Cases reported "Shoulder Pain"

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1/12. Preoperative work-up of a solitary diaphragmatic mass in a patient with right shoulder pain: a case for diagnosis.

    A patient presented with right shoulder pain. Imaging studies revealed an apparently solitary soft tissue pleural lesion, accompanied by a very small pleural effusion. On medical thoracoscopy, a diffuse malignant pleural mesothelioma was found. thoracoscopy proved to play an essential part in the diagnostic work-up, avoiding a futile thoracotomy for a presumed solitary soft tissue tumour.
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keywords = operative
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2/12. An operative technique for recurrent shoulder dislocations in older patients.

    Recurrent anterior shoulder dislocation in the elderly is not as exceptional as it was once thought to be. That anterior shoulder dislocation in older patients is caused by a rotator cuff tear through the posterior mechanism is well accepted. However, in the subset of patients who have multiple recurrent or intractable dislocations develop, there may be combined pathologic conditions at work: large or massive rotator cuff tears together with anterior capsulolabral injuries such as a Bankart lesion or fracture of the glenoid rim. These patients have multiple recurrences because of disruption of both the anterior and the posterior stability mechanisms. We suggest a procedure that provides anterior stabilization with the capsular shift technique and that is supplemented by Bankart repair as necessary. The capsule transfer is performed superiorly and posteriorly to close the defect in the cuff. In this way a capsulodesis effect can be achieved that displaces the humeral head downward and produces active centering of the head in the course of abduction. Use of only the anterior capsule for the shift, and not the subscapularis tendon, does not compromise subscapularis function. Between 1990 and 1996, we used this technique to treat 16 patients older than 55 years of age with multiple recurrent anterior shoulder dislocation and massive rotator cuff tear. We report the results for the first 10 patients with a minimum follow-up of 2 years (range 2 to 7 years) and an average follow-up of 52 months. There were 7 excellent results, 2 good results, and 1 fair result according to the Rowe criteria. None of the patients had a recurrence of the dislocation. All the patients regained full or functional range of motion with stable shoulders, and most of them could perform activities of daily living without limitation. The average Constant score was 83%. This procedure appears to be successful in treating older patients with recurrent shoulder dislocation.
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keywords = operative
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3/12. Suprascapular nerve entrapment at the spinoglenoid notch in a professional baseball pitcher.

    Suprascapular nerve injuries at the spinoglenoid notch are uncommon. The true incidence of this lesion is unknown; however, it appears to be more common in athletes who participate in sports involving overhead activities. When a patient is being evaluated for posterior shoulder pain and infraspinatus muscle weakness, electrodiagnostic studies are an essential part of the evaluation. electromyography will identify an injury to the suprascapular nerve as well as assist in localizing the site of injury. In addition, imaging studies are also indicated to help exclude other diagnoses that can mimic a suprascapular nerve injury. The initial management should consist of cessation of the aggravating activity along with an organized shoulder rehabilitation program. If the patient fails to improve with 6 months to 1 year of nonoperative management, surgical exploration of the suprascapular nerve should be considered. Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function.
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ranking = 0.25
keywords = operative
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4/12. Quadrilateral space syndrome: diagnosis, pathology, and treatment.

    Quadrilateral space syndrome is an infrequent, recently established neurovascular compression syndrome affecting young active adults. With this syndrome, the neurovascular bundle, consisting of the posterior humeral circumflex artery (PHCA) and the axillary nerve, is compressed by fibrotic bands as it traverses the quadrilateral space. Symptoms result from compression of the axillary nerve, not from PHCA occlusion. Because of the vague, often nonspecific, clinical presentation of patients with quadrilateral space syndrome, diagnosis is challenging and requires a high index of suspicion from the orthopedist. Subclavian arteriography confirms the diagnosis. Treatment is usually conservative; operative management is reserved for selected patients. A posterior approach with detachment of the deltoid and teres minor muscles is recommended for surgical decompression and for lysis of fibrous tissue. We report two cases of persistent quadrilateral space syndrome in young adults, treated surgically, with 2-year follow-up. In the present report, diagnostic criteria, pathology, management, operative technique, and recent literature are also reviewed.
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ranking = 0.5
keywords = operative
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5/12. Anterior internal impingement: An arthroscopic observation.

    PURPOSE: The source of pain in patients with a stable shoulder and clinical signs of impingement is traditionally thought to be subacromial or outlet impingement, as popularized by Neer. This report introduces the concept of anterior internal impingement in patients with signs and symptoms of classic impingement syndrome and arthroscopic evidence of articular-side partial rotator cuff tear. Contact that occurs between the fragmented undersurface of the rotator cuff and the anterosuperior labrum is the apparent source of pain in these patients. TYPE OF STUDY: Case series. methods: Ten patients with a primary symptom of pain and an arthroscopic finding of a partial rotator cuff tear were reviewed. Arthroscopic visualization of the subacromial space revealed no evidence of subacromial impingement or bursitis in any patient. All patients had clinical signs and symptoms of classic impingement. The initial part of the surgical procedure consisted of a complete diagnostic arthroscopy in a low-volume gas medium using a single posterior portal. While performing the Hawkins test, the locations of any areas of abnormal soft-tissue contact and impingement were observed directly. RESULTS: There was anterior internal impingement in all 10 patients with partial-thickness rotator cuff tears. The abnormal and fragmented rotator cuff tissue made contact with the anterior superior labrum when the shoulder was visualized from the posterior portal while performing the Hawkins test. Preoperative magnetic resonance imaging correctly showed a partial-thickness rotator cuff tear in 20% of the cases. CONCLUSIONS: Recognition of anterior internal impingement as a clinical entity is important because magnetic resonance imaging results are often misleading. This is of particular importance in young patients with isolated lesions in whom arthroscopic acromioplasty and capsular reefing procedures would be unnecessary. When anterior internal impingement is recognized as the source of unresolved shoulder pain, patient selection for surgery and procedure selection can be improved.
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ranking = 0.25
keywords = operative
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6/12. An indication for continuous cervical paravertebral block (posterior approach to the interscalene space).

    We present a patient who required perioperative analgesia with continuous nerve block for shoulder disarticulation, for whom the only approach possible to the brachial plexus was from posterior. A 51-yr-old woman was suffering from intractable upper extremity pain and dysfunction as a result of severe lymphedema after metastatic spread of breast cancer to the axilla. Her pain was poorly controlled despite aggressive treatment with oral, systemic, and intrathecal opiates. She presented for amputation of her arm as a last resort for management of pain. In order to provide optimal postoperative analgesia, continuous peripheral nerve block was selected in consultation with the patient, and due to anatomic disfigurement and tumor invasion, a continuous cervical paravertebral block was placed preoperatively and shoulder disarticulation was performed using a combined regional/general anesthesia technique. The patient had an uneventful recovery without pain for the 6 postoperative days that the catheter was in place and 0.25% bupivacaine was infused at 5 mL/h. Because of anatomic considerations, which precluded the use of all other approaches to the brachial plexus, the posterior cervical paravertebral approach provided an effective means of pain control in this difficult clinical situation.
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ranking = 1
keywords = operative
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7/12. darier disease: sustained improvement following reduction mammaplasty.

    darier disease is an autosomal-dominant inherited genodermatosis. A woman is described who had darier disease and hereditary spherocytosis whose inframammary darier disease had dramatic and sustained improvement following reduction mammaplasty. The postoperative resolution of the dermatosis beneath the patient's breasts introduces the possibility that, when appropriately indicated, breast reduction surgery may have a potential role in the management of severe inframammary darier disease.
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ranking = 0.25
keywords = operative
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8/12. Pectoralis major tendon avulsion from rappelling.

    To our knowledge, we are reporting the first case of a pectoralis major tendon avulsion from rappelling. The mechanism of injury in this case differs biomechanically from the commonly associated activity of bench pressing. The patient's initial presentation, course of corrective treatment, and postoperative rehabilitation is discussed in detail. A review of the historical and current literature on pectoralis major tendon injuries is included. The results of current biomechanical studies are discussed in relation to the complex anatomy of the pectoralis major muscle. This report is relevant to individuals involved in rappelling, high-demand athletes, and the surgeons who treat them. Nonoperative management of pectoralis major tendon tears is contrasted with operative repair. The current literature supports operative treatment in high-demand athletes, laborers, and military personnel to allow them to regain full strength and endurance.
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ranking = 1
keywords = operative
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9/12. Shoulder hemiarthroplasty to manage haemophilic arthropathy: two case studies.

    Bleeds within the shoulder joint can lead to significant joint destruction and may have associated pain, decreased range of movement (ROM), and impaired function. Conservative management should involve prompt administration of Factor VIII and physiotherapy to address all surrounding structures so as to minimize further damage. If conservative management fails to relieve severe, unremitting shoulder pain in the presence of underlying arthropathy, then arthroplasty may be considered. Outcomes of arthroplasties performed for osteoarthritis and rheumatoid arthritis appear favourable. Few articles, however, have addressed shoulder arthroplasty to manage haemophilic arthropathy, and no reports have documented the rehabilitation process. Three hemiarthroplasties were performed at the Royal Brisbane and women's Hospital on two men with haemophilia. There were no surgical or postoperative complications. rehabilitation included intensive physiotherapy. The results in each case revealed a decrease in pain, and an increase in ROM and function postoperatively. These findings suggest that hemiarthroplasty with postoperative physiotherapy may be a feasible option to manage severe, chronic and progressing shoulder pain as a result of haemophilic arthropathy of the shoulder.
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ranking = 0.75
keywords = operative
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10/12. Increases in bispectral index lead to interventions that prevent possible intraoperative awareness.

    In this case a woman underwent a cervical laminectomy with a total i.v. anaesthesia technique and during her care two problems occurred with propofol delivery. In both cases, bispectral index increases alerted caregivers to the decreased propofol delivery and allowed them to make corrections in a manner timely enough to prevent the occurrence of awareness during anaesthesia. The case illustrates how intraoperative processed electroencephalographic monitoring may decrease the incidence of recall of awareness following surgery.
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ranking = 1.25
keywords = operative
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