Kyoung Jin Park

Role of the superior shoulder capsule in passive stability of the glenohumeral joint

BACKGROUND The shoulder capsule is the main static stabilizer of the glenohumeral joint. However, few studies specifically address the function of the superior shoulder capsule, which is usually damaged in patients with complete rotator cuff tears. Therefore, the purpose of this study was to determine the biomechanical contribution of the superior shoulder capsule to passive stability of the glenohumeral joint. METHODS Seven cadaveric shoulders were tested with a custom testing system. Glenohumeral translations, subacromial contact pressure, and glenohumeral external and internal rotations were quantified at 5°, 30°, and 60° of glenohumeral abduction. Data were compared among 3 conditions: (1) intact superior capsule, (2) after detaching the superior capsule from the greater tuberosity (tear model), and (3) after complete removal of the superior capsule from the greater tuberosity to the superior glenoid (defect model). RESULTS A tear of the superior capsule significantly (P < .05) increased anterior and inferior translations compared with those in the intact capsule. Creation of a superior capsular defect significantly (P < .05) increased glenohumeral translation in all directions, subacromial contact pressure at 30° of glenohumeral abduction, and external and internal rotations compared with those of the intact capsule. CONCLUSION The superior shoulder capsule plays an important role in passive stability of the glenohumeral joint. A tear in the superior capsule at the greater tuberosity, which may be seen with partial rotator cuff tears, increased anterior and inferior translations. A defect in the superior capsule, seen in massive cuff tears, increased glenohumeral translations in all directions.

Cauda Equina Syndrome by Lumbar Disc Herniation after Caesarian Section Delivery - A Case Report -

Cauda equina syndrome develops as rapidly progressive neurologic deficit of lower extremities and urogenital system often resulting in serious outcome such as complete irreversible paraparesis. Therefore prompt diagnosis and decompression is mandatory. However, if it occurs after childbirth, it may be overlooked being regarded as symptoms related to pregnancy and delivery. We experienced a cauda equina syndrome by ruptured disc in a 32-year-old woman just after Caesarian section in a local obstetric clinic who was transferred to us 2 days after development of progressive neurologic deficits. We managed her with prompt decompressive surgery and achieved favorable result. Because of the importance of early detect and prompt decompression for cauda equina syndrome and possible occurrence at perinatal period, we report this case reviewing the literature especially concerning about pregnancy and cauda equina syndrome.