Shoulder capsulitis: What relation with diabetes mellitus in a moroccan population?

Introduction: Shoulder capsulitis (SC) is a common musculoskeletal complication in patients with diabetes. It can be particularly disabling. It is often overlooked by clinicians. The aim of this study is to evaluate the prevalence of retractile capsulitis and to identify the risk factors in a population of Moroccan diabetic patients. Materials and Methods: We realised a cross-sectional study including patients with diabetes mellitus (DM). We recorded the demographic and diabetic characteristics of our patients. SC and vascular complications were assessed by clinical and para-clinical investigations. The prevalence of SC was calculated. The factors associated with SC were evaluated by suitable statistical tests. Results: Three hundred and Sixty-five patients were included; 84.9% had Type 2 DM (T2DM). The mean age of the participants was 52.6 ± 13.6. Shoulder capsulitis was present in 12.6% of patients. In statistical analysis, age >50 years (P = 0.001), T2DM (P = 0.03), duration of progression >10 years (P = 0.03), dyslipidemia (P = 0.013) and macrovascular complications (P = 0.009) were associated with an increased frequency of SC. Conclusion: This study shows that the prevalence of SC is higher in diabetic patients. Therefore, inclusion of this pathology in the global management of the diabetic patient is necessary.

Résumé Introduction: la capsulite rétractile de l'épaule (CR) est une complication musculo-squelettique fréquente chez les patients diabétiques. Elle peut être particulièrement invalidante. Elle est souvent méconnue par les cliniciens. Cette étude a pour objectif d'évaluer la prévalence de la capsulite rétractile et d'identifier les facteurs de risque dans une population de patients diabétiques marocains. Methodes: Une étude transversale incluant des patients diabétiques. Nous avons enregistré les caractéristiques démographiques et les caractéristiques du diabète de nos patients. La CR et les complications vasculaires ont été évalués par des examens cliniques et para cliniques. La prévalence de la CR a été calculée, ensuite les facteurs associés à la CR ont été évalués par des tests statistiques adaptés. Resultat: 365 patients ont été inclus ; 84.9 % avaient un diabète de type 2. L'âge moyen des participants était de 52.6 ±13.6. Une capsulite de l'épaule était présente chez 12,6 % des patients. Dans l'analyse statistique, l'âge supérieur à 50 ans (P=0,001), le diabète de type 2 (P=0.03), la durée d'évolution >10 ans (P=0.03), la dyslipidémie (P=0.013) et les complications macro vasculaires (P=0.009) étaient associées à une fréquence accrue de la capsulite rétractile. Conclusion: cette étude montre que la prévalence de la CR est plus élevée chez les patients diabétiques. D'où la nécessité d'inclure cette pathologie dans la prise en charge globale du patient diabétique, et de la même manière, réaliser un dépistage de diabète chez les patients souffrant d'un capsulite rétractile. Mots clés: diabète sucré, complications musculo squelettiques, capsulite rétractile.

Multiple pelvic and thigh hydatid cyst: a case report.

Bone cystic echinococcosis is rare disease and its management remain difficult to treat due to frequent recurrences, related to certain locations such as proximal femur and ilium, where radical surgery is difficult to achieve. Medical therapy using Mebendazol can be an ultimate way to insure stabilization and remission of the parasitosis. We present a case of a 37-year-old male who had complaints of pain in left hip and limp four years after surgical management of pertrochanteric fracture of his right lower limb. The first clinical and radiological diagnosis was osteoarthritis of proximal femur and hip. However, higher imaging modalities revealed the diagnosis of hydatid disease of hip with extensive pelvic hydatid cyst localizations. The patient underwent anthelminthic chemotherapy. At 7 years follow-up, the lesions remains stable and the patient has tolerate hip pain, support and walking are impossible without crutches. Hydatid disease of the proximal femur and pelvis must be kept in mind in the differential diagnosis of pathologies of hip-like septic arthritis or tuberculosis. Prolonged medical therapy with anthelmintic medications can constitute an alternative to surgery at very high risk and for extensive lesions where surgery can not achieve carcinologic goals.

Simultaneous Ipsilateral Floating Hip and Knee: A Complex Combination and Difficult Surgical Challenge.

