Attrition tendinitis of long head of biceps brachii in relation to humeral head osteonecrosis: case report.

This case report identifies a 41-year-old male patient who developed anterior shoulder pain in the setting of humeral head osteonecrosis. As a consequence of the cartilage degeneration, multiple loose bodies formed and migrated into the bicipital tendon sheath, causing attrition tendinitis, which was a feature of the clinical presentation. The patient was treated by a combination of arthroscopic glenohumeral joint debridement and open tenodesis of the biceps using a suture anchor. Follow-up revealed asymptomatic shoulder function by 18 months. This is the first report in the literature of bicipital tendinitis in the context of avascular necrosis of the shoulder.

Ulnar nerve injuries in Guyon canal: a report of 32 cases.

PURPOSE: In this study, the surgical outcomes of 32 patients with ulnar nerve injuries in the Guyon canal are presented. Outcomes were analyzed in relation to various factors such as age, surgical timing, zone of injury, and type of nerve reconstruction. METHODS: Between 1990 and 2007, 32 patients with injury in Guyon canal were managed surgically. Twelve patients had ulnar nerve injury proximal to its bifurcation (zone I); 14 patients had isolated motor branch injury (zone II); and six patients had isolated sensory branch injury (zone III). End-to-end repair was achieved in 12 (38%) of 32 patients, while nerve grafting was performed in 20 (62%) cases. The mean follow-up period was 22 months. RESULTS: Good and excellent motor function was restored in 25 (96%) of 26 cases with motor branch injury. Good and excellent sensory results were achieved in 15 (83%) of 18 cases with sensory branch injury. Outcomes were significantly better for those who had early repair (<4 weeks) when compared with those who had repair 4 weeks after injury (P < 0.05). There were no significant differences between outcomes after end-to-end repair or nerve grafting (P > 0.05) and between outcomes from repair of injuries in different zone (P > 0.05). CONCLUSIONS: Early diagnosis and surgical treatment with careful dissection of the ulnar nerve branches within the canal is very important. Adequate exposure is usually required to repair the nerve in the Guyon canal. Nerve grafting in this level could give analogous results as the end-to-end repair.

Median nerve changes following steroid injection for carpal tunnel syndrome.

INTRODUCTION: Neuromuscular ultrasound is a painless, radiation-free, high-resolution imaging modality for assessment of the peripheral nervous system. The purpose of this study was to use neuromuscular ultrasound to assess the changes that occur in the median nerve after steroid injection for carpal tunnel syndrome (CTS). METHODS: Ultrasound and nerve conduction studies were performed at baseline and 1 week, 1 month, and 6 months after steroid injection in 19 individuals (29 wrists) with CTS. RESULTS: Significant changes were noted in median nerve cross-sectional area (P < 0.001), mobility (P = 0.001), and vascularity (P = 0.042) at the distal wrist crease after steroid injection, and the nerve cross-sectional area correlated with symptom score and electrodiagnostic parameters. Changes in the ultrasonographic parameters were seen within 1 week of injection. CONCLUSIONS: These findings suggest neuromuscular ultrasound is potentially helpful for the assessment of individuals undergoing treatment for CTS, as typical changes can be expected after successful treatment injection.

The clinical outcome of the 'Surgilig' technique for the reconstruction of acromioclavicular dislocations: A systematic review.

PURPOSE: To investigate whether the 'Surgilig' technique is safe and effective for the treatment of patients suffering from acromioclavicular joint (ACJ) dislocations graded as Rockwood's type III or higher. METHODS: A systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The failure rate of the "Surgilig" implant was very low (3.5%), while patients' satisfaction was high (88.3%). However, the quality of most studies was low. CONCLUSIONS: There is low evidence to show that the reconstruction of ACJ dislocations with the 'Surgilig' technique could be a safe and effective treatment.

Superiority of synovial membrane mesenchymal stem cells in chondrogenesis, osteogenesis, myogenesis and tenogenesis in a rabbit model.

