Aim Congenital undescended scapula (Sprengel deformity) is a rare deformity that is reported in the literature mostly as small case series with short-or medium-term follow-up periods. Here, we aimed to present the long-term results of this deformity treated with modified Green procedure. Method The modified Green procedure was performed in 24 patients (28 shoulders) with Sprengel deformity. Clavicular osteotomy accompanied in all, and omovertebral bone excision in 13 shoulders. The mean age of the patients at the time of surgery was 4.5 years (range 1.5-17 years). Mean follow-up period was 11 years 4 months (4.3-17 years). Preoperative cosmetic appearance was noted as Cavendish III in 17 shoulders and as IV in 11 shoulders. In addition to the Cavendish scale, shoulder abduction, shoulder asymmetry, and scapular elevation and medialization were evaluated.
ResultsThe decrease in scapular elevation and Cavendish scale, and the improvement in shoulder abduction and scapular medialization postoperatively were statistically significant (P \ 0.001). Cosmetic improvement of at least one Cavendish grade were attained in 88.9% of shoulders. One patient (unilateral) who was Cavendish grade IV preoperatively died in the early postoperative period from unrelated causes. Of the remaining 10 preoperatively grade IV shoulders, 2 remained at the same grade, 1 improved to grade III, and 7 shoulders to grade I. Of the 17 preoperatively grade III shoulders, 1 shoulder stayed the at same grade, 7 shoulders improved to II, and 9 shoulders to grade I. Postoperative winging in 2 shoulders and hypertrophic scarring in 6 shoulders were noted. Conclusion The modified Green procedure is a relatively safe and reliable method in the treatment of severe Sprengel deformity cases and provides highly constructive and aesthetic results in the long term.
On sonography and elastography, we observed thickening and softening in Achilles tendons of athletes in comparison with healthy volunteers who had similar ages and body mass indices. These changes could be associated with early tendon degeneration. Further longitudinal studies may support this consideration.
A 20-year-old female presented with a painful swelling in the right knee and snapping sensation on joint motion that appeared without trauma and recurred several times. She had no history of a bleeding disease or trauma. Physical examination showed no signs of rash or temperature change or systemic or local findings of an infection. The knee was tender and knee motion was painful, with 90 degrees of flexion and full extension. The ballottement test was positive. All laboratory tests including rheumatologic and bleeding parameters were normal. Joint effusion analysis was normal except for its rusty-brown color. Magnetic resonance imaging showed synovial hypertrophy and grade 2 degeneration in the medial meniscus. During diagnostic and surgical arthroscopy, rust-colored synovial hypertrophy was noted in the suprapatellar pouch accompanied by patchy villi and nodules and cystic changes. The gross appearance of the synovium mimicked that of pigmented villonodular synovitis. Biopsy specimens were obtained from different parts of the synovium and a subtotal synovectomy was performed. The histopathologic diagnosis was reported as hemosiderotic synovitis. During a three-year follow-up, she had no pain, snapping sensation, or limitation of motion. There were no recurrent effusions.
Background. Gabapentin, as a structural analogue of γ-aminobutyric acid, has been investigated to provide pain relief in the early postoperative period following various surgical interventions.
Augmentation with a free transfer of the coracoacromial ligament provides excellent and promising functional results in the operative treatment of massive rotator cuff tears with a mini-open technique.
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