scholarly journals Subscapularis Myotendinous Junction Tears Presenting with Posterior Shoulder Pain in Overhead Throwing Athletes

2019 ◽  
Vol 48 (2) ◽  
pp. 205
Author(s):  
Eric M. Tarkowski ◽  
Imran M. Omar ◽  
Kevin J. Blount ◽  
Stephen M. Gryzlo
Keyword(s):  
Shoulder Pain ◽  
Case Reports ◽  
Acute Onset ◽  
Return To Play ◽  
Myotendinous Junction ◽  
Musculoskeletal Radiology ◽  
Presenting Symptoms ◽  
Posterior Shoulder ◽  
Overhead Throwing ◽  
Baseball Pitchers

<p><strong>Objective</strong>. Acute inferior subscapularis myotendinous junction injuries are occasionally seen in overhead throwing athletes, and can present with posterior shoulder pain.</p><p><strong>Case Reports</strong>. Four professional baseball pitchers presented with acute onset of posterior shoulder pain while pitching. After thorough, routine physical examination of the shoulder by the referring orthopaedic surgeon magnetic resonance imaging (MRI) was performed within 7-10 days of the onset of presenting symptoms and interpreted in consensus by 2 fellowshiptrained musculoskeletal radiologists with 9 and 5 years of experience and a musculoskeletal radiology fellow. The patients were then treated conservatively for subscapularis musculotendinous injuries and clinically assessed for symptom resolution before they were allowed to return to play.</p><p><strong>Conclusion</strong>. Inferior subscapularis myotendinous junction injuries should be included in the differential diagnosis of baseball pitchers with posterior shoulder pain.</p>

scholarly journals Latissimus Dorsi Tendon Reconstruction at the Myotendinous Junction With Acellular Dermal Allograft

2021 ◽  
Vol 1 (5) ◽  
pp. 263502542110326
Author(s):  
Andrew J. Recker ◽  
LeeAnne Torres ◽  
Eric Dennis ◽  
Donald J. Scholten ◽  
Brian R. Waterman
Keyword(s):  
Latissimus Dorsi ◽  
Case Series ◽  
Return To Play ◽  
Myotendinous Junction ◽  
Full Thickness ◽  
Tendon Reconstruction ◽  
Axillary Incision ◽  
Overhead Throwing ◽  
Baseball Pitchers ◽  
Acellular Dermal

Background: Limited available data have shown latissimus dorsi tendon reconstruction to be an effective treatment for tendon tears in specific subpopulations of elite overhead throwing athletes. Indications: Primary indication for latissimus dorsi tendon reconstruction is a symptomatic, full-thickness humeral avulsion with or without a concomitant teres major tendon tear. Surgical candidates are typically young, high-demand, elite or professional overhead throwing athletes. In this case, the patient is a 29-year-old male former minor league pitcher and current pitching coach with a full-thickness avulsion of the latissimus dorsi tendon. Technique Description: The patient was positioned left lateral decubitus with a dynamic limb positioner maintaining the arm in 90° abduction and maximal internal rotation. This technique used a single posterior axillary incision, which was performed and dissected down to the ruptured latissimus dorsi tendon. We circumferentially applied an acellular dermal allograft to augment the reconstruction at the myotendinous junction. Subsequently, the construct was prepared for transfer with a Krackow suture technique. Suture buttons were used to secure the reconstructed latissimus dorsi tendon to the anatomic footprint on the proximal humerus with a tension slide technique. Results: One case series showed return to the previous level of competition for all baseball pitchers who underwent a latissimus dorsi reconstruction with excellent improvement in visual analog scale pain, American Shoulder and Elbow Surgeons, and Kerlan-Jobe Orthopaedic Clinic scores. Another larger study demonstrated equal return to play rates for professional baseball pitchers with a latissimus dorsi tear treated either nonoperatively or operatively. However, those treated operatively had no decline in performance, whereas the nonoperative cohort saw decline in some statistics. Conclusion: Latissimus dorsi tendon reconstruction using an acellular dermal allograft at the myotendinous junction is a viable treatment option for elite overhead throwing athletes with full-thickness tendon avulsions. It allows for full return to play, particularly if the patient has failed nonoperative management.

scholarly journals Atypical Presenting Symptoms of Acute Onset Systemic Lupus Erythematosus with Enteritis and Cystitis

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Mayu Yagita ◽  
Kohei Tsujimoto ◽  
Masato Yagita ◽  
Masaaki Fujita
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Bowel Perforation ◽  
Acute Onset ◽  
Systemic Lupus ◽  
Severe Diarrhea ◽  
Presenting Symptoms ◽  
Initial Symptoms ◽  
Old Japanese ◽  
Lupus Enteritis

Lupus enteritis and lupus cystitis are relatively rare manifestations of systemic lupus erythematosus. Some patients develop severe complications such as bowel perforation, infarction, obstruction, or irreversible bladder dysfunction. Early diagnosis is critical for management of lupus enteritis and cystitis. We report a 48-year-old Japanese man who presented with initial manifestations of abdominal pain, severe diarrhea, and bloody feces. The diagnosis was delayed due to atypical initial symptoms, resulting in clinical worsening. Physicians should be aware of typical computed tomography findings of lupus enteritis and lupus cystitis.

