Case Report of Herpes Zoster Infection of the Cervical Dermatome - A Rare Cause of Acute Shoulder Pain.

Introduction: Acute shoulder pain is among the most common presenting complaints in the clinic. Clinicians may find it challenging with the myriad of potential etiologies to explain for the presenting complaint. We present a unique case, where a herpes zoster infection in the C6 dermatome mimicked the presentation of rotator cuff pathology and was admitted to the care of orthopedics. We have also included a detailed literature review on the topic in our study. Case Report: The patient was a 38-year-old Chinese female who presented with acute atraumatic right-sided shoulder pain and weakness which was potentially confounded by an attempt of traditional Chinese medicine. Clinical examination revealed that the range of motion was globally reduced and painful in all directions with equivocal impingement testing. Examination of the skin revealed the presence of polymorphous eruption of erythematous papules and vesicles in the right shoulder and C6 region. In this paper, we discuss a possible algorithm to aid clinicians in an acute shoulder pain history with accompanying red flags to look out for. This is accompanied by a detailed literature review on the topic which demonstrates the rarity of this presentation which eventually confounded the initial management of the patient. Conclusion: A thorough history and physical examination must remain the cornerstone of a clinician's diagnostic algorithm. Zoster neuropathy at the level of the cervical spine is a rare entity. This case report also emphasizes the need for cognizance of local traditional remedies practiced and their interactions with clinical diagnosis and treatment.

MPFL reconstruction corrects patella alta: a cohort study.

PURPOSE: Patella alta is an established risk factor for recurrent lateral patella dislocations. Medial patellofemoral ligament (MPFL) reconstruction has been shown to reduce patella height. Our hypothesis is that isolated MPFL reconstruction corrects patella alta, thereby reducing the risk of recurrent patella dislocation. METHODS: A prospective cohort study of 33 knees which underwent MPFL reconstruction for recurrent patella dislocation. The pre-operative and post-operative patella height and Kujala knee outcome scores, as well as tibial tuberosity-trochlear groove (TT-TG) distance, and the grade of trochlear dysplasia were recorded. RESULTS: The mean age was 21.5 years (16-34 years). There was significant reduction in patella height in all patients (p < 0.001), a 67% normalisation of patella alta (CD ≥ 1.2) (p < 0.004), and improvement in the Kujala scores 57.1 (pre-operatively) to 94.8 (post-operatively, p < 0.0001). The recurrent dislocation rate was 3%. CONCLUSION: MPFL reconstruction alone results in correction in patella alta and improvement in clinical outcomes.

Technique for All-Inside Repair of Bucket-Handle Meniscus Tears.

Bucket-handle meniscal tears (BHMT) remain a challenge to treat due to their complex pathology and technical difficulty. Subtotal meniscectomy has shown to improve symptoms early but leads to accelerated osteoarthritis in the affected compartment and poor long-term outcomes. BHMT repair and meniscal preservation is the preferred option. This can be performed with inside-out, all-inside, or hybrid meniscus repair techniques. All-inside meniscus repair avoids the need for additional safety incisions, trained assistants for suture passing, and reduce concerns of soft-tissue and neurovascular complications. In this Technical Note, we detail our all-inside technique for BHMT technique and share tips for a successful repair.

Intra-operative fractures in cementless bipolar hemiarthroplasty.

PURPOSE: To compare patients with or without intra-operative fracture during cementless bipolar hemiarthroplasty. METHODS: Records of 76 men and 202 women who underwent cementless bipolar hemiarthroplasty for femoral neck fractures were reviewed. Patients with and without intra-operative fractures and patients with different types of intra-operative fractures were compared. RESULTS: Two men and 22 women aged 62 to 93 (mean, 80) years sustained intra-operative fractures at the lesser trochanter (n=18), the greater trochanter (n=5), and the subtrochanter (n=1). All 18 lesser trochanteric fractures and 4 of the greater trochanteric fractures were recognised intra-operatively and managed with cerclage wiring (n=21) or conversion to cemented hemiarthroplasty with cerclage wiring (n=1). The remaining 2 fractures were recognised postoperatively on radiographs and managed conservatively or with revision surgery and cerclage wiring and plating on day 4. Intra-operative fractures correlated with female gender (p=0.03) and operative delay to optimise patients (p=0.02), whereas the fracture site correlated with the time of fracture recognition (p=0.01). Postoperatively, 5 patients were allowed partial weight bearing and 18 were instructed to mobilise with a wheelchair for at least 6 weeks. One patient died from an unrelated cause. At one year, 21 patients reported no hip pain and 2 reported minimal pain. 17 could walk with or without aids and 6 were wheelchair-bound. CONCLUSION: Surgeons should be familiar with the size difference in trial and actual implants used in bipolar hemiarthroplasty in order to better estimate the extent of broaching required. In most patients with an intra-operative fracture, the one-year outcome was not compromised, despite the poorer short-term outcome.