Simultaneous ipsilateral floating hip and floating knee are extremely rare. To the best of our knowledge, only four cases have been described in the literature. This uncommon injury is mostly caused by high-velocity impact and associated with life-threatening lesions. We report a unique case of concomitant ipsilateral floating hip and floating knee following road traffic accident. The patient presented ipsilateral hip dislocation and acetabular, femoral, and tibial fractures associated with chest trauma. The aim of this report is to highlight the severity and rarity of this combination and to describe the therapeutic recommendations.

Tibial tubercle avulsion fractures in school sports injury: A case report.

INTRODUCTION: Most injuries in adolescent occur during school sports like volleyball, football or basketball. Tibial tubercle avulsion fractures (TTAF) are an unusual condition, resulting from a forced extension of the knee opposed to fixed leg. PRESENTATION OF THE CASE: A 16 years old male was hurt during school basketball, X-rays displayed avulsion fracture of tibial tuberosity of left knee, the treatment was operative using two cancellous screws, results were good including complete knee mobility and early coming back to school sport at 6 months. DISCUSSION: TTAF remains rare accounting for <3% of all epiphyseal injuries, it is frequent in teenage boys with open physis during school sport. We review the pathophysiology, mechanism, classification, diagnosis, and management of this injury. CONCLUSION: complications are occasional and functional recuperation is common after closed reduction and cast immobilization for slightly or no displaced fractures, otherwise open reduction and internal fixation for displaced fractures.

Chondrosarcoma metastasis in the thyroid gland: a case report.

INTRODUCTION: Chondrosarcoma metastases in the thyroid gland are exceptional. To the best of our knowledge, only two cases have been previously reported in the literature. Here we report the third case. CASE PRESENTATION: We report the case of a 51-year-old Arab woman who presented in 2011 with a diaphyseal chondrosarcoma of her right tibia treated by surgery. In the last quarter of 2013, she presented a hard mass in her thyroid gland with dyspnea and a right laryngeal paresis. She underwent a debulking surgery with tracheostomy in order to prevent difficulty in respiration. The final pathology revealed the diagnosis of a chondrosarcoma metastasis within her thyroid gland. She died several days later. CONCLUSIONS: Even if primary and metastatic chondrosarcomas of the thyroid gland are exceptional, they should be considered in the differential diagnosis of thyroid gland masses. The prognosis is poor but surgery may help preserve quality of life.

Irreducible dorsal metatarsophalangeal joint dislocation of the fifth toe: a case report.

The authors report a case of a dorsal dislocation of the fifth metatarsophalangeal joint that could not be reduced by closed manipulation, and instead required open reduction with Kirschner-wire fixation to maintain alignment. Although metatarsophalangeal joint dislocation is not unheard of, it is not common for the deformity to resist efforts at closed reduction and immobilization or percutaneous pin fixation. One year after surgery, the patient described in this article had returned to his baseline activity level, and was ambulating without pain while demonstrating full range of motion in the fifth metatarsophalangeal joint.

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) of the forefoot.

Nora's tumour is an uncommon benign tumour, involving mostly tubular bones of hands and feet, and characterized by a proliferation of chondroid, bony and fibrous tissues. Main differential diagnoses are osteochondroma, chondrosarcoma, and osteosarcoma. The authors report a case involving the left foot. The diagnosis was suspected by imaging characteristic features and was confirmed by histological examination. Treatment was surgical, with complete excision. There are no clinical or radiological signs of recurrence on further review one year postoperatively.

Lymphangiomyoma of the shoulder: an exceptional localisation. A case report.

Lymphangioleiomyomatosis (LAM) is a rare condition usually occurring in young women of childbearing age. It is characterised by the presence of abnormal smooth muscle cells (LAM cells) in the lungs, lymph nodes, and/or other organs, with a few reports of isolated extrapulmonary cases. We report the case of a 26-yr-old female who presented with a painless shoulder mass. Ultrasonography, computed tomography and magnetic resonance imaging revealed an intermuscular mass with cystic and solid tissue components, measuring 6 cm x 4 cm. The mass was removed surgically after the diagnosis of LAM was made following tru-cut biopsy. This case corresponds to an exceptional localisation of LAM.

Isolated complex dislocation of the metacarpophalangeal joint of the third finger.

Two unusual cases of isolated closed complex dislocation of the metacarpophalangeal joint of the third finger are presented. The single most important element preventing reduction was interposition of the volar plate between the proximal end of the phalanx and the head of the metacarpal, but the deep transverse ligament was also intimately involved in the entrapment mechanism. Such dislocations require open reduction as in the two cases presented, and we found the dorsal approach to be simple and effective.