completely pain free, had regained a full work activity level, and returned to overhead sports. On postoperative standard radiographs and magnetic resonance images, the bony fragment was shown to be consolidated in an anatomic position. In cases of displaced isolated fractures of the lesser tuberosity without significant subluxation or dislocation of the long head of the biceps arthroscopic reconstruction using suture anchors can lead to a good clinical and radiological result.- - - - - - - - - - ranking = 4.3689451454538keywords = physical examination, physical (Clic here for more details about this article) |
3/8. Avulsion fractures of the lesser tuberosity of the humerus in adolescents: review of the literature and case report.Isolated fracture of the lesser tuberosity is an unusual phenomenon in children and adolescents. These injuries are difficult to diagnose acutely and often present as chronic shoulder pain. In this study, we report on 1 case of a displaced lesser tuberosity apophysis avulsion fracture in an adolescent treated with open reduction and internal fixation, as well as a review of the literature. A 14-year-old adolescent male presented to the senior surgeon complaining of left shoulder pain and weakness 10 days after a wrestling injury. He was diagnosed with a displaced, isolated fracture of the lesser tuberosity apophysis for which he underwent open reduction and internal fixation. A combination of sutures passed through drill holes in the proximal humerus and bioabsorbable suture tacks were used to anatomically fix the lesser tuberosity fragment and subscapularis tendon. Postoperatively, he underwent a progressive physical therapy regimen. At 4 months follow-up, he had full range of motion, complete return of strength, and returned to competitive athletics. We report here on the successful surgical treatment of a fracture of the lesser tuberosity apophysis in an adolescent.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Management of a patient with an isolated greater tuberosity fracture and rotator cuff tear.STUDY DESIGN: Case report. BACKGROUND: patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear. CASE DESCRIPTION: The patient was a 45-year-old male who sustained a shoulder injury as the result of a fall while skiing. After the initiation of physical therapy, he was diagnosed with an isolated greater tuberosity fracture. Little is known regarding the optimal management and overall prognosis of this type of fracture. Conservative nonoperative management and postoperative physical therapy management are discussed. OUTCOMES: With conservative nonoperative management, the patient was unable to regain high-level functional shoulder use. Suspicion of continued pathology of the greater tuberosity dictated further diagnostic imaging, which led to surgical intervention. Upon completion of postoperative rehabilitation, he was able to resume full recreational activities. DISCUSSION: It is recommended that sound clinical decision-making dictate the management and ongoing evaluation of traumatic shoulder injuries, especially when managing a patient with an injury for which optimal treatment and prognosis is not well established.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
5/8. Fracture separation of the coracoid process associated with acromioclavicular dislocation: conservative treatment--a case report and review of the literature.Complete acromioclavicular dislocation associated with fracture separation of the base of the coracoid process is uncommon. This is a report of a 51-year-old man with severe emphysema and limited physical demands in whom the acromioclavicular dislocation and coracoid process fracture were treated conservatively with sling immobilization and early motion and exercises. Good power and full, painless range of motion with minimal symptoms was observed at 6 months follow-up. The strong coracoclavicular ligaments, rather than rupture, may avulse the coracoid process near its base and with disruption of the acromioclavicular joint may allow complete dislocation of the clavicle. A satisfactory result may be obtained without operative reduction of either the acromioclavicular joint or the coracoid process.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. diagnosis of post-traumatic syringohydromyelia presenting as neuropathic joints. Report of two cases and review of the literature.Two paraplegic men with post-traumatic syringohydromyelia presented initially with neuropathic arthropathy of the elbow and shoulder, respectively. Both patients had sustained spinal trauma years earlier and had been lost to orthopedic and neurosurgical follow-up study. Characteristic history and physical findings were present in both patients. Conventional myelography failed to demonstrate the lesion in the first patient. The diagnosis in the second patient was confirmed by lumbar injection of low-dose metrizamide followed by immediate and delayed computerized axial tomography in the supine and lateral positions. Both patients were treated by surgical decompression and subarachnoid shunts with arrest of the neurologic deterioration. To the authors' knowledge, this is the first report of patients with post-traumatic syringohydromyelia presenting with neuropathic joints. The present case reports illustrate the need for long-term follow-up studies of patients with spine injury in specialty clinics. The use of computerized axial tomography and low-dose intrathecal metrizamide is advocated for diagnosing post-traumatic syringohydromyelia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Radiological and histological improvement of oxalate osteopathy after combined liver-kidney transplantation in primary hyperoxaluria type 1.A 15-year-old patient with severe bone disease (with bilateral fractures of hips and shoulders) due to primary hyperoxaluria type 1 (PH1) was treated with combined liver-kidney transplantation after a 4-year hemodialysis period. Normalization of excessive oxalate synthesis brought in by the liver graft combined with the slow excretion of skeletal oxalate stores by the renal graft led to progressive improvement of clinical, radiological, and histological evidence of oxalate osteopathy. This allowed bilateral hip replacement 3 years after transplantation, which led to complete physical rehabilitation of the crippled patient. Combined liver-kidney transplantation constitutes the treatment of choice for end-stage renal failure due to PH1, even in the face of severe oxalate bone disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Arthroscopic subscapularis tenolysis: a technique for treating refractory glenohumeral stiffness following open reduction and internal fixation of a displaced three-part proximal humerus fracture.This case illustrates the treatment of a stiff shoulder following open reduction and internal fixation of a three-part fracture of the proximal humerus. motion could not be improved with physical therapy or with manipulation under general anesthesia. Arthroscopic subscapularis tenolysis provided a dramatic increase in range of motion. The unique pathological findings may render such cases refractory to manipulation because of thick unyielding scar tissue. In such cases, arthroscopic subscapularis tenolysis may provide the only means of improving the final range of motion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |