Ultrasound Features Associated With Shoulder Complaints: Calcifications Larger Than 6 mm in Young Patients and Positive Doppler Are Associated With Pain.

Objectives: To identify ultrasound (US) features associated with the presence of shoulder complaints. Methods: This observational, case-control study, compared US findings between participants with and without shoulder complaints, matched for age, sex, and dominancy. Data was collected from February 2018 to June 2020. Two-tailed Fisher's and Mann-Whitney U-tests were used, with p-values < 0.05 considered significant. Results: A total of 202 participants were enrolled (median age 56 years, range 18-70, 155 women), comprising 140 cases and 62 controls. A calcification size ≥6 mm, when age < 56 (p = 0.02), and a distance to tendon insertion ≥6 mm, when age ≥56 (p = 0.009), were only found in symptomatic shoulders. Color Doppler in rotator cuff (RC) tendons predominated in the presence of symptoms (26/140 vs. 2/62, p = 0.003). An algorithm also combining the number of calcifications, tendon echotexture and insertional thickening, osseous irregularity, cuff tears, and subacromial effusion showed a 92% (57/62) specificity for shoulder pain on this study sample. Conclusion: Calcification diameter of 6 mm or more is associated with shoulder pain in patients younger than 56 years. A distance from calcification to tendon insertion of 6 mm or more is related to pain in older patients. Doppler signal also is associated with shoulder pain. An algorithm based on a set of specific ultrasonographic criteria have a strong association with the presence of symptoms.

Palm-up test and range of motion in flexion and external rotation provide best correlation with disability and perceived pain in patients with shoulder complaints.

The aim of this study was to find a reliable set of clinical tests to predict pain and disability in patients with shoulder pain. Shoulder pain is the second most frequent musculoskeletal complaint in the primary care setting and has a great impact in work and leisure activities. Patient reported outcomes measuring pain and disability are available, but they are time-consuming, often biased by psychological and sociological factors and depend on patient collaboration. This was an observational, cross-sectional study, including patients with shoulder pain aged 18 to 70 years. Patients filled in the questionnaires Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and Shoulder Pain and Disability Index (SPADI) pain scale. A Visual Analogue Scale (VAS) for current pain was applied and sociodemographic and clinical data were collected. Physical examination included the Jobe, Neer and palm-up signs, range of motion (ROM) of shoulder abduction, flexion and rotation (internal and external), both active and passive. An independent t-test to compare differences between groups and the Spearman's coefficient for evaluation of bivariate correlation were used. Linear regression analysis was applied to relevant predictors. Tests were two-tailed and p values < 0.05 were considered significant. A total of 127 patients were included. Female patients and those with a positive Jobe, Neer or palm-up tests, complaints on dominant side, no leisure activity involving shoulder effort, a history of previous shoulder tendinopathy or taking analgesics had significantly higher DASH scores. Age and all range of motion variables significantly correlated with DASH scores. A linear regression model with six dependent variables (Palm-up test, range of motion in active flexion and external rotation, age, gender and complaints on dominant side) produced the highest correlation (R = 0.665), explaining 44% of the variance of DASH score. A model based on few physical examination items and individual objective data like age, gender and dominancy, can help predict disability and perceived pain in shoulder disorders. Palm-up test and range of motion in active flexion, abduction and external rotation showed best correlation with the outcome, but abduction was found redundant for the obtained prediction model.

Urachal abscess mimicking malignant tumor: can imaging tell them apart?

The urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure can lead to infectious or neoplastic complications later in life. We report a case of an 84-year-old man that presented with a urachal complex mass which, after proper investigation, revealed to be a urachal abscess. Urachal abscesses are rare and usually occur in severe infections. Urachal abscesses can be indistinguishable from urachus carcinoma on imaging studies. This article reviews the clinical and imaging aspects of urachal abscess and carcinoma and possible differentiating elements in imaging. However, definitive diagnosis usually depends on a biopsy or fluid aspiration.

Severe limb-girdle muscular dystrophy 2A in two young siblings from Guinea-Bissau associated with a novel null homozygous mutation in CAPN3 gene.

Limb-girdle muscular dystrophy 2A (LGMD2A) or calpainopathy is the most common type of LGMD worldwide, representing about 30-40% of all described cases. Nevertheless, its prevalence in sub-Saharan African countries is unknown. We report two young siblings from Guinea-Bissau with recessive calpainopathy due to novel null homozygous c.1702Gdup mutation in CAPN3 gene. Their phenotype was quite aggressive concerning limb-girdle atrophy and muscle weakness as well as respiratory involvement. The proband needed nocturnal non-invasive ventilation at the age of 32, and his 33-year-old affected sister succumbed to an acute respiratory arrest after an intercurrent infection. This is the first description of calpainopathy in the sub-Saharian African region. Although there is no consistent genotype-phenotype correlation in calpainopathy, the new null homozygous mutation found in the CAPN3 gene may be associated with the particularly severe phenotype observed in our patients.