RESUMEN
Suprascapular fossa lipoma extending to the suprascapular notch causing traction injury to the suprascapular nerve is a rare presentation. We report a 47-year-old male with progressive weakness of the right shoulder joint of 8 months duration, with a palpable mass over the spine of the scapula was noticed 2 months earlier and developed a sudden drop in arm following a moderate strain. A magnetic resonance imaging (MRI) scan revealed a rotator cuff tear involving the supraspinatus and infraspinatus muscles with a tumor like lesion in the suprascapular fossa, displacing the suprascapular muscle mass and extending into the suprascapular notch. Electromyography and nerve conduction velocity studies revealed suprascapular neuropathy. After histopathologic confirmation, an arthroscopic excision of the mass with decompression of the suprascapular notch was performed along with repair of the rotator cuff. Six months after the procedure, the patient had improved considerably in terms of function and postoperative MRI revealed a complete excision of the mass, and further follow-up of 2 years showed no recurrence. Suprascapular nerve entrapment can be caused by a lipoma in the shoulder, leading to weakness, atrophy, and consequent tear of the rotator cuff tendons. Arthroscopic management, after histopathological confirmation, gives good results in this situation. LEVEL OF EVIDENCE: Level IV.
RESUMEN
Arthroscopic Latarjet has evolved as a reproducible procedure to address significant anterior glenoid bone loss in recurrent anterior instability of the shoulder joint. While arthroscopic Bankart procedure for anterior shoulder instability has changed from metal anchors to absorbable or soft all-suture anchors to avoid metal-ware and subsequent abrasion in cases of osteolysis or backout, Latarjet procedure, until recently couple of titanium screws were used to fix the coracoid bone to the anterior glenoid. Arthroscopic techniques for Latarjet procedure of coracoid bone transfer have shown results similar to the open technique in many recent studies. We use an all-arthroscopic technique that is different and easier from the currently described technique using FiberTape cerclage loops, with 2 ultrabraid tapes fixing the coracoid bone to the prepared anteroinferior glenoid surface. The repair is completed using all-suture anchors to fix the anterior capsule over the attached coracoid, thus exteriorizing the transferred bone and preventing contact with the moving humeral head.
RESUMEN
BACKGROUND: Patellar instability is a painful condition which affects the quality of life and mobility of young individuals. The aim of this study is to observe the results of medial patello-femoral ligament reconstruction with hamstring autograft along with a modified Fulkerson osteotomy, for recurrent instability of patella with high-grade trochlear dysplasia in Indian population. MATERIALS & METHODS: We conducted a prospective observational study of 26 knees (21 patients) who attended our outpatient department from June 2014 to February 2019, with recurrent instability of the patella and high-grade trochlear dysplasia. All knees were treated with MPFL reconstruction with hamstring autograft and modified Fulkerson osteotomy. RESULTS: The mean follow-up period was 30 months (range: 24-50). The mean Lysholm scores improved from 49.9 (range: 30-63) preoperatively to 82.5 (range: 51-100) (p < 0.05), Kujala scores from 55.5 (36-67) to 85.9 (55-100) and International Knee Documentation Committee (IKDC) scores from 50.2 (31.6-62.3) to 82.9 (54.7-98.3) (p < 0.05) at 2 years follow-up. TT-TG distance decreased from 21.2 mm (18-25) to 11.6 mm (10-13) (p < 0.05) and patellar tilt angle decreased from 24.2° (18°-35°) to 7.2° (5°-10°) (p < 0.05). One knee had superficial skin infection in immediate post-operative period. Three knees had postoperative stiffness, which improved on manipulation under anesthesia. Six knees had implant irritation from the osteotomy screws which were removed after bony union was achieved. Functional scores were low in two knees due to patello-femoral pain, but they did not have recurrent instability. CONCLUSION: MPFL reconstruction with tibial tubercle transfer gives good functional outcomes in 92.3% patients with recurrent patellar instability, associated with high-grade trochlear dysplasia in Indian population.
