Childhood soft tissue chondroma: a case report

In this paper we draw attention to the existence of soft tissue chondromas in childhood. This entity is well recognized in adults, where over 90% of the recorded cases have occurred in the hands and feet. Our case is unusual in that the child was only 10 years of age and the lesion was on the back, not in the extremity. The importance of recognizing this condition is that these chondromas may exhibit increased cellularity and mitoses and should not be mistaken for a malignant condition.

Three-dimensional MRI of the glenoid labrum

The objective of this study was to assess the accuracy of three-dimensional (3D) magnetic resonance imaging (MRI) reformation in the evaluation of tears of the glenoid labrum complex (GLC). Fifty-five shoulders were evaluated by MRI using standard spin-echo sequences. Gradient-refocused-echo axial projections were used to assess the GLC on the two-dimensional (2D) studies. Three-dimensional Fourier transform multiplanar gradient-recalled imaging with a resolution of 0.7 mm was also performed in all patients. Independent analyses of the anterior and posterior labra were performed in a blinded manner for both the 2D and 3D studies by three experienced musculoskeletal radiologists. Observations of the imaging studies were compared with the videoarthroscopic findings. The appearance of the GLC was rated on a scale of 0 to 4 (0-2 = normal, 3, 4 = abnormal or torn). The diagnostic confidence was averaged from the three reader's scores. Anterior labral tears were effectively detected with sensitivities of 89% and 96% and specificities of 96% and 100% (P < 0.0001) for the 2D and 3D studies, respectively. For posterior labral tears, the sensitivity and specificity of the 2D method were 47% and 98%, respectively. The sensitivity and specificity of the 3D volume sequence were 53% and 98%, respectively. The lower sensitivity of both imaging methods for detecting posterior labral tears may be influenced by the smaller number (n = 5) of arthroscopically confirmed cases in our study and reflects the difficulty of visualizing the posteroinferior borders of the GLC with present MRI techniques.

Giant adenoid basal cell carcinoma

The giant adenoid basal cell carcinoma is an unusual skin tumor that has aggressive biological behavior and has been reported to exhibit geometric growth, deep invasion, and metastasis. A case of giant adenoid basal cell carcinoma is presented, with recommendations for diagnosis and treatment.

Elastofibroma dorsi: case report and brief review

An unusual soft-tissue tumor, an elastofibroma, was excised from the back of a 67-year-old woman. Details of the case and a brief review are presented.

Giant basal cell carcinoma. Report of two cases and review of the literature

Only 10% of all basal cell carcinomas are located on the trunk. Giant basal cell carcinomas are rare and are preferentially located on the trunk. We report two giant basal cell carcinomas of the trunk, one of which was fatal. Our review also includes a summary of previously reported cases of giant basal cell carcinoma. An analysis of these cases discloses an interesting feature of large basal cell carcinoma: Once giant basal cell carcinomas reach a critical mass, they demonstrate extremely aggressive behavior.

[The characteristics of stabbing-cutting injuries with a 2-phase insertion of the blade]

The mechanism of formation of angular cut injuries is described, in which the blade is first partially stuck in in one plane (phase 1) and then plugged at some angle to it (phase 2). It is not enough to know the length of the main incision to make a judgement on the width of the blade of injuring instrument; identification signs should be searched both in the first and second incisions.

Labral-ligamentous complex of the shoulder: evaluation with MR arthrography

PURPOSE

To determine the usefulness of magnetic resonance (MR) arthrography in assessment of the labral-ligamentous complex and test the hypothesis that the inferior glenohumeral ligament (IGHL) is an important anatomic feature of clinical instability.

MATERIALS AND METHODS

Forty-eight shoulders with labral diagnoses proved with arthroscopy or open surgery were prospectively examined with MR arthrography after intraarticular injection of gadopentetate dimeglumine.

RESULTS

Surgical findings showed that 14 labra were normal, 29 were torn, and six were deficient. (One labrum was torn and deficient in separate locations.) MR arthrographic findings had a diagnostic sensitivity of 91% and specificity of 93%. In 32 patients with proved labral abnormalities, 30 lesions involved the labral-bicipital junction, origins of the glenohumeral ligaments, or both. In 22 of 23 shoulders considered clinically unstable, a labral abnormality involved the origin of the IGHL.

CONCLUSION

MR arthrography accurately shows the relationship of labral lesions to the origins of the glenohumeral ligaments and helps in distinction between stable and unstable lesions.

