A Second Case of Malformation of the Left Shoulder-Girdle; Removal of the Abnormal Portion of Bone. With Remarks on the Probable Nature of the Deformity

A 74-year-old man, with inflammatory arthritis, recently commenced on adalimumab, presented with a 4-week history of left-sided chest pain, malaise and shortness of breath. Admission ECG showed age-indeterminate left bundle branch block. Troponin T was 4444 ng/L (normal range <15 ng/L) and acute coronary syndrome treatment was commenced. Catheter angiogram revealed mild-burden non-obstructive coronary disease. Cardiac magnetic resonance (CMR) was performed to refine the differential diagnosis and demonstrated no myocardial oedema or late gadolinium enhancement. Extracardiac review highlighted oedema and enhancement of the left shoulder girdle muscles consistent with acute myositis. Creatine kinase was subsequently measured and significantly elevated at 7386 IU/L (normal range 30–200 IU/L in men). Electrophoresis clarified that this was of predominantly skeletal muscle origin. Myositis protocol MRI revealed florid skeletal muscle oedema. The MR findings, together with positive anti-Scl-70 antibodies, suggested fulminant immune-mediated necrotising myopathy presenting as a rare mimic of myocardial infarction with non-obstructive coronary arteries, diagnosed by careful extracardiac CMR review.

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An unusual case of clavicular prosthesis migration causing traumatic injury to the ascending aorta

Perfusion ◽

10.1177/02676591211012574 ◽

2021 ◽

pp. 026765912110125

Author(s):

Aaina Mittal ◽

Azhar Hussain ◽

Hazem Ali ◽

Genti Jakaj ◽

Habib Khan ◽

...

Keyword(s):

Rare Case ◽

Unusual Case ◽

Traumatic Injury ◽

Shoulder Girdle ◽

Ascending Aorta ◽

Left Shoulder ◽

Descending Aorta ◽

Aortic Injuries ◽

Lethal Event

Traumatic aortic injuries can be a lethal event. Almost 88% of patients with traumatic aortic injuries die within the first hour and only 2% survive long enough to develop a chronic aneurysm. Injury to the ascending aorta, whether acute or chronic, are typically managed with surgery, and those in the descending aorta, are managed conservatively or in some cases with stents. We present a rare case of a 53-year old gentleman with intra-aortic migration of a left clavicular prosthesis used for restoration of the left shoulder girdle.

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Fístula liquórica cervical ventral simulando doença do neurônio motor: relato de caso

10.5327/1516-3180.157 ◽

2021 ◽

Author(s):

Paulo de Lima Serrano ◽

Paulo Sousa Frota ◽

Igor Braga Farias ◽

Bruno de Mattos Lombardi Badia ◽

José Marcos Vieira de Albuquerque Filho ◽

...

Keyword(s):

Motor Neuron ◽

Motor Neuron Disease ◽

Intracranial Hypotension ◽

Clinical Manifestations ◽

Shoulder Girdle ◽

Cervical Region ◽

Left Shoulder ◽

Blood Patch ◽

Chronic Denervation ◽

Fluid Leak

Introduction: Motor neuron disease is currently irreversible, and the grave implications of the diagnosis should raise concerns over missing a potencial mimic disorder. The cervical region should be carefully evaluated, since many pitfalls are encounterd there. We present a case of a longitudinal extensive ventral cervical cecerebrospinal fluid leak causing a progressive monomelic amyothrophy associated with intracranial hypotension, mimicking a motor neuron disorder. Objective: To describe the course, clinical manifestations and to raise concern about a rare disorder, potentially treatable that could mimic a motor neuron disease. Methods: A case report seen in the neuromuscular service of the federal university of São Paulo.SP. Results: Cervical pain irradiating to the left shoulder was the first symptom. Pogression to weakness of the bíceps and shoulder girdle with fasciculations happened months after. The patient also complained about severe headache worsening when lowering the head or lyind down. Eletroneuromiography showed chronic denervation. Magnetic ressonance imaging of the cervical spine demonstrated ventral dural displacement with longitudinal extensive cerebrospinal fluid colection. Epidural blood patch procedure was indicated. After the treatment the patient showed complete improvement of the headache, significant decrease in fasciculations and evolutionary strength improvement. Conclusion: We described a rare form of amyothrophy that could be associated or not with intracranial hypotension. Ventral cervical cerebralpinal fluid leak should always be on the list of differential diagnosis and early indentification should be sought, since its a treatable cause.

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Massage-Induced Brachial Plexus Injury

Physical Therapy ◽

10.2522/ptj.20130487 ◽

2015 ◽

Vol 95 (1) ◽

pp. 109-116 ◽

Cited By ~ 3

Author(s):

Chih-Ya Chang ◽

Yung-Tsan Wu ◽

Liang-Cheng Chen ◽

Rai-Chi Chan ◽

Shin-Tsu Chang ◽

...