Gastric-type adenocarcinoma of the cervix in patients with Peutz-Jeghers syndrome: a systematic review of the literature with proposed screening guidelines

2021 ◽  
pp. ijgc-2021-002997
Author(s):  
Sushmita B Gordhandas ◽  
Ryan Kahn ◽  
Dib Sassine ◽  
Emeline M Aviki ◽  
Becky Baltich Nelson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Pap Smear ◽  
Early Stage ◽  
Case Reports ◽  
High Risk Population ◽  
Normal Cytology ◽  
Presenting Symptoms ◽  
Gastric Type ◽  
Peutz Jeghers Syndrome

ObjectivesTo perform a systematic review of gastric-type adenocarcinoma of the cervix and lobular endocervical glandular hyperplasia (a possible precursor lesion) in Peutz-Jeghers syndrome, and to analyze data from the literature, along with our institutional experience, to determine recommendations for screening and detection.MethodsA comprehensive literature searc and retrospective search of pathology records at our institutio were conducted. Articles were screened by two independent reviewers. Case reports/series on lobular endocervical glandular hyperplasia/gastric-type adenocarcinoma of the cervix in Peutz-Jeghers syndrome were included. Demographic, clinical, and radiologic information was collected.ResultsA total of 1564 publications were reviewed; 38 met the inclusion criteria. Forty-nine were included in the analysis (43 from the literature, 6 from our institution). Forty-three reported on gastric-type adenocarcinoma alone, 4 on lobular endocervical glandular hyperplasia alone, and 2 on concurrent lobular endocervical glandular hyperplasia/gastric-type adenocarcinoma. Median age at diagnosis was 17 (range, 4–52) for patients with lobular endocervical glandular hyperplasia alone and 35 (range, 15–72) for those with gastric-type adenocarcinoma. The most common presenting symptoms were abdominal/pelvic pain and vaginal bleeding/discharge. Imaging was reported for 27 patients; 24 (89%) had abnormal cervical features. Papanicolaou (Pap) smear prior to diagnosis was reported for 12 patients; 6 (50%) had normal cytology, 4 (33%) atypical glandular cells, and 2 (17%) atypical cells not otherwise specified. Patients with gastric-type adenocarcinoma (n=45) were treated with surgery alone (n=16), surgery/chemotherapy/radiation (n=11), surgery/chemotherapy (n=9), surgery/radiation (n=5), or radiation/chemotherapy (n=4). Twelve (27%) of 45 patients recurred; median progression-free survival was 10 months (range, 1–148). Twenty patients (44%) died; median overall survival was 26 months (range, 2–156). Thirteen patients (27%) were alive with no evidence of disease.ConclusionsGastric-type adenocarcinoma in Peutz-Jeghers syndrome is associated with poor outcomes and short progression-free and overall survival. Screening recommendations, including pathognomonic symptom review and physical examination, with a low threshold for imaging and biopsy, may detect precursor lesions and early-stage gastric-type adenocarcinoma, leading to better outcomes in this high-risk population.PROSPERO registration numberCRD42019118151

The Role of Dynamic Ultrasound in the Assessment of the Pathological Changes of Acromioclavicular and Sternoclavicular Joints

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Zeinab Yousif Ishag Abdelhafiz ◽  
Khalid Ahmed Mohammed Ali ◽  
Safaa Kamal Mohammed Badraldeen
Keyword(s):  
Shoulder Pain ◽  
Dynamic Assessment ◽  
Cost Comparison ◽  
University Hospital ◽  
Patient Comfort ◽  
Radiology Department ◽  
Control Group ◽  
Diagnostic Modality ◽  
Presenting Symptoms ◽  
Dynamic Ultrasound

