Michimasa Ui

FRACTURES OF THE CORACOID PROCESS

We reviewed 67 consecutive patients with fractures of the coracoid process, classifying them by the relationship between the fracture site and the coracoclavicular ligament. The 53 type-I fractures were behind the attachment of this ligament, and the 11 type-II fractures were anterior to it. The relationship of three fractures was uncertain. Type-I fractures were associated with a wide variety of shoulder injuries and consequent dissociation between the scapula and the clavicle. Treatment was usually by open reduction and fixation for type-I fractures and conservative methods for type-II. At follow-up of the 45 available patients, 87% had excellent results, with no significant differences between the operative and non-operative groups or between the type-I and type-II fractures. We consider that operative treatment should be reserved for patients with multiple shoulder injuries with severe disruption of the scapuloclavicular connection.

Humeral shaft fracture sustained during arm wrestling: report on 30 cases and review of the literature.

Thirty cases of humeral shaft fracture sustained during arm wrestling were analyzed. Twenty eight were men and two were women. Eighteen were fractures of the right arm and 12 were of the left. The patients ranged in age from 15 to 60 years old, averaging 30 years. Although there was no prominent tendency for the injuries to occur at a certain phase of the match, they happened in all cases while full force was being exerted in an effort to win or to change the tide of the contest. All cases were spiral fractures, of which 23% presented with a medial butterfly fragment, and also 23% of which had radial nerve palsy. We infer that, through a shift in body weight and subsequent counterattack from the opponent, the shoulder internal rotator muscles suddenly changed from their maximum concentric contraction to eccentric contraction, resulting in development of an intense rotational force leading to the subsequent fracture. Therefore, this type of fracture may occur in anyone of any age engaging in this type of sport.

Fracture-separation of the medial humeral epicondyle caused by arm wrestling

Ten cases with fracture-separation of the medial humeral epicondyle occurring during arm wrestling were studied to clarify the nature of injury and the mechanism involved. Patients were all male, aged 13 to 15 years. The following results were obtained: (1) the injury often occurred in children immediately before closure of the epiphyseal plate, (2) the injury occurred only when the arm wrestler took a posture in which his center of gravity could shift easily, (3) the injury developed only when one wrestler tried to force the end of the match and the other countered that move, and (4) no lateral instability of the elbow was observed in patients with this injury. These results suggest that the injury is caused by muscular violence. When the maximally contracted muscles attaching to the medial humeral epicondyle are suddenly and passively stretched by shifting of the patients center of gravity and by the opposing wrestlers counterattack, a shift from concentric contraction to eccentric contraction could occur and apply a large muscle force to the medial humeral epicondyle.

Symptomatic Osteochondroma of the Clavicle. A Report of Two Cases

An osteochondroma is a benign lesion that is often considered to be the most common type of bone tumor; however, it is actually a developmental physeal growth defect19. A solitary osteochondroma is encountered more frequently than are multiple hereditary osteochondromas18,25. This defect may develop in any bone in which endochondral ossification occurs, but the principal locations are the long bones, especially the femur, the humerus, and the tibia18,25. The lesion rarely occurs in the clavicle. Although it typically presents as an asymptomatic slow-growing osseous mass, symptoms resulting from various causes may occur after local expansion4,5,8,9,13,18,23,25,26. We report the cases of two patients who had a painful solitary osteochondroma that was located at the lateral end of the clavicle. CASE 1. A twenty-six-year-old man who worked as a clerk was seen in July 1995 because of a three-year history of pain in the left shoulder. The pain occurred with movement but not at night or at rest. The patient reported no history of trauma to the shoulder. The lateral end of the clavicle bulged slightly upward, but no instability was noted. The supraspinatus and infraspinatus muscles were slightly atrophic, and both were rated as grade 4 of 5 on manual muscle-testing, but tenderness and a palpable defect of the rotator cuff were absent. The active range of motion of the left shoulder was reduced, compared with that of the right shoulder, by 15 degrees in elevation and by 20 degrees in external rotation. The impingement sign, which is elicited by forced elevation of the arm against the acromion with simultaneous stabilization of the scapula, was negative, but forceful horizontal adduction was noted to …

Subdeltoid lipoma: a case with symptoms mimicking glenohumeral instability and subacromial impingement.

Lipoma is the most frequently occurring benign soft tissue tumor in the shoulder and the axillary region in middle-aged and older persons, yet few such lipoma cases have been associated with clinical symptoms. A 38-year-old right-handed man presented with an enlarged feeling and a painful back-and-forth popping in his left shoulder. Although moderate tenderness of the subacromial bursa and bicipital groove existed, an obvious impingement sign was absent. Also not evidenced were signs of neurological deficits, limited range of motion, or any physical findings suggestive of instability. Magnetic resonance imaging showed a homogenous tumor in the subdeltoid that was isointense relative to the subcutaneous fat and fluid collection in the hypertrophic subacromial bursa. As the tumor was considered from the clinical and imaging findings to be attributable to all clinical symptoms, it was resected en bloc with a satisfactory result. Histopathologically, the tumor showed typical features of a simple lipoma. To our knowledge, the present case is the first of a subdeltoid intermuscular lipoma of which mechanism developing symptoms was preoperatively surmised from imaging. The symptom-mimicking shoulder instability was assumed to be produced by the back-and-forth snapping of the lipoma beneath the deltoid muscle. The mechanism for developing the subacromial impingement-like symptom was surmised to derive from the middle deltoid fibers pressuring the lipoma to push up into the subacromial space. This case is presented to emphasize the careful reading of imaging in considering the pathomechanism of the attributing symptoms.

Brachial plexus palsy presenting as an initial manifestation of hemophilia in a middle-aged man

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Fractures Of The Coracoid Process

A, Cohn M. lniury to the eleventh cranial nerve in a high school wrestler. Orthop Rev 1986; 1559-64. 5. Donner TR( Kline DG, Extracranial spinal accessory nerve injury. Neurosurgery 1993;32:907-1 1. 6. Eisen A, Bertrand G, Isolated accessory nerve palsy of spontaneous origin. Arch Neural 1972;27:496-502. 7, Hanford JM. Surgical excision of tuberculous lymph nodes of the neck. Surg Clin North Am 1933; 13:301-10. 8. logigian El, Mclnnes JM( Berger AR, Busis NAI lehrichJR, Shahani BT. Stretch-induced spinal accessory nerve palsy Muscle Nerve 1988; 1 1: 146.50. J Shoulder Elbow Surg September/October 1998