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Range Of Motion ◽

Brachial Plexus Injury ◽

Exercise Program ◽

Shoulder Girdle ◽

Rehabilitation Program ◽

Home Exercise ◽

Left Shoulder ◽

Asian Woman

Background and PurposeThere are few reports in the literature of adverse effects resulting from massage therapy (MT) and no reports of brachial plexus injury (BPI) associated with MT. This case report describes an uncommon case of BPI that developed after a session of MT and reviews previously published reports of peripheral nerve injury following MT.Case DescriptionA 58-year-old Asian woman developed sudden unilateral paralysis of her left shoulder girdle after a session of MT. A diagnosis of acute BPI was suspected due to her recent history and the results of several examinations. The results of electrodiagnostic studies indicated a possible location for the lesion and ultimately led to a different diagnosis.OutcomesThe patient regularly participated in a twice-weekly rehabilitation program targeting the left shoulder. The rehabilitation program included supervised passive range of motion, strengthening, and stretching exercises as well as a home exercise program. A 12-month follow-up showed the patient had achieved gradual recovery of shoulder strength, resolution of limitations of range of motion, and relief of shoulder pain.DiscussionThis is believed to be the first report of BPI associated with MT. This case report serves as a reminder to massage therapists and physical therapists that MT of the neck should be carefully performed to avoid injury. Further studies will help design safer and more effective MT for the future.

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Intentional Overscrewing of Humeral Head in Comminuted Fracture of Proximal Humerus and its Impact on Shoulder Function . A Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0013.5075 ◽

2019 ◽

Vol 21 (4) ◽

pp. 297-305

Author(s):

Grzegorz Szczęsny ◽

Karol Ratajczak ◽

Grzegorz Fijewski ◽

Paweł Małdyk

Keyword(s):

Humeral Head ◽

Proximal Humerus ◽

Shoulder Girdle ◽

Shoulder Function ◽

Left Shoulder ◽

X Rays ◽

Range Of Movement ◽

Comminuted Fracture ◽

The Right ◽

Shoulder Brace

An 86-year-old female was operated on due to a comminuted fracture of the right proximal humerus whose configuration necessitated over-screwing of the humeral head to improve stability, with the screws directed divergently: anteriorly and posteriorly, to minimize their conflict with the acetabulum. 3.5 years later she sustained a corresponding fracture of the left shoulder which was stabilized without over-screwing. On both occasions, the fractures were stabilized with titanium interlocking plates (ChM, Poland) and the limbs were immobilized in a shoulder brace for three weeks followed by intensive rehabilitation. The patient attended a follow-up visit at 12 months (i.e. 52 months post the right shoulder fracture) which included an assessment of radiographs, pain and limb function as well as tests of the range of movement of the shoulder and girdle. Assessments were repeated at 12 and 18 months afterwards. Patient denied limb pain and dysfunction. Abduction was reduced by 20°, which was compensated for by the scapulothoracic joint. Shoulder (girdle) abduction reached 50° (150°) for the right and 70° (170°) for the left extremity. Flexion was reduced by 20°, but extension and rotations were comparable. At 12 months post fracture, no improvement of limb mobility was noted despite continued intensive physiotherapy. X-rays showed satisfactory bone union. The patient scored 87 for the right and 89 for the left shoulder according to the Constant score and 6.8 points for each limb according to the QuickDash score. Overscrewing of the humeral head is not the most beneficial method for improving stability of comminuted proximal humeral fractures; however, it may be used when alternative and more suitable methods are unavailable. Moreover, directing screws divergently anteriorly and posteriorly to minimize their conflict with the scapular acetabulum does not interfere with joint function outcomes.

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Isolated Fracture of the Coracoid Process

Case Reports in Orthopedics ◽

10.1155/2014/482130 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ali Güleç ◽

Harun Kütahya ◽

Recep Gani Göncü ◽

Serdar Toker

Keyword(s):

Traffic Accident ◽

Glenohumeral Joint ◽

Full Range ◽

Shoulder Girdle ◽

Coracoid Process ◽

Left Shoulder ◽

Joint Movement ◽

Computerised Tomography ◽

Current Case ◽

Previous Occupation

Coracoid fractures are rarely seen fractures. In the shoulder girdle, coracoid process fractures generally accompany dislocation of the acromioclavicular joint or glenohumeral joint, scapula corpus, clavicula, humerus fracture, or rotator cuff tear. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. In this paper, a 34-year-old male manual labourer presented to the emergency department with complaints of pain and restricted movement in the left shoulder following a traffic accident. On direct radiographs and computerised tomography images a fragmented fracture was observed on the base of the coracoid process. In addition to the coracoid fracture, a mandibular fracture was determined. The patient was admitted for surgery on both fractures. After open reduction, fixation was made with a 3.5 mm cannulated screw and washer. At the postoperative 6th week, bone union was determined. The patient returned to his previous occupation pain-free and with a full range of joint movement. In conclusion, in the current case of isolated fragmented coracoid process fracture showing minimal displacement in a patient engaged in heavy manual work, surgery was preferred as it was thought that nonunion might be encountered particularly because of the effect of forces around the coracoid.