Abstract Background Sonography is a useful imaging tool for the examination of musculoskeletal pathology. There are many advantages to this technique, including easy accessibility, low cost, comparison with the asymptomatic limb, and patient comfort. Unlike other available modalities, dynamic assessment is readily performed using sonography. Furthermore, the use of Doppler technique allows assessment of vascularity, inflammation, and anatomical relationships of the structure in question to adjacent vessels. Aim of Study This study investigates the value of dynamic ultrasound in the evaluation of AC and SC joints abnormality in comparison with the asymptomatic limb. Patients & Methods This prospective study included fifty cases, thirty patients were clinically positive for shoulder pain. Twenty healthy persons examined as control group. The patients were referred from Rheumatology and Immunology Department of Ain Shams University.US evaluation was performed at the Radiology Department of Ain –Shams University Hospital in period from January to June2018, to characterizing the AC and SC joints, their pathogenesis and sequelae. Dynamic US examination was also performed in all the cases. Results This study included 30 patients. The most common presenting symptoms in the primary care were shoulder pain which present in all 30 patients. Appropriate history and physical examination coupled with correct radiographs usually lead to an accurate diagnosis, we add that dynamic US which served a role in directing the management plan in 18 patients, this further confirmed with a positive clinical examination, in contrast to the other 12 patients for whom there was negative clinical findings. Conclusion High-resolution US technology, coupled with good anatomical knowledge and proper technique, has become valuable in the assessment of ACJ pathology as can be a useful initial diagnostic modality in SCJ osteoarthritis. Using US as a first line investigative tool can eliminate the need for further more expensive investigation like CT/ MRI and serve as a guide for further imaging and management.

Posterior shoulder pain and anterior instability: a preliminary clinical study

2008 ◽  
Vol 91 (2) ◽  
pp. 79-83 ◽  
Author(s):  
Alessandro Castagna ◽  
Marco Conti ◽  
Mario Borroni ◽  
Giuseppe Massazza ◽  
Enzo Vinci ◽  
...  
Keyword(s):  
Clinical Study ◽  
Shoulder Pain ◽  
Anterior Instability ◽  
Posterior Shoulder

scholarly journals Hemorrhagic vestibular schwannoma: an unusual clinical entity

1998 ◽  
Vol 5 (3) ◽  
pp. E14 ◽  
Author(s):  
Dean Chou ◽  
Prakash Sampath ◽  
Henry Brem
Keyword(s):  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Unusual Case ◽  
Case Reports ◽  
Clinical Entity ◽  
Vestibular Schwannomas ◽  
Presenting Symptoms ◽  
Cranial Nerve Dysfunction ◽  
Nerve Dysfunction ◽  
Management Issues

Hemorrhagic vestibular schwannomas are rare entities, with only a few case reports in the literature during the last 25 years. The authors review the literature on vestibular schwannoma hemorrhage and the presenting symptoms of this entity, which include headache, nausea, vomiting, sudden cranial nerve dysfunction, and ataxia. A very unusual case is presented of a 36-year-old man, who unlike most of the patients reported in the literature, had clinically silent vestibular schwannoma hemorrhage. The authors also discuss the management issues involved in more than 1000 vestibular schwannomas treated at their institution during a 25-year period.

Posterior Shoulder Instability After Infraclavicular Block for Outpatient Hand Surgery

Hand ◽  
2021 ◽  
pp. 155894472110650
Author(s):  
Ajay C. Kanakamedala ◽  
Jared S. Bookman ◽  
David L. Furgiuele ◽  
Jacques H. Hacquebord
Keyword(s):  
Regional Anesthesia ◽  
Shoulder Instability ◽  
Case Reports ◽  
Hand Surgery ◽  
Orthopedic Procedures ◽  
Postanesthesia Care Unit ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder Dislocation ◽  
Posterior Shoulder ◽  
Increased Risk

Regional blocks are being increasingly utilized for anesthesia for various orthopedic procedures. Several studies have shown that regional anesthesia has fewer side effects and improved postoperative pain relief compared to general anesthesia, but regional blocks are not without risks. We present case reports of 2 patients who experienced posterior shoulder instability, one of whom had a posterior shoulder dislocation, immediately in the postanesthesia care unit after undergoing hand surgery with regional anesthesia. This paper highlights the importance of being aware that patients might be at increased risk of shoulder instability after upper extremity regional anesthesia, and appropriate perioperative precautions should be taken.

Effects of Non-Assisted Posterior Shoulder Stretches on Shoulder Range of Motion Among Collegiate Baseball Pitchers

2010 ◽  
Vol 2 (4) ◽  
pp. 163-170 ◽  
Author(s):  
Sakiki Oyama ◽  
Candice P. Goerger ◽  
Benjamin M. Goerger ◽  
Scott M. Lephart ◽  
Joseph B. Myers
Keyword(s):  
Range Of Motion ◽  
Shoulder Range Of Motion ◽  
Posterior Shoulder ◽  
Collegiate Baseball ◽  
Baseball Pitchers ◽  
Shoulder Range

scholarly journals Prediction of Shoulder Pain in Youth Competitive Swimmers: The Development and Internal Validation of a Prognostic Prediction Model

2020 ◽  
Vol 49 (1) ◽  
pp. 154-161
Author(s):  
Stef Feijen ◽  
Thomas Struyf ◽  
Kevin Kuppens ◽  
Angela Tate ◽  
Filip Struyf
Keyword(s):  
Logistic Regression ◽  
Shoulder Pain ◽  
Muscle Endurance ◽  
Internal Validation ◽  
Competitive Swimming ◽  
Final Model ◽  
Shoulder Muscle ◽  
Multivariable Logistic Regression ◽  
Posterior Shoulder ◽  
Competitive Swimmers

