Lars Neumann

Non-operative treatment of multidirectional shoulder instability.

Abstract. At an average follow-up of 3.7xa0years we assessed the results of non-operative treatment of 84 symptomatic shoulders in 59 patients with a diagnosis of multidirectional shoulder instability. Sixty-two shoulders had received no previous surgical treatment (group A) while 22 had failed to respond to surgical treatment before the rehabilitation programme (group B).Subjectively 11 of the non-operated shoulders (group A) were cured and 27 improved, 23 of the shoulders remained the same and one was worse at follow-up. According to the age and gender adjusted Constant score, 38 of the non-operated shoulders had either no disability or only mild disability, nine had moderate disability, while the remaining 15 had severe or total disability. These figures were far worse in group B. In group A only four shoulders required operation, while in group B seven required operation following rehabilitation.Patients who had had previous shoulder surgery, those with a work related injury and those with psychological problems were less likely to benefit from the rehabilitation programme.Résume. Nous avons suivi pendant 3.7xa0ans 84 épaules chez 59 patients avec une instabilité multidirectionnelle traitée par un programme de rééducation. Soixante-deux épaules (groupe A) ne recevaient aucun traitement chirurgical, et 22 épaules (groupe B) ont eu un traitement chirurgical inefficace avant la rééducation. Dans le groupe A, 11 sont sans symptôme, 27 sont améliorés, 23 restent sans changement, et une est aggravé. Selon le score de Constant, 38 épaules navaient aucune insuffisance ou avaient des signes cliniques très modérés, neuf avaient des signes modérés et 15 avaient une instabilité sérieuse. Les résultats dans le groupe B ont été beaucoup plus mauvais. Dans groupe A quatre épaules et dans le groupe B sept épaules ont été opérées après la rééducation. Les patientes qui étaient traités chirurgicalement á cause dun accident du travail ont fait leur programme de rééducation avec moins de succès.

MR imaging of edematous anconeus epitrochlearis: another cause of medial elbow pain?

Two patients with unusual medial elbow pain had MRI scans performed that revealed edema of the aberrant muscle of the anconeus epitrochlearis. MRI of this anconeus epitrochlearis muscle are presented.

Glenothoracic fusion AN ADJUNCT TO RADICAL SCAPULECTOMY

We describe a surgical procedure used to achieve glenothoracic fusion after one-stage radical, near total scapulectomy for primary or secondary malignant lesions in six patients. The aim was complete excision of the lesion and preservation of the glenoid to provide a fulcrum for movement of the arm. Post-operative assessment involved determination of the range of movement and the application of the Musculoskeletal Tumour Society score and the Constant score to evaluate function. The results showed that a functional range of movement was attainable despite such radical surgery, although there was a considerable reduction in power and ability to lift.

Acute plastic bowing fractures of both the tibia and the fibula in a child

A case of acute plastic bowing fractures of both the fibula and tibia in a child is presented. This type of fracture has never been reported in the tibia, but has now been reported in all the major bones of the limbs. The clinical picture is described, and the indications for treatment discussed. In case of doubt, radiographs should be taken of the opposite limb, if the clinical picture suggests a bowing fracture.