Histological characteristics of sternoclavicular beta 2-microglobulin amyloidosis and clues for its histogenesis.
(9/1127)
BACKGROUND: The pathogenesis of beta 2-microglobulin amyloidosis (A beta 2m) has yet to be fully elucidated. METHODS: We describe the distribution and extent of A beta 2m deposition and macrophagic infiltration in cartilage, capsule, and synovium of sternoclavicular joints obtained postmortem from 54 patients after 3 to 244 (median 46) months of dialysis. Twenty-four nonuremic patients served as a control group. The diagnosis of amyloidosis (A) rested on a positive Congo Red staining (typical birefringence) and that of A beta 2m on positive immunostaining of the A deposits with a monoclonal anti-beta 2m antibody. The size of A deposits was measured. RESULTS: A beta 2m was detected in 32 (59%), and non-beta 2m amyloid (Anon beta 2m) was detected in an additional 8 (15%) of the 54 dialyzed patients. A beta 2m deposits were present in the cartilage of all A beta 2m (+) patients (100%). They were localized solely in the cartilage in 27% of the cases, either as a thin patchy layer or as a continuous thicker layer (identified as stage I). A beta 2m was additionally present in the capsule and/or synovium without macrophages in 27% of the cases (identified as stage II). The correlation between the size of cartilaginous deposits and dialysis duration (P = 0.02) as well as with the prevalence (P = 0.03) and size of capsular deposits (P = 0.02) suggests that stage II is a later stage of A deposition. Clusters of macrophages were detected around capsular and synovial amyloid deposits in 46% of the cases (identified as stage III). The longer duration of dialysis in those with stage III as well as the relationship between the size of the A beta 2m deposits and the prevalence of macrophagic infiltration suggests that stage III is the last stage of A beta 2m deposition. Marginal bone erosions were observed in 9 out of 12 patients with stage III deposits. Their size was correlated with that of cartilaginous deposits (P = 0.01). Among the 24 control patients, Anon beta 2m was detected in 12 patients (cartilage 100%, capsule 8%, synovium 30%). CONCLUSIONS: The earliest stage of A beta 2m deposition occurs in the cartilage. A beta 2m subsequently extends to capsule and synovium. These two first stages do not require macrophage infiltration. Macrophages are eventually recruited around larger synovial or capsular deposits in the final stage. Marginal bone erosions develop in this late stage. (+info)
Shoulder instability in young athletes.
(10/1127)
The term "shoulder instability" constitutes a spectrum of disorders that includes dislocation, subluxation and laxity. Anterior instability is the most common form of glenohumeral instability and may be associated with nerve injury. The diagnosis of anterior, posterior or multidirectional instability is based on a thorough history and physical examination that includes specific provocative maneuvers. The load-and-shift test, the relocation test, the drawer test, the sulcus test and the anterior apprehension test are useful for assessment of the shoulder. Radiographic studies should include special views to delineate specific lesions, such as a Bankart lesion and a Hill-Sachs defect. Early surgical intervention may be a consideration, especially in younger patients. Recent studies suggest that surgical intervention after the first dislocation may reduce the rate of recurrence. Rehabilitation is accomplished in four phases, beginning with rest and pain control and proceeding to isometric and isotonic exercises. The goal is for the patient to reach 90 percent strength in the injured shoulder compared with the uninjured shoulder. (+info)
Comparative efficacy and safety of nimesulide and diclofenac in patients with acute shoulder, and a meta-analysis of controlled studies with nimesulide.
(11/1127)
Adverse events, particularly gastrointestinal, partially offset the therapeutic value of NSAIDs. The abilities of nimesulide to inhibit COX-2 preferentially and to exert other novel anti-inflammatory actions are consistent with good efficacy and safety. This is borne out by a double-blind multicentre comparison of nimesulide and diclofenac in 122 patients with acute shoulder, and by a meta-analysis of various nimesulide trials. At the end of the 14 day double-blind study, nimesulide was at least as effective as diclofenac (investigator ratings: good/very good in 79.0% of patients given nimesulide, and 78.0% with diclofenac; patient ratings: good/very good in 82.3 and 78.0% respectively). Four patients (6.5%) dropped out in the nimesulide group (two early recovery, one lack of effect, one adverse event), compared with 13 (21.7%) in the diclofenac group, due mainly to adverse events (P=0.003). Global tolerability was judged by the investigators to be good/very good in 96.8% of the nimesulide group compared with 72.9% of those given diclofenac. Judgements by the patients were 96.8 and 78.0% respectively. Both differences are highly significant statistically. The meta-analysis demonstrates that nimesulide given for 2 weeks is far more efficacious than placebo in treating osteoarthritis, and is at least comparable to other NSAIDs The benefit-risk ratio for nimesulide was better in all individual studies since 100 mg nimesulide twice daily was about equal to placebo in safety and tolerability, especially regarding gastrointestinal adverse events. (+info)
Dynamic stability of glenohumeral joint during scapular plane elevation.
