Arthroscopic treatment of symptomatic calcific periarthritis on the medial side of the knee after posterior cruciate ligament reconstruction: Case report and literature review.

Calcific periarthritis in the distal femur is a rare condition. Forty two year old Asian male visited to the outpatient clinic of orthopedic department with acute excruciating knee pain. The arthroscopic posterior cruciate ligament (PCL) reconstruction was performed 20 years ago with the bonepatellar tendon-bone (BPTB) autograft combined with Trevira (polyethylene terephthalate) artificial ligament. Severe tenderness was noted incidentally over the medial epicondyle area of the distal femur which the cancellous screw was inserted for PCL reconstruction, without any preceding trauma history or medial joint line tenderness due to degenerative change. The poorly defined calcific deposition was found in plain radiograph. The arthroscopic debridement of the calcification and screw removal from the distal femur was performed due to resist to conservative treatment with analgesics. After operation, the symptoms were resolved completely. The arthroscopic debridement of calcific periarthritis should be considered in specific cases, such as refractory cases with conservative management during 4-6 weeks. We present the arthroscopic treatment of the symptomatic calcific periarthritis on distal femur after PCL reconstruction can be effective.

[Bilateral ultrasound-guided supraclavicular brachial plexus block in shoulder joint release surgery for shoulder periarthritis].

OBJECTIVE: To observe the anesthetic efficacy and safety of bilateral ultrasound-guided supraclavicular brachial plexus block in patients undergoing arthrolysis for shoulder periarthritis. METHODS: Twenty-seven patients (ASA class I-II) undergoing bilateral shoulder joint release surgery and 24 ml received bilateral ultrasound-guided supraclavicular brachial plexus block anesthesia with 0.4% ropivacaine and 0.8% lidocaine. The visual analogue scale (VAS) scores for shoulder joint pain were recorded before and after anesthesia. The efficacy of axillary nerve, dorsal scapular nerve and suprascapular nerve block was evaluated, and the anesthetic effect and complications was assessed during surgery. Before and after anesthesia, the range of left and right diaphragmatic muscle movement was measured when the patient took a quiet breath and a deep breath. RESULTS: The patients showed no significant variations in MAP, HR, or SpO2after anesthesia. The VAS scores of shoulder joint pain during anteflexion, abduction, posterior extension, rotation, posterior extension and medial rotation were significantly lowered after anesthesia (P<0.05), but the left and the right diaphragm movement range showed no significant difference between quiet breath and deep breath (P>0.05). The rates of complete block of the axillary nerve and dorsal scapular nerve was 100%, and that of suprascapular nerve was 92.6%. Partial phrenic nerve block occurred in 1 case with mild local anesthetic toxicity in another. CONCLUSIONS: Bilateral ultrasound-guided supraclavicular brachial plexus block in patients has excellent analgesic effect in should joint release surgery with good safely.

Arthroscopic treatment of anterior ankle impingement.

Anterior ankle impingement is a common cause of chronic ankle pain in the athletic population. Its cause can be either soft tissue or osseous in nature. Arthroscopic debridement results in favorable and reproducible outcomes. However, in the population in which ankle instability or narrowing of the ankle joint occur, outcomes may be less favorable.

Idiopathic chronic calcific periarthritis in a child.

Calcific periarthritis is a calcium deposition disease of the periarticular tissues. Deposits of calcium from calcific periarthritis can be found in the periarticular tissues of the shoulders, hips, elbows, wrists, and knees. This disease is often the manifestation of another primary process, such as end-stage renal disease, collagen vascular disease, and systemic diseases (eg, diabetes mellitus, rheumatoid arthritis), among others. Furthermore, calcific periarthritis has been linked to certain areas of the body because of pathologic stress related to repetitive motions, microtrauma, and local hypoxia. This type of soft-tissue mass is usually found in older men and women. In addition, its incidence, calcium deposits related to calcific periarthritis, and soft-tissue masses in general, are rare in children. Here we present the first report of idiopathic chronic calcific periarthritis in a child. The diagnosis was suspected on the basis of clinical and radiographic appearance and despite the rarity of the disease in children. The patient underwent surgical treatment and was free of local recurrence. The cause of this case was never determined.

