Background The suprascapular notch (SN) represents the point along the route of the suprascapular nerve (SSN) with the greatest potential risk for injury and compression. Thus, factors reducing the area of the notch have been postulated for suprascapular neuropathy development. Methods Thirty-one fresh-frozen shoulders were dissected. The contents of the SN were described according to four types as classified by Polguj et al and the middle-transverse diameter of the notch was measured. Also, the presence of an ossified superior transverse scapular ligament (STSL) was identified. Results The ligament was partially ossified in 8 specimens (25.8%), fully ossified in 6 (19.35%), and not ossified in the remaining 17 (54.85%). The mean middle-transverse diameter of the SN was 9.06 mm (standard deviation [SD] = 3.45). The corresponding for type-I notches was 8.64 mm (SD = 3.34), 8.86 mm (SD = 3.12) was for type-II, and 14.5 mm (SD = 1.02) was for type III. Middle-transverse diameter was shorter when an ossified ligament was present (mean = 5.10 mm, SD = 0.88 mm), comparing with a partially ossified ligament (mean =7.67 mm, SD = 2.24 mm) and a nonossified one (mean = 11.12 mm, SD = 2.92 mm). No statistically significant evidence was found that the middle-transverse diameter depends on the number of the elements, passing below the STSL. Conclusion Our results suggest that SSN compression could be more likely to occur when both suprascapular vessels pass through the notch. Compression of the nerve may also occur when an ossified transverse scapular ligament is present, resulting to significant reduction of the notch's area.
Lecture 4Diagnosis and management of posterior and cruciate ligament tears has advanced over the past two decades due to important understanding of the natural history of injury and basic science principles. Despite the current advances, our understanding of posterior cruciate ligament (PCL) injury and treatment continues to lag behind that of the anterior cruciate ligament (ACL). In addition, there is still controversy regarding indications for surgical intervention, use of one versus two reconstructive graft bundles, location of the femoral tunnels and the ideal degree of graft tensioning.The classic mechanism of injury to the PCL in sports due to a fall on a flexed knee with the foot in plantar flexion. A PCL injury can be partial or complete and it can be isolated or involve multiple ligaments.The grading system is normal: A, B and C. Grade A is defined as partial tear and grade B as a complete PCL tear. Grade C PCL injuries are frequently associated with additional injury to the posterolateral corner or the medial aspect of the knee.In general, acute isolated grade A and B PCL injuries can be treated non-operatively. In grade C injuries with associated ligament pathology, we recommend repairing or reconstructing all ligaments.
Hip arthroscopy has gradually evolved over the past two decades.Recently hip arthroscopy has increase its role in diagnosis and treatment for specific intraarticular and extraarticular hip injuries and especially for soft tissue injuries.Material and methodsFebruary 2004–March 2010, 48 athletes, football players, basketball players, weight lifters, gymnasts, three water polo players. Mean age: 32 years. (19–39 year old)Instrumentation and equipment70°, 4.5 mm arthroscope, High flow rate mechanical pump, 15 gauge 6″ cardiac needle, Convex full radius chondroplasty blades, special electrocautery. Distraction apparatus, DVD unit, mechanical water pump unit, mage intensifierIndicationsUndiagnosed hip pain, early osteoarthritic signs, labral pathology, loose bodies, osteochondral defects, sepsis, ligamentum teres, trauma, synovitis, femoral acetabular impingment (FAI), ‘frozen hip’, chondrocalcinosis.SymptomsDeep dull ache pain during hip flexion and external or internal rotation, decrease range of motion, decreased hip flexion.Clinical findings30/48 Cam sign: positive, 12/48 Pincher sign: positive, impingement syndrome in hip flexion and internal and rotation and occasionally in external rotation, snapping hip, iliopsoas tendinitis.SurgeryStandard orthopaedic traction table, supine position, hip is extended and abducted 25°PortalsAnterolateral, posterolateral, modified anterolateralIntraoperative findingsDetachment of the labrum, 10/48 erosion of the articular cartilage of the acetabulum and drilling of the bare area, 30/48 Cam sign excision, 12/48 pincer sign excision, 8/48 superior medial and superior lateral labrum repair with anchors. (intra-articularly)ResultsThe modified Harris Hip Score was used for their classification of their symptoms. Two of the athletes had a residual pain due to an iliopsoas tendinitis. 45/48 had relief from their arm symptoms, 1/48 will need to be reoperated shortly (after he developed FAI), 2/48 are treated for the iliopsoas tendinitis.ConclusionThe athletes with symptoms of an internal hip pain and FAI signs after a detailed clinical exam of their hip and after failure of their conservative treatment, will certainly get a benefit from an arthroscopic procedure (which is technically demanding).
The bovine artery is considered the most frequent aortic arch branching variation. Despite being considered a normal variation of the aortic arch branching, still it has been linked with various issues regarding the thoracic aorta. The aim of this study is to highlight the prevalence of bovine artery among specific vascular pathologies throughout the literature and to provide information to clinicians about the importance of identifying this variation. For this specific review, we acquired potentially relevant studies for inclusion from the electronic database of PubMed. We limited our investigation to papers published within the last decade (from 2011 to 2021). Single case reports, papers with language restrictions, letters to the editor, conference abstracts, studies that were non-human centered and studies with unextractable and incomplete data were not included. Searching the PubMed database, it was evident that there is a close relationship between bovine arch and thoracic aortic arch pathology. In the defined period 2011–2021 that our research was focused, we selected eight studies tackling this issue. The majority of the studies in this review (except one) provided concerning data about the prevalence of this aortic arch variant among patients with aortic aneurysmal dilatation and aortic dissection. Following our results, we strongly believe that bovine arch should no longer being considered as a normal variation with no clinical significance, but rather as a potential risk factor for thoracic aortic arch morbidities.
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