(12/1127)
OBJECTIVE: To investigate the muscle-controlled dynamic stability of the glenohumeral joint through X-ray fluoroscopy in active and passive shoulder elevation in scapular plane. METHODS: Sixty healthy volunteers were collected in this study, including 23 men and 37 women, with an average age of 28.4 years. Passive and active shoulder elevation in scapular plane were observed under X-ray imaging. In 18 subjects, X-ray films were taken when the shoulder elevated in scapular plane from 0 degree to 150 degrees with a 30 degrees interval at each stage in both active and passive movements. The angles between the pivot of the humerus and the glenoid surface (GHA) during the active and passive motion were calculated and analyzed. Manual examination was also applied in the same manner. RESULTS: The pivot of the humerus had a tendency to be vertically closer to the glenoid surface in the active elevation than in the passive elevation. The differences of GHA between the active and passive motion at 0 degree, 30 degrees, 60 degrees, 90 degrees, 120 degrees and 150 degrees elevation were 4.55 degrees +/- 0.37 degree, 5.44 degrees +/- 1.16 degrees, 6.50 degrees +/- 1.50 degrees, 4.94 degrees +/- 0.82 degree, 4.50 degrees +/- 0.40 degree and 1.44 degrees +/- 0.68 degree, respectively. Manual examination found the angle between the scapula and the humerus tended to be larger in the active motion than in the passive motion. CONCLUSION: The active coordination of the muscles around the shoulder is beneficial to the dynamic stability of the glenohumeral joint. (+info)
An unlearned principle for controlling natural movements.
(13/1127)
Recently, Gottlieb and colleagues discovered a linear relation between elbow and shoulder dynamic torque in natural pointing movements in the sagittal plane. The present study investigates if the process of learning to reach involves discovering this linearity principle. We inspected torque data from four infants who were learning to reach and grab a toy in front of them. In a longitudinal study, we collected data both in the period before and after they performed their first successful reaches. Torque profiles at the shoulder and elbow were typically multipeaked and became more and more biphasic toward the end of the first year of life. Torques at the shoulder and elbow were correlated tightly for movements in the prereaching period as well as for reaches later in the year. Furthermore, slopes of a regression of shoulder dynamic torque on elbow dynamic torque were remarkably constant at a value approximately 2.5-3.0. If linear synergy is used by the nervous system to reduce the controlled degrees of freedom, it will act as a strong constraint on the complex of possible coordination patterns for arm movement early in life. Natural reaching movements can capitalize on this constraint because it simplifies the process of learning to reach. (+info)
Effectiveness of glenoid osteotomy in atraumatic posterior instability of the shoulder associated with excessive retroversion and flatness of the glenoid.
(14/1127)
In this investigation, patients with atraumatic posterior instability of the shoulder were appraised in order to evaluate the effectiveness of glenoid osteotomy in the correction of excessive retroversion and flatness of the glenoid. In a series of 32 patients, 17 with posterior instability had no history of trauma. Posterior glenoid osteotomy was performed to correct excessive retroversion and to deepen the glenoid; 95% were re-examined after 5 years. In 81% the results were rated as good or excellent (Constant-Murley and Rowe scores), only 12.5% having had a recurrence. The glenoid could be deepened and on average the angle could be altered from -9.35 degrees to -4.62 degrees. In comparison, 50 volunteers had average angles of -4.4 degrees, thus differing significantly from the preoperative group. Twenty-five per cent of the patients showed postoperative degenerative changes in the glenohumeral joint. The study shows that excessive retroversion and flatness of the glenoid in persons with atraumatic posterior instability can be successfully treated by a posterior glenoid osteotomy. Nevertheless, the high rate of postoperative degenerative changes must be taken into account. (+info)
The para-articular ossifications in our paraplegics and tetraplegics: a survey of 704 patients.
(15/1127)
The X-ray examination of 704 spinal cord injured patients have showed that in 20 per cent of the cases para-articular ossifications were present most frequently in the hips. They were less frequently found in non-traumatic and incomplete cases. No other clear relationship was found. (+info)
Alternative and effective treatment of shoulder ganglion cyst: ultrasonographically guided aspiration.
(16/1127)
The therapeutic effect of ultrasonographically guided aspiration of a ganglion cyst of the shoulder is evaluated. Fifteen patients (nine male, six female) with chronic shoulder pain were enrolled in this study. Each patient was referred to rule out rotator cuff lesion. The ultrasonographic examination showed an anechoic cystic lesion in the shoulder region in every patient and abnormality of the rotator cuff in only four patients. Under ultrasonographic guidance, an 18 gauge needle was inserted into the cyst to aspirate the fluid. Initial sonographic imaging showed the cyst, which appeared as a localized fluid accumulation and was located between the deltoid muscle and the subscapularis tendon in seven patients, between the deltoid muscle and the biceps tendon in one patient, below the coracoacromial ligament in five patients, and over suprascapular notch area in one patient. The ganglion cysts ranged in size from 3.5 to 30 mm. The amount of aspirated fluid in each cyst varied from 0.4 to 12 ml (mean, 2.6 ml +/- 3.1) with a clear or light yellowish color and a jelly-like appearance. No major complications occurred during or after this procedure. The symptom (pain) was improved after sonographically guided aspiration in each patient. Follow-up study showed complete relief of pain in four patients, marked improvement in nine patients, and mild improvement but still persistent shoulder pain in two patients. Duration of follow-up study ranged from 2 to 24 months (mean, 6.4 months +/- 6.9). The success rate for sonographically guided aspiration was 86% on the basis of marked symptom improvement or relief. Ultrasonographically guided aspiration of shoulder ganglion cysts is an effective procedure in the management of shoulder pain caused by ganglion cysts. (+info)