'Goose bumps' as presenting feature of intraventricular glioblastoma multiforme.

'Goose-bumps' seizures are rare manifestations of epilepsy. They are rarely reported by patients and can be easily dismissed by clinicians. Clinically, it carries some diagnostic localising value especially with unilateral onset. In this report, we present a case of intraventricular glioblastoma multiforme with ipsilateral goose bumps and review the literature.

The management of proximal rectus femoris avulsion injuries.

Injuries to the quadriceps muscle group are commonly seen in sporting activities that involve repetitive kicking and high-speed sprinting, including football (soccer), rugby and athletics.The proximal rectus femoris is prone to avulsion injuries as rapid eccentric muscle contraction leads to asynchronous muscle activation and different force vectors through the straight and reflected heads.Risk factors for injury include previous rectus femoris muscle or hamstring injury, reduced flexibility of the quadriceps complex, injury to the dominant leg, and dry field playing conditions.Magnetic resonance imaging (MRI) is the preferred imaging modality as it enables the site of injury to be accurately located, concurrent injuries to be identified, preoperative grading of the injury, and aids surgical planning.Non-operative management is associated with highly variable periods of convalescence, poor return to preinjury level of function and high risk of injury recurrence.Operative treatment of proximal rectus femoris avulsion injuries with surgical repair or surgical tenodesis enables return to preinjury level of sporting activity and high functional outcomes.Surgical tenodesis of proximal rectus femoris avulsion injuries may offer an avenue for further reducing recurrence rates compared to direct suture anchor repair of these injuries. Cite this article: EFORT Open Rev 2020;5:828-834. DOI: 10.1302/2058-5241.5.200055.

Reverse shoulder replacement: a day-case procedure.

BACKGROUND AND HYPOTHESIS: Reverse shoulder arthroplasty (RSA) is an increasingly popular treatment modality for glenohumeral joint arthritis in association with rotator cuff arthropathy. A prolonged hospital stay following joint arthroplasty risks increased complications for patients plus financial implications for institutions. We hypothesized that RSA could be safely and effectively carried out as an outpatient procedure with reduced risks to patients and institutional costs. METHODS: Patients attending our institution for RSA during March 2015 to August 2018 were reviewed preoperatively for consideration for RSA as an outpatient procedure. The inclusion criteria were arthritis of the shoulder having failed conservative management, age older than 50 years, and intact deltoid muscle function. Patients were excluded if they underwent RSA for trauma or for revision following previous total shoulder replacement or hemiarthroplasty. Overall health, social circumstances, and individual wishes were considered. RESULTS: A total of 21 patients underwent RSA as an outpatient procedure. The mean age was 74 years (range, 59-84 years). There were 8 male and 13 female patients. No overnight stays were required in patients in whom outpatient surgery was planned. The Oxford Shoulder Score increased from a mean of 16 (range, 4-30) preoperatively to a mean of 31 (range, 7-35) at 6 months postoperatively; it was a mean of 36 (range, 7-48) at 12 months postoperatively. Of the patients, 88% were "very satisfied" or "satisfied" with the service and 81% would undergo the surgical procedure again as a day-case procedure. CONCLUSION: RSA as an outpatient procedure can be carried out effectively with high patient satisfaction rates in carefully selected patients.

A radiological sign in chronic collateral ligament injuries of the thumb metacarpophalangeal joint.

BACKGROUND: Differentiating chronic from acute injuries of the collateral ligament of the metacarpophalangeal joint (MCPJ) of the thumb can be difficult in the absence of a conclusive history and examination. We aimed to establish the presence of a radiological sign in patients with a chronic injury and the reliability of the sign in differentiating chronic from acute ligament injury. METHODS: Consecutive patients undergoing surgical treatment for chronic (n = 14) or acute (n = 8) ligament injury of the MCPJ of the thumb were identified retrospectively. Six upper limb orthopedic surgeons and four musculoskeletal radiologists were recruited from three regional centers. Observers judged the presence or absence of the sign, an exostosis at the level of the neck of the thumb metacarpal, on radiographs presented on a computer program. The radiographs were then observed in a different random order. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the radiological sign were evaluated for each observer and the intra- and interobserver error was calculated. RESULTS: The mean observer specificity and sensitivity for the sign were 84 and 54 %, respectively. The PPV and NPV were 89 and 52 %, respectively. The kappa statistic for intraobserver error was 0.69 and interobserver error 0.34. CONCLUSIONS: A radiological sign associated with chronic collateral ligament injuries of the MCPJ of the thumb is established. The presence of the sign can increase the confidence of the clinician in differentiating chronic from acute collateral ligament injuries, when history and examination are inconclusive in this respect.