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Late-onset radiation-induced brachial plexopathy

BMJ Case Reports ◽

10.1136/bcr-2021-243354 ◽

2021 ◽

Vol 14 (9) ◽

pp. e243354

Author(s):

Kelly Anne Attard ◽

James Carlos Vella ◽

Charmaine Chircop

Keyword(s):

Nasopharyngeal Carcinoma ◽

Muscle Wasting ◽

Late Onset ◽

Shoulder Girdle ◽

Left Shoulder ◽

Brachial Plexopathy ◽

Lung Cancers ◽

Insidious Onset ◽

Radiation Induced

The late-onset variant of radiation-induced brachial plexopathy is most often seen after treatment for breast or lung cancers. It has an insidious onset, with symptoms noted years after receiving radiotherapy, and the condition gradually continues to deteriorate with time. We present the case of an elderly man who we saw in view of worsening paraesthesias and weakness of his left arm with associated prominent muscle wasting along the left shoulder girdle. Fifteen years prior to this, he had received radiotherapy for the treatment of nasopharyngeal carcinoma.

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The use of dry needling to treat painful shoulder syndrome – a case report

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0014.1653 ◽

2020 ◽

Vol 14 (1) ◽

pp. 1-9

Author(s):

Joanna Rajfur ◽

Katarzyna Rajfur ◽

Łukasz Kosowski ◽

Tomasz Matusz

Keyword(s):

Case Report ◽

Range Of Motion ◽

Rating Scale ◽

Shoulder Girdle ◽

Left Shoulder ◽

Dry Needling ◽

Painful Shoulder ◽

Patient Reported ◽

Degree Of Disability ◽

Shoulder Syndrome

Background. Painful shoulder syndrome is a common condition in society. Most patients experience pain and reduced mobility of the affected limb, which can have an impact on the quality of life. This report presents a case of a patient with pain and reduced range of motion in the left shoulder. Aim of the study. The study aim was to evaluate the efficacy of dry needling in the treatment of painful shoulder syndrome, based on functional measures of pain, disability and range of motion. Case report. A 42-year old patient reported pain in her left shoulder. A series of 6 dry needling sessions were performed, twice a week, for a period of 3 weeks. Prior to, and immediately after, the therapy a subjective pain assessment using the VAS pain rating scale and an assessment of the degree of disability using the Modified Laitinen Pain Questionnaire were performed. The range of motion within the shoulder girdle was also measured with a goniometer. Conclusion. Following the dry needling therapy, a reduction in pain and improved shoulder girdle mobility was observed.

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The Characteristics of Shoulder Muscles in Archery Athletes

Clinics in Shoulder and Elbow ◽

10.5397/cise.2018.21.3.145 ◽

2018 ◽

Vol 21 (3) ◽

pp. 145-150 ◽

Cited By ~ 1

Author(s):

Ri Na Kim ◽

Jin Hyuck Lee ◽

Seok Ha Hong ◽

Jin Ho Jeon ◽

Woong Kyo Jeong

Keyword(s):

External Rotation ◽

Peak Torque ◽

Shoulder Girdle ◽

Left Shoulder ◽

Shoulder Muscles ◽

Adductor Muscles ◽

Angular Velocities ◽

Muscle Groups ◽

Shoulder Girdle Muscles ◽

High Level

BACKGROUND: This study evaluated the shoulder girdle muscle characteristics of elite archery athletes and provides suggestions for archery training programs.METHODS: This study enrolled 15 cases of high level archery athletes (7 males, 8 females) and 30 cases of (15 males, 15 females) sex, age-matched, healthy, non-athletic individuals. We measured peak torques of flexion (FL), extension (EX), abduction (ABD), adduction (ADD), external rotation (ER) and internal rotation (IR) of both shoulders at an angular velocity of 30°/sec, 60°/sec, and 180°/sec. The peak torques and peak torque ratios of FL/EX, ABD/ADD, and ER/IR of the two groups were compared.RESULTS: The archer group had a greater peak torque of IR and ADD, but only in the left shoulder (p < 0.05). In the same group, both shoulders had greater peak torque of EX and lower peak torque of FL. The peak torque ratios of FL/EX of both shoulders were significantly lower in the archer group at all three angular velocities (p < 0.05). The peak torque ratios of ABD/ADD were significantly greater in only the left shoulder of the archer group (p < 0.05).CONCLUSIONS: The prominent characteristics of the shoulder girdle muscles of an elite archer are stronger adductor muscles of the bow shoulder and stronger extensors of both shoulders, as compared to healthy, non-athletic individuals. These muscle groups of the shoulder probably contribute a major role in maintaining the accuracy and stability during archery shooting. Hence, a training program that selectively enhances the adductor and extensor muscles could prove helpful in enhancing the archery skills of the athlete.

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