Deltoid contracture: MR imaging features

Surgical results of concomitant treatment of deltoid contracture and rotator cuff tear

BACKGROUND

Contracture of the deltoid muscle is an uncommon disorder. The symptoms usually are nonspecific and the diagnosis may be missed, especially when combined with other shoulder disorders, such as rotator cuff lesions. Few reports have described the surgical treatment of combined deltoid contracture and a torn rotator cuff. The purpose of this study was to share our experiences in the diagnosis and treatment of patients, who sustained deltoid contracture combined with rotator cuff tearing.

MATERIALS AND METHODS

Between April 2001 and December 2006, 18 consecutive patients underwent concomitant treatment for distal release of deltoid contracture and repair of a torn rotator cuff. The mean age at operation was 55.1 years. There were eight female and ten male patients. The acromial type, winging angle of the scapula and thickest diameter of the deltoid fibrotic band were measured using preoperative magnetic resonance imaging studies. The abduction-contracture angle, extension-contracture angle, horizontal-adduction angle and Constant and Murley scores were measured preoperatively and at the latest follow-up.

RESULTS

There were nine complete rotator cuff tears and nine partial tears. At an average of 5 years and 3 months' follow-up, the mean abduction-contracture angle significantly improved from 27° to 0° (p<0.001), the mean extension-contracture angle improved from 13° to 0° (p<0.001), and, the mean horizontal-adduction angle improved from 8° to 44° (p<0.001). The mean Constant score also improved from 69 points to 95 points (p<0.001).

CONCLUSIONS

If a symptomatic torn rotator cuff and deltoid contracture co-exist, simultaneous operative treatment of both conditions is highly recommended.

Deltoid contracture mimicking shoulder dislocation in a 7-year-old boy

Contracture of the deltoid muscle, a relatively uncommon disorder in children, can be caused by repeated intramuscular injection, trauma, or congenital disease. The typical clinical manifestations of deltoid contracture (i.e., a palpable fibrous cord within the deltoid muscle, abduction contracture of the shoulder, winged scapula, and skin dimpling over the fibrous bands), however, may be atypical or even lacking, thus, leading to misdiagnosis. The procedure going from misdiagnosis to recognition of the correct diagnosis is reviewed in a 7-year-old boy with deltoid contracture.

Role of intrinsic muscle atrophy in the etiology of claw toe deformity in diabetic neuropathy may not be as straightforward as widely believed

OBJECTIVE

Clawing of the toes in the diabetic neuropathic foot is believed to be caused by muscle imbalance resulting from intrinsic muscle atrophy. However, experimental data that support this mechanism are lacking. The aim of this study was to evaluate this hypothesis using magnetic resonance imaging (MRI).

RESEARCH DESIGN AND METHODS

In 20 neuropathic diabetic patients, 10 with claw toe deformity and 10 with normally aligned toes, multiple plane images of the foot and lower leg were acquired using T1-weighted spin-echo MRI. Atrophy of the intrinsic and extrinsic muscles controlling the toes was assessed using a semiquantitative 5-point atrophy scale. An intrinsic-to-extrinsic foot muscle imbalance score was derived from these atrophy scores, and correlation coefficients were established.

RESULTS

The mean +/- SD intrinsic muscle atrophy score was 3.1 +/- 1.1 for the toe deformity group and 2.6 +/- 1.2 for the non-deformity group (not significantly different). The intrinsic muscle atrophy score was not significantly correlated with degree of toe deformity (r = -0.18). The muscle imbalance score was not significantly different between study groups and was not significantly correlated with degree of toe deformity (r = -0.14).

CONCLUSIONS

Neither intrinsic muscle atrophy nor muscle imbalance discriminated between neuropathic patients with or without claw toe deformity, suggesting that the role of these muscle factors in claw toe development may not be primary or as straightforward as previously believed. These findings shed new light on the etiology of foot deformity in diabetes and suggest a more complex nature of development, potentially involving anatomical and physiological predisposing factors.

Deltoid contracture: a case with multiple muscle contractures

Deltoid contracture is relatively uncommon. The literature consists primarily of case reports and few articles on large case series. The pathogenesis has been well studied. Muscle contractures can occur in the deltoid, biceps, triceps, gluteus and quadriceps muscles; however, cases of multiple muscle contractures are rare. We reported a patient with multiple contractures of the bilateral deltoid, bilateral gluteus, and bilateral quadriceps muscles, who had received repeated intramuscular injections during childhood and adulthood. The radiographic, including magnetic resonance imaging (MRI), features of the bone and joint abnormalities are presented. Some literatures reported that damage to the structures of the body due to intramuscular injection is related to the site of injection, age of the patient, and the volume, pH, chemical composition, and diffusional capacity of the injectate. Our patient had muscular contracture induced by needle injection regardless of her age, medication and injection site.

Fibrous deltoid muscle in Vietnamese children

To evaluate the clinical and functional results of surgical treatment for fibrous deltoid muscle in children, a retrospective study has been undertaken. The data were analysed on 105 patients with age over 5 years (182 shoulders) from August 1994 to December 2004. Surgical techniques performed by the author were divided into four types: (i) type I, proximal release of intermediate portion of deltoid muscle; (ii) type II, distal release of intermediate portion of deltoid muscle; (iii) type III, lengthening of intermediate portion of deltoid muscle; and (iv) type IV, distal release of intermediate portion of deltoid muscle and transfer of posterior portion of deltoid muscle to fill the gap. Accordingly, clinical and functional results were compared among four groups. The average duration of follow-up was 3 years and 2 months (range, 2-9 years and 5 months). Overall, in 174 shoulders (95.6%, 99 patients), we had a good clinical result; in two shoulders (1.1%, two patients) a fair result; and poor result in only six shoulders (3.3%, four patients). Postoperative formation of stairstep deformity or loss of roundness of the lateral aspect of shoulder in type I: 46.2%; type II: 30.3%; type III: 16.7%; type IV: 4.3%. Generally, surgical treatment gave good results. Technique type IV had reduced rate of stairstep deformity or loss of the natural roundness of the lateral aspect of the shoulder muscle. Sixty-eight patients (98.6%) in this group achieved a satisfactory outcome.

Imaging Factors Related to Rotator Cuff Tear in Patients with Deltoid Contracture

BACKGROUND

Bony deformity and muscular malfunction around the shoulder induced by deltoid contracture may influence rotator cuff function and lead to subsequent tearing. The purpose of this study was to investigate the imaging and clinical factors related to rotator cuff tear in patients with deltoid contracture.

METHODS

We retrospectively reviewed 48 shoulders in 44 patients with magnetic resonance imaging diagnosis of deltoid contracture and surgically-proven rotator cuff tear. These shoulders were subdivided into partial-thickness and full-thickness tear groups. Another 17 shoulders in 17 patients with deltoid contracture but no evident rotator cuff tear were included as the control group. The characteristics, including age, gender and imaging features, of these three groups were compared.

RESULTS

Two patients who underwent initial operations for cuff tears required secondary operations for distal release of deltoid contracture. The age of patients with full-thickness tear was significantly greater than that of patients with partial-thickness tear or without tear. The winging angle of the glenoid (WAG) in the full-thickness