Transient postoperative inferior subluxation of the shoulder after surgical stabilization of recurrent anterior dislocation in a patient with myasthenia gravis: a case report

The authors present a case of transient postoperative inferior subluxation of the shoulder after arthroscopic surgical stabilization for recurrent anterior dislocation. The patient was a 61-year-old woman with myasthenia gravis (MG). The first anterior shoulder dislocation occurred because of a fall to the ground. Despite a successful closed reduction, two more dislocations occurred in 3 weeks. Magnetic resonance imaging revealed an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion, an engaging Hill-Sachs lesion, and large tears of the supraspinatus and infraspinatus tendons. The patient underwent arthroscopic rotator cuff repair and ALPSA repair with a remplissage procedure. Intraoperatively, no tendency for instability was found; however, a widened glenohumeral joint space and inferior subluxation of the humeral head without functional compromise was observed on the day after surgery and disappeared spontaneously on radiographs 2 weeks later. To the authors’ knowledge, this is the first report documenting the occurrence of transient postoperative inferior subluxation of the shoulder in a patient with MG.

Can a Two Simple Stitches Method Provide Secure Fixation Strength in Biceps Tenodesis?:Biomechanical Evaluation of Various Suture Techniques

Background@#The purpose of this study was to compare the initial fixation strength between four different suture methods for the long head of the biceps. @*Methods@#Forty-eight fresh frozen porcine flexor hallucis longus tendons (mean width at suture site, 8.5 ± 0.9 mm) and phalanx bones were randomly assigned to one of the four arthroscopic biceps tenodesis techniques: simple stitch (SS), mattress suture (MS), lasso-loop (LL), and two simple stitches (2SS). A biceps tenodesis was performed according to the four techniques using all-suture type suture anchors (1.9-mm SUTUREFIX anchor with No. 1 ULTRABRAID sutures). Biomechanical evaluations were performed to test load to failure (N), stiffness (N/mm), stress (N/m 2 ), and mode of failure. @*Results@#As for the SS, MS, LL, and 2SS, the mean load to failure was 50.9 ± 14.61 N, 82.3 ± 24.8 N, 116.2 ± 26.7 N, and 130.8 ± 22.5 N (p < 0.001), respectively; mean stiffness was 6.1 ± 1.3 N/mm, 6.7 ± 2.6 N/mm, 7.8 ± 1.4 N/mm, and 8.1 ± 4.2 N/mm, respectively (p = 0.258); and mean stress was 0.7 ± 0.3 N/m 2 , 1.4 ± 0.8 N/m 2 , 2.9 ± 0.7 N/m 2 , and 2.7 ± 0.8 N/m 2 , respectively (p < 0.001). All the failures happened by the suture cutting through the tendon along its longitudinal fibers. @*Conclusions@#Neither the SS nor the MS method was enough to securely fix the biceps tendon with a significantly lower mechanical strength; however, the 2SS method showed similar initial fixation strength as the LL technique.

Metastasis of renal cell carcinoma around suture anchor implants

We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.

Metastasis of renal cell carcinoma around suture anchor implants

We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.

Changes in Shoulder Muscle Activities Depending on Static and Dynamic Body Positions during Shoulder External Rotation Exercises Using Kinetic Chain Concept / 대한스포츠의학회지

Purpose@#We aimed to evaluate shoulder muscle activities during shoulder external rotation exercises using an elastic band with the arm at the side or at 90° of abduction in static and dynamic body positions. @*Methods@#In 2017, a total of 19 right-handed male subjects were included in this study. Surface electromyography signals were recorded from the anterior deltoid, middle deltoid, upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscles. The subjects underwent maximal voluntary isometric contraction testing of each muscle in the W position or 90/90 position. Subjects performed the exercise in the sitting, static squat, static rotational squat, dynamic squat to standing (DSS), and dynamic squat to standing and trunk rotation (DSSR) positions. @*Results@#The main finding of this study was that shoulder external rotation exercises in the DSSR position were effective in reducing shoulder muscle activities except in the serratus anterior compared with static rotational squat position. @*Conclusion@#DSSR enabled effective control of scapular motion with less shoulder muscle activation. Therefore, the kinetic chain exercises incorporated with lower extremity, hip, or trunk would be beneficial for shoulder muscle exercises, which is required for patients with weak periscapular muscles, in whom the lower trapezius activities were found to be frequently decreased.