Background: Knowledge of predictors for shoulder pain in swimmers can assist professionals working with the athlete in developing optimal prevention strategies. However, study methodology and limited available data have constrained a comprehensive understanding of which factors cause shoulder pain. Purpose: To investigate risk factors and develop and internally validate a multivariable prognostic model for the prediction of shoulder pain in swimmers. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 201 pain-free club- to international-level competitive swimmers were followed for 2 consecutive seasons. The cohort consisted of 96 male (mean ± SD age, 13.9 ± 2.2 years) and 105 female (13.9 ± 2.2 years) swimmers. Demographic, sport-specific, and musculoskeletal characteristics were assessed every 6 months. Swim-training exposure was observed prospectively. Shoulder pain interfering with training was the primary outcome. Multiple imputation was used to cope with missing data. The final model was estimated using multivariable logistic regression. We applied bootstrapping to internally validate the model and correct for overoptimism. Results: A total of 42 new cases of shoulder pain were recorded during the study. Average duration of follow-up was 1.1 years. Predictors included in the final model were acute:chronic workload ratio (odds ratio [OR], 4.31; 95% CI, 1.00-18.54), competitive level (OR, 0.19; 95% CI, 0.06-0.63), shoulder flexion range of motion, posterior shoulder muscle endurance (OR, 0.96; 95% CI, 0.92-0.99), and hand entry position error (OR, 0.37; 95% CI, 0.16-0.91). After internal validation, this model maintained good calibration and discriminative power (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.60-0.94). Conclusion: Our model consists of parameters that are readily measurable in a swimming setting, allowing the identification of swimmers at risk for shoulder pain. Multivariable logistic regression showed the strongest predictors for shoulder pain were regional competitive swimming level, acute:chronic workload ratio, posterior shoulder muscle endurance, and hand entry error.

scholarly journals Ulnar Collateral Ligament Repair with Internal Brace Augmentation in Amateur Overhead Throwing Athletes

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Jeffrey R. Dugas ◽  
Christopher A. Looze ◽  
Christopher Michael Jones ◽  
Brian L. Walters ◽  
Marcus A. Rothermich ◽  
...  
Keyword(s):  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Time Frame ◽  
Return To Play ◽  
Overhead Athletes ◽  
Late Failure ◽  
Internal Brace ◽  
Overhead Throwing ◽  
A Prospective Study

Objectives: There has been a renewed interest in UCL repair in overhead athletes. This is largely due to greater understanding of UCL pathology, improvement in fixation technology and the extensive rehab required to return from UCL reconstruction. Initial data regarding UCL repair in overhead athletes was poor and therefore UCL repair was largely abandoned in favor of reconstruction. However, recent literature examining UCL repair with anchor only fixation demonstrated an excellent rate of return to play, reduced time to return to play and a low complication rate. Based on this promising data, we have developed a novel technique of UCL repair with internal brace augmentation that we have used in overhead throwing athletes. We performed a prospective study evaluating the outcomes of this procedure with respect to return to play, time to return to play, functional outcome score and complications. Methods: Overhead athletes undergoing UCL repair with internal brace augmentation were prospectively followed for a minimum of one year. Patients were carefully selected from those who would traditionally be considered for UCL reconstruction. Initially, patients were considered if they had an avulsion of the UCL with otherwise healthy UCL tissue and had a vested interest in shortened rehab. As the study progressed, interest in shortened rehab became a less stringent criteria. Demographic and operative data were collected at the time surgery. This data was compiled for both desciption and comparison between subgroups. Patients were then contacted 1 year postoperatively and assessed for return to play, time to return to play and KJOC scores. Complications were documented and patients having complications were detailed. Results: 66 overhead athletes underwent UCL repair with internal brace augmentation during the study period. 8 were lost to follow up, leaving 58 athletes included in the study. Average age at the time of surgery was 17.9 years old. There were 43 baseball pitchers, 8 baseball position players, 4 softball players, 2 football quaterbacks, and 1 javelin thrower. 96% (54/56) of those who desired to return to the same or higher level of competition were able to do so at an average time of 6.1 months (range 3.2-12 months). 65% of these were able to return in less than 6 months. Many of those who took longer than 6 months did so due to timing within the season. Average KJOC score was 90.2 at 1-year follow-up. 3 patients required return to the operating room, 2 of which were eventually able to return to their previous level of play. There was 1 late failure over 3 years from the index procedure. Comparative subgroup data is presented in table 1. Conclusion: UCL repair with internal brace augmentation is a viable option for overhead throwers with selected UCL pathology who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction. [Table: see text]

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