MR evaluation of rotator cuff impingement: correlation with confirmed full-thickness rotator cuff tears

OBJECTIVE

To clarify the efficacy of MRI for the evaluation of rotator cuff impingement beneath the coracoacromial arch, MRI findings were correlated with confirmed full-thickness rotator cuff tears (FTRCTs).

MATERIALS AND METHODS

Thirty-four shoulders with FTRCT and 49 control shoulders without FTRCT were selected for this study. Direct measurement of the subacromial space (SAS) and MRI grading of SAS and subacromioclavicular space (SACS) were correlated with FTRCT. In addition, the MRI impingement score (sum of SAS grade and SACS grade) was correlated with age and FTRCT.

RESULTS

Direct measurement of the SAS showed poor correlation with FTRCT. The SAS grade showed significant correlation with FTRCT; however, SACS grade showed poor correlation. Shoulders with higher MRI impingement scores were associated with FTRCT in patients over 40 years of age.

CONCLUSION

The MRI sign of rotator cuff impingement is fairly reliable and helpful in discriminating patients with FTRCT, especially older patients.

Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance

PURPOSE

To determine the relationship between labral cysts and labral tears and glenohumeral instability.

MATERIALS AND METHODS

Magnetic resonance (MR), clinical, and arthroscopic examinations of the shoulder and the surgical findings of 20 patients were correlated and retrospectively analyzed. A cystic-appearing mass adjacent to the labrum was the selection criterion for inclusion.

RESULTS

MR imaging showed labral tear intimately associated with cystic-appearing mass in these 20 patients. The tear and cyst complex was located anteriorly in two patients, posteriorly in nine, and superiorly in nine. The mass extended into the spinoglenoid notch in six patients, the suprascapular notch in three, and both notches in four. Physical examination showed glenohumeral instability in the direction of the labral tear and cystic-appearing mass in 11 patients (55%). Findings at intraarticular surgery, performed in eight patients, confirmed a labral tear with communication between the joint space and the cyst.

CONCLUSION

Glenoid labral cysts are associated with glenoid labral tears and shoulder instability.

Case report 823: Fibro-osseous pseudotumor of the scapula

A unique lesion discovered in the scapula of a 36-year-old woman is presented. The lesion has microscopic features resembling those of fibrous dysplasia and osteoid osteoma which we believe is identical to an entity previously only documented in the rib (fibro-osseous lesion of rib). We are of the opinion that the lesion probably represents a reactive response to trauma rather than a neoplasm and suggest the name of "fibro-osseous reparative pseudotumor" for this entity.

Case report 809: Squamous cell carcinoma of the skin invading the shoulder

Bone invasion by squamous cell carcinoma (SCC) is very rare in locations other than the head and neck region. The case of a 30-year-old man with slow-growing SCC of the shoulder region, aggressively invading neighboring bony structures, was presented.

Case report 803: Gorham's disease (Gorham-Stout syndrome) of scapula

In summary, a 36-year-old man presented with pain and limited motion in the shoulder. Clinical examination revealed obliteration of normal scapular landmarks in the conspicuous absence of any palpable soft tissue mass. Roentgenograms showed progressive osteolysis of the scapula. Biopsy confirmed the diagnosis of Gorham's disease. MRI played a key role in defining the extent of disease involvement and in displaying the distinct soft tissue anatomy. These MRI features are to our knowledge previously undescribed.

Giant cell tumor arising in Paget's disease of bone. Recurrences after 36 years

A 96-year-old woman had both Paget's disease and a giant cell tumor of the same bone, the left scapula. Despite five surgical procedures, a full course of radiation therapy, and treatment with salmon calcitonin, human calcitonin, and finally disodium etidronate, the tumor has recurred over a 36-year period. The characteristic viral-like nuclear and cytoplasmic inclusions found in the osteoclasts of Paget's disease were found in the tumor giant cells, in specimens excised over an eight-year period, and in specimens obtained during orthopedic procedures on her other pagetic bone lesions over 12 years.

Magnetic resonance imaging in the diagnosis of suprascapular nerve syndrome

The authors report the findings in a case of early suprascapular nerve syndrome caused by a ganglion in the spinoglenoid notch. The diagnosis was established by magnetic resonance imaging. The exquisite soft-tissue detail provided by this modality allows differentiation among many causes of shoulder pain.