[Effects of adhesion releasing under nerve block and arthrolysis on adhesive scapulohumeral periarthritis: a comparative study].

OBJECTIVE: To compare the effects of adhesion releasing under nerve block and arthrolysis on adhesive scapulohumeral periarthritis. METHODS: Sixty patients with adhesive scapulohumeral periarthritis 24 males and 36 females, aged 52.5 (40 - 67), were randomly divided into 4 equal groups: Group I, undergoing adhesion releasing under brachial plexus block, Group II, undergoing adhesion releasing under stellate ganglion block, Group III, undergoing limited adhesion releasing under stellate ganglion block, and Group IV undergoing arthrolysis under stellate ganglion block. The clinical effects were recorded and compared. RESULTS: The short-term effect of Group IV was significantly superior to the other 3 groups (all P < 0.05). The frequency of block + manipulation treatment of Group I was significantly less than those of the other 3 groups (all P < 0.01), and the frequency of pain point injection of Group I was significantly higher than those of the other 3 groups (all P < 0.01). CONCLUSION: The 4 methods are all effective for the treatment of adhesive scapulohumeral periarthritis. In particular, arthrolysis under stellate ganglion block shows greater improvement in the joint function and less uncomfortableness caused by numbness and weakness of the arm.

[Teutschländer disease. A rare benign differential diagnosis of proliferative space-occupying lesions in the periarticular soft tissue]. / Morbus Teutschländer. Eine seltene benigne Differenzialdiagnose proliferativer Raumforderungen im paraartikulären Weichteilgewebe.

The tumoral calcinosis (synonym: Teutschländer disease) is a very rare benign metabolic dysfunction of unknown etiology. It manifests principally as massive subcutaneous soft tissue deposits of calcium phosphate near the large joints and is also characterized by slow progressive growth. Causally, a disturbance of the calcium and phosphate metabolism/balance with, among others, autosomal dominant heredity is suspected. It appears frequently in the black African population in all age groups, but preferentially in the 1st and 2nd decades of life. Medical help is most frequently sought because of increasing tumor size causing displacement and consecutive pain as well as decreased joint play. We present here a case of Teutschländer disease in a 50-year-old woman on long-term hemodialysis and describe the clinical, radiological, and pathological signs of this rare disease. Subsequently, speculative etiology, differential diagnostic considerations as well as the therapeutic interventions for tumoral calcinosis are discussed taking into consideration the current literature.

[Proximal row carpectomy: a 'salvage' procedure for radio-carpal arthritis of the wrist]. / Proximale-rijcarpectomie als behandeling voor radiocarpale artrose van de pols.

In 4 patients, a woman aged 46 years, and 3 men aged 58, 28 and 60 years, respectively, a proximal row carpectomy was done for pain and loss of function due to scapho-lunate dissociation, scaphoid nonunion, Kienböck's disease and scapho-lunate advanced collapse wrist deformity (bilateral). Pain relief was achieved post-operatively in all patients, allowing patients to return to their previous work and activities. Proximal row carpectomy involves the removal of the os scaphoideum, the os lunatum and the os triquetrum. This improves wrist extension and ulnar deviation. Intensive postoperative treatment is essential to achieve good mobility and strength.

[Peri-articular calcinosis. Tumor simulating calcinosis and differential diagnosis]. / Periartikuläre Verkalkungen. Die tumoröse Kalzinose und ihre Differentialdiagnose.

The disease of tumorous calcinosis is presented in order to one case and a survey of literature. The epidemiology and etiology are discussed, because of a rare manifestation of metabolic disorders. The differential diagnosis includes genetic disorders, recurrent soft-tissue trauma and renal failure. The clinical symptoms like swelling or deficit of function as well as radiologic appearances may lead to the diagnosis. The way of treatment is given by radical excision and metabolic supervision. The multiloculated presentation of periarticular, dental, subcutaneous and other lesions is pointed out.

