A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain.

AIM: To compare the effectiveness of landmark-guided local injections and ultrasonography (USG) guided injections for shoulder pain. METHODS: A total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled, and randomly assigned to receive triamcinolone (40 mg) either by landmark-guided (LMG, n=30) or USG guided (n=30) injection. The patients were evaluated on admission and 6 weeks after the injection. Clinical assessment included demographic and clinical data, a visual analoge scale (VAS) for pain (0 to 10 cm), the Constant scale (0 to 100) for function, passive and active shoulder range of motion (ROM) with goniometric evaluation, and postinjection adverse effects. RESULTS: Initial demographic, clinical and USG findings in the groups exhibited no significant differences. Six weeks after injection, the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group (mean VAS score decrease: 4.0+/-1.7 for USG vs. 2.2+/-0.9 for LMG, P<0.05; mean Constant score change: 32.2 for USG vs. 12.2 for LMG, P<0.05). Significant improvements were observed in active and passive ROM values in both groups, USG group values being better. Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM, of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection (P<0.05). CONCLUSIONS: Our results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG-guidance may improve therapeutic effectiveness and reduce adverse effects.

Primary hypertrophic osteoarthropathy (pachydermoperiostosis): a case report.

Hypertrophic osteoarthropathy is characterized by digital clubbing and periosteal reaction of long bones. Most cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia, and gastrointestinal polyps. We report a 19-year-old man presenting with arthritis, broadening of the fingers and clubbing of the fingers and toes for the previous 3 years. The ankles and knees were swollen. X-rays showed periosteal apposition. The search for a secondary cause remained negative. In cases of arthralgia/arthritis together with clubbed fingers, consideration must be given to hypertrophic osteoarthropathy. The primary or idiopathic form is rare and has a good prognosis.

Hair zinc level in Down syndrome.

Immunological, endocrinological, and haematological abnormalities are relatively common in people with Down syndrome (Cuadrado & Barrena, 1996; Decoq & Vincker, 1995; Hestnes et al., 1991; Sustrova & Strbak, 1994; Nespoli, Burgio, Ugazio & Maccario, 1993; Kempski, Chessells & Reeves, 1997; Kivivuori, Rajantie, & Siimes, 1996; David et al., 1996; Gjertson, Sturm & Berger, 1999). Zinc is one of the elements that act in the maintenance of normal function of these systems. This study was designed to investigate zinc levels in children with Down syndrome. Zinc levels were measured in hair using atomic absorption spectrophotometry. The hair zinc level of 19 children with Down syndrome was compared with the zinc level of 11 typically developing children. Hair zinc levels were found to be significantly lower (p < .05) in those with Down syndrome (average 95.18 +/- 56.10 ppm) than in the typically developing children (average 208.88 +/- 152.37 ppm). Some of the problems experienced by children with Down syndrome may be due to these low zinc levels, but further research is required to confirm these results, and to establish any correlation with these problems.