Clinicopathological features of untreated fibrous hamartoma of infancy

AIM

To study the clinicopathological features of fibrous hamartoma of infancy in Nigerian children.

METHODS

Six children aged between 6 months and 10 years were studied. All specimens were stained with haemotoxylin and eosin and examined routinely. The children were followed up for between one and three years.

RESULTS

In four of the children lesions were present at birth; in the other two they appeared by the age of 1 year. Some of the children had had the lesion for between three and 10 years. All lesions were located in the subcutis. They were solitary and varied in size and shape. They had grown rapidly up to the age of 5, after which growth decelerated, but did not stop or regress. The younger the child the less clearly demarcated was the tumour on the deep surface. In the older children the capsule was more developed.

CONCLUSIONS

Fibrous hamartoma of infancy is rare, but it is important for clinicians to know that it is benign and readily amenable to treatment.

Peripheral nerve entrapment, occupation-related syndromes and sports injuries, and bursitis

A growing interest in nonarticular rheumatic conditions has been shown recently by the large number of articles published on the subject. In this review, three nerve entrapment syndromes and problems of four tendons of the ankle region are covered. Suprascapular neuropathy is underrecognized and, in many cases, may be treated conservatively. Entrapment of the radial and ulnar nerves may be caused by a variety of conditions, some of which are unusual. Tenosynovitis and rupture of the tendons of the ankle region, including the posterior tibial, anterior tibial, peroneus longus, and Achilles tendons, are reviewed.

Scapulothoracic arthrodesis in facioscapulohumeral muscular dystrophy. Review of seventeen procedures with three to twenty-one-year follow-up

The scapula was fixed to the ribs in twelve patients who had facioscapulohumeral muscular dystrophy, in order to provide stability for activities involving the upper limbs. The duration of follow-up ranged from three to twenty-one years. Abduction, in 30 degrees of flexion, improved an average of 60 degrees, and gains in strength for carrying and lifting were reported by the patients. Complications included a brachial plexus palsy, which resolved, and a frozen shoulder. All of the patients but one were pleased with the result.

The influence of variations of the coracoacromial arch on the development of rotator cuff tears

In order to define the geometry of the coracoacromial arch in both its bony and soft parts and to bring it into relationship with rotator cuff tears, 54 cadaver shoulders (from subjects aged 47-90 years) were dissected and X-rayed (anteroposterior projection and supraspinatus outlet view). Partial rotator cuff tears were assessed additionally by transillumination and polarized microscopy. After transfixation of the coracoacromial arch with a polyurethane mould, sections were made along the coracoacromial ligament. The morphology of the acromion was described following the classification of Bigliani et al. [5]. Amongst other parameters, measurements were taken between the long axis of the scapula, the spina, and the acromion. In 19 of 22 cases, a traction osteophyte was associated with rotator cuff tears. In incomplete tears, spurs were completely encased within the ligament and did not impair the subacromial space. The number of rotator cuff tears was significantly increased in shoulders with "curved" acromia, flat acromial slope, and increased angle between the scapular plane and the spina (intact, mean 58 degrees; tears, mean 47 degrees). The morphology of the subacromial space was secondarily determined by this angle. In contrast to Bigliani et al. we were unable to find a "hooked" acromion. These results indicate that the combination of a flat and curved acromion or a position of the acromioclavicular joint above the cranial pole of the glenoid must be regarded as considerable risks for the development of rotator cuff tears. The concept of anterior acromioplasty is supported by our results.

Shoulder-arm-syndrome after radical neck dissection: its relation with the innervation of the trapezius muscle

In a clinical and electromyographic follow-up of 54 patients who underwent radical neck dissection, vast differences in the individual severity of the shoulder-arm-syndrome were found: 31% experienced severe limitations of shoulder mobility combined with severe pain, whereas 41% suffered only mild discomfort and 28% were free of complaints. These clinical findings were compared to recent anatomical observations concerning individual patterns of innervation of the trapezius muscle. It could be shown that the role of the cervical plexus in the innervation of the trapezius muscle is of great importance and that its subfascial branches are able to maintain the motor supply following radical neck dissection in about 2/3 of patients.

Anatomy of the coraco-acromial arch. Relation to degeneration of the acromion

We examined 200 scapular bones for signs of degenerative changes in the coraco-acromial arch. The slope and length of the acromion and the height of the arch were found to be most closely associated with degenerative change. These anatomical features are not significantly altered by current techniques of subacromial decompression.