The use of arthroscopy in the treatment of resistant frozen shoulder.

Arthroscopy serves as a useful adjunct to manipulation under anesthesia in the treatment of resistant frozen shoulder. In this technique the shoulder is manipulated under interscalene brachial plexus block anesthesia, followed by arthroscopic examination and debridement of the glenohumeral joint and the subacromial space. The addition of arthroscopy allows the identification and treatment of associated pathology, such as impingement lesions and secondary subacromial space inflammation, calcific deposits, and acromioclavicular arthritis. Range of motion can also be increased by arthroscopically guided sectioning of the coracohumeral ligament. This treatment regimen has yielded overall satisfactory results in 25 (83%) of 30 shoulders in this series. The subgroup with diabetes mellitus fared less well than the other groups, with only 64% satisfactory results. While most patients with frozen shoulder will respond to nonoperative treatment, the technique of manipulation under anesthesia followed by arthroscopy offers a safe and reliable treatment for the resistant frozen shoulder.

[Arthroscopic subacromial decompression--indications in os acromiale?]. / Arthroskopische subakromiale Dekompression--Indikation beim Os acromiale?

A total of 122 patients with subacromial pathology without tears in the rotator cuff underwent arthroscopic subacromial decompression (ASD) and were re-examined 1-3 years after the operation. All patients' data were recorded before and after operation with reference to a 100-point shoulder score. The group included 12 patients who proved to have an os acromiale on X-ray. Postoperatively scores wee significantly higher (p < 0.05). Patients with os acromiale had a slightly but not significantly worse outcome than the others. Results were excellent in 43% of all patients, good in 17%, and fair in 25%, while 15% were considered failures. Again patients with an os acromiale had a slightly, but not significantly, worse result. Patients with a preoperative pain history of more than 1 year had a significantly worse result than those with a preoperative course of less than 1 year (p < 0.05). This was true for both groups without any differences between them. Older patients also scored worse in both groups. Other factors, e.g. sex, preoperative range of motion, and muscle atrophy, did not significantly influence the result. Our results after ASD in patients with subacromial pathology without rupture of the rotator cuff and with os acromiale are encouraging. Therefore, this minimally invasive procedure seems to be a reasonable alternative to other complex procedures with ORIF in selected cases.

Shoulder joint stability after arthroscopic subacromial decompression.

In 55 patients with type I or type II impingement lesions we performed arthroscopic subacromial decompression. Fifty-two patients are followed up 1 year postoperatively. In all patients the condition of the affected shoulder before and after decompression was documented using a 100-point shoulder score (pain on activity, 15 points; pain without activity, 15 points; function, 20 points; weight lifting, 10 points; muscle strength, 15 points; range of motion, 25 points). At follow-up we also documented the extent of passive inferior shift of the humeral head by ultrasound. The mean score preoperatively was 60.9 (+/- 13.8). Postoperatively there was a significant increase to 84.7 (+/- 12.5). The average postoperative hospital stay was 8.8 days (+/- 2.1). In 12 patients (23%) the postoperative score was less than 85 points, and in these the treatment was considered to have failed. Comparison of these patients as a group with those in whom the treatment was successful revealed no difference in age, a small but not significant difference in the preoperative duration of shoulder complaints, and no difference in the postoperative length of stay in hospital. However, there was a significant difference in the extent of passive inferior shift of the humeral head: in the failure group the mean inferior shift was 4.6 +/- 1.9 mm, while in the other patients the shift was only 2.7 +/- 1.0 mm. This difference was statistically highly significant. There was a statistical highly significant negative Pearson correlation coefficient of -5.56 between postoperative score and inferior shift of the humeral head. We conclude that patients with subacromial pathology and hypermobile glenohumeral joints may not be good candidates for subacromial decompression.