Engineering complex tissues is perhaps the most ambitious goal of all tissue engineers. Despite significant advances in tissue engineering, which have resulted in successful engineering of simple tissues such as skin and cartilage, there are a number of challenges that remain in engineering of complex, hybrid tissue structures, such as osteochondral tissue. Mesenchymal stem cells (MSCs) have the capacity to highly proliferate in an undifferentiated state and the potential to differentiate into a variety of different lineages, providing a promising single cell source to produce multiple cell types. MSC obtained from adult human contribute to the regeneration of mesenchymal tissues such as bone, cartilage, fat, muscle, tendon and marrow stroma. In the present study, the regeneration capacity of multipotent MSCs derived from different tissues in the rabbit were compared. Specifically the aim of this study was to isolate and characterize rabbit adult stem cell populations from bone marrow, adipose, synovial membrane, rotator cuff, ligament and tendon and assess their cell morphology, growth rate, cell surface markers and differentiation capacity. MSCs derived from synovial membrane showed superiority in terms of chondrogenesis, osteogenesis, myogenesis and tenogenesis, suggesting that synovial membrane-derived MSCs would be a good candidate for efforts to regenerate musculoskeletal tissues.

Bone tumours around the elbow: a rare entity.

Bone tumours around the elbow are rare. Even nowadays diagnostic dilemmas and delays are common. During recent decades the management and prognosis of patients with elbow bone tumours has improved significantly.Benign tumours can be treated using minimally invasive procedures, whereas malignant ones require a multidisciplinary team approach based on an adjuvant therapeutic regimen of chemotherapy, radiotherapy and limb salvage procedures.This article reviews the most commonly encountered elbow bone tumours and their management. Cite this article: EFORT Open Rev 2019;4:133-142. DOI: 10.1302/2058-5241.4.180086.

Total Talectomy and Reconstruction Using a 3-dimensional Printed Talus Prosthesis for Ewing's Sarcoma: A 3.5-Year Follow-up.

Ewing's sarcoma is extremely rare in the foot. Below the knee amputation is indicated for most primary malignant bone tumors of the hindfoot, with few cases of successful limb salvage surgery having been reported. The use of 3-dimensional printed implants may successfully address reconstruction challenges after tumor resection. The authors present a case of a 30-year-old woman with a Ewing's sarcoma of the talus who underwent total talectomy and replacement of the entire talus with a custom-made 3-dimensional printed talar prosthesis. [Orthopedics. 2019; 42(4):e405-e409.].

A Review of Novel Antibiotic Regimens for the Treatment of Orthopedic Infections.

As a result of the increasing numbers of joint replacement surgeries and other implant-associated procedures performed, the incidences of periprosthetic joint infections and osteomyelitis are on the rise. Antibiotic resistance to gram-positive species, which are mostly isolated from such infections, is a significant obstacle in clinical practice. Promising clinical outcomes have been reported with the use of novel antibiotics for patients with periprosthetic joint infections and osteomyelitis. Further research is necessary for the establishment of these novel antibiotic therapies in routine clinical practice. [Orthopedics. 2018; 41(6):323-328.].

Extra-Articular Diffuse Giant Cell Tumor of the Tendon Sheath: A Report of 2 Cases.

Two rare cases of extra-articular diffuse variant giant cell tumor of the tendon sheath are presented, at the elbow of a 68-year-old female and the foot of a 56-year-old male. Both patients presented with a palpable masses and marginal excision was performed; histological sections confirmed the diagnosis of extra-articular giant cell tumor. No adjuvant therapy was administered. At the latest follow-up, minimum 24 months after excision both patients were disease-free.

Surgery of the upper extremity in cerebral palsy.

Functional activities of the upper extremity are limited in most individuals with a diagnosis of cerebral palsy (CP). However, surgical interventions are applied in less than 20% of pediatric patients with an upper extremity affected by CP. This article covers the surgical interventions used for the reconstruction of the upper limb in patients with CP. The optimal surgical approach for each deformity type is described. In addition, the various evaluation techniques of the upper extremity, the general principles of an operative treatment plan, and the appropriate postoperative care of these patients is presented.