Olecranon Nonunion after Operative Treatment of Fracture

PURPOSE: Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment. MATERIALS AND METHODS: We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion. RESULTS: According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases). CONCLUSION: Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.

Anthropological Study on Human Skeletons from Joseon Tomb, for Confirming Ryu Ja-Gwang, a Famous Historical Figure of Medieval Korea / 체질인류학회지

Anthropological study on human skeletons from Joseon tomb, for confirming Ryu Ja-Gwang, a famous historical figure of medieval Korea. Ryu Ja-Gwang was the famous figure of Joseon Dynasty who achieved great successes in royal court. According to the records in Joseon Dynasty, he tried to hide his own tomb after death under the apprehension that the political enemies might do harm to his corpse. In 1974, the descendants of Younggwang Ryu clan discovered a Joseon tomb that was lost for the past several hundred years. Since they suspected if the tomb might be their legendary ancestor's, anthropological studies were asked to be done on the skeletons collected from the tomb. In our study, the estimated stature of a male from the tomb was 160.5+/-3.8 cm. The age at death was estimated to be 58.6+/-5.2. He seems to have been suffered from diffuse idiopathic skeletal hyperostosis (DISH), the disease prevalent among the people taking high-caloric diets. Since nuclear DNA could not be amplified in this case, the personal identification of the dead person could not be successfully traced by molecular techniques. Taken together, we could not conclude that the skeletons were those of Ryu Ja-Gwang because the radiocarbon dating, age at death or height data could not be well matched with those described in historical documents. Even so, this study could be significant to the related researchers because it was one of the first trials to identify debatable historical figure using various anthropological techniques. Considering that the anthropological studies on famous historical people have been performed briskly, our study could be the basis for the similar studies in Korea, performed in near future.

Primary Serous Papillary Carcinoma of the Peritoneum: A Case Report

Primary serous papillary carcinoma of the peritoneum is a rare neoplasm arising from the mesothelium. Histologically it is indistinguisable from ovarian serous papillary carcinoma, but it should be free of tumor or involved only superficially with the ovary. Radiologically its common findings are peritoneal and omental masses with ascites, and it is indistinguisable from peritoneal carcinomatosis or malignant mesothelioma. We report a case of surgically proven primary serous papillary carcinoma of the peritoneum in a 63-year-old woman.

Screening Examination of Breast Cancer: Review of the Recommended Guidelines / 영남의대학술지

BACKGROUND: Delays in breast cancer diagnosis may occur in young women due to a low index of suspicion. The purpose of this study was to compare mammography and breast sonography in detection of breast cancer and to suggest a reasonable guideline for breast cancer screening examination. MATERIALS AND MATHODS: Among 820 patients, 102 patients were under 35 years and 122 patients were above 60 years of age. We reviewed medical records, mammograms and/or ultrasonography of 49 patients under 35 years and 48 patients above 60 years of age with pathologically-proven breast cancer. Pathological reports were as follows: Invasive ductal carcinoma(IDC) was present 61.2% of patients in the young age group and ductal carcinoma in situ(DCIS) in 16.3%. IDC was present in 66.6% of the patients in the old age group, and DCIS in 8.33%. We analyzed mammography and ultrasonography to evaluate their usefullness in detecting breast cancer in patients under 35 years and over 60 years of age. RESULTS: The mammographic results are as follows: 1) detection rate of lesion: 83.8%(under 35yrs), 100%(over 60yrs) 2) sensitivity of cancer: 67.6%(under 35yrs), 91.2%(over 60yrs) The ultrasonographic results are as follows: 1) detection rate of lesion: 100% 2) sensitivity of cancer: 87.2%(under 35yrs), 96.7%(over 60yrs) The breas cancer detection rate in women under 35 years old was comparable to that of women above 60 years old in our study. CONCLUSION: A striking histologic finding in the two groups was a higher incidence of nuclear Grade II and III tumors. This finding correlates with the reported increased incidence of high grade tumors inyoung women and may correlae with the poorer prognosis of breast cancer in young patients. We conclude that early screening examination is helpful for early detection of breast cancer in women under age 35.