Adhesive capsulitis of the shoulder.

Adhesive capsulitis of the shoulder is a relatively common problem that can cause significant functional morbidity in a wide variety of patient populations. Numerous treatment methods have been advocated and are reviewed and summarized in this article. Although several advances have been made in determining the etiology of this disorder, it remains poorly understood and without any definitive treatment algorithm.

[Arthroscopic subacromial decompression. 1-3 year results]. / Die arthroskopische subacromiale Dekompression. 1-3 Jahresergebnisse.

In 148 patients with impingement lesion type I or type II, we performed an arthroscopic subacromial decompression (ASD). 122 patients ran a follow up one to three years post-operatively. All patients were pre- and postoperatively documented by a 100 point shoulder score. The mean score was 57.9 (+/- 11.5) preoperatively. Postoperatively there was a significant increase to 80.7 (+/- 17.9) (p < 0.05). 15% of the patients with a postoperative score less than 70 points were determined as failures. Patients with a preoperative pain history of more than one year had a significantly worse result (79.1 +/- 8.4) compared to those patients with a preoperative course less than one year (88.8 +/- 11.6) (p < 0.05). Other significant factors were the patient's age, and calcific tendinitis, whereas sex, preoperative range of motion, muscle atrophy, and degeneration of the acromioclavicular joint did not significantly influence the result. Our results after ASD in patients with subacromial pathology without a rupture of the rotator cuff are encouraging. Therefore, ASD seems to be a reasonable alternative to open acromioplasty.

[Analysis of the collective term "periarthritis humeroscapularis"]. / Analyse des Sammelbegriffes "Periarthritis humeroscapularis".

The functional and anatomical consideration of the shoulder joint in relation to the clinical aspects can differentiate the general term of "scapulohumeral periarthritis". The most frequently pathological findings are seen in the rotary cuff and the long head of the biceps muscle. Significant causes are further arthrosis of the acromioclavicular joint, the instability of the shoulder joint and the frozen shoulder. The exact diagnosis of the disease makes on operative therapy possible.

[Surgical treatment of painful shoulders caused by lesions of the rotator cuff and biceps, treatment as a function of lesions. Reflections on the Neer's concept]. / Traitement chirurgical des épaules douloureuses par lésions de la coiffe et du long biceps en fonction des lésions. Réflexions sur le concept de Neer.

On the basis of their clinical and surgical experience of 480 shoulders operated upon for rotator cuff pathology, together with a review of the literature, the authors undertake a critical analysis of the Neer impingement syndrome. Since this syndrome cannot explain all lesions and above all cover all rotator cuff pathology, they suggest an anatomical classification based upon a description of lesions. They describe their indications for surgery on the basis of their results and of those from the literature.

[Rupture of the rotator cuff]. / Rupture de la coiffe des rotateurs.

Spontaneous or traumatic ruptures almost always occur in a cuff that has degenerated due to overuse. Despite the lack of absolute anatomico-clinical correlation, two clinical types can be described: a conflictual, often hyperalgesic shoulder with its painful arch corresponding to a small anterosuperior rupture, or a pseudo-paralytic shoulder betraying a major posterosuperior rupture. Standard radiography with Leclercq's manoeuvre is performed primarily to find out whether the cuff is continent or incontinent. Modern medical imaging (ultrasonography or MRI) adds precision to the lesions when surgery is contemplated. When medical treatment has failed, partial ruptures are treated by arthrolysis; ruptures of the superficial and deep layers of the cuff without calcification benefit from endoscopy; ruptures involving tendons or associated with calcifications are treated by surgery. Small and medium ruptures with a continent cuff require endoscopic or surgical anterior decompression combined, in cases where the intra-articular long head of the biceps is exposed, with repair, usually by suture. Extensive ruptures with an incontinent cuff are treated by muscle transfer alone of combined with arthroplasty, or by semi-constrained total prosthesis when arthrosis of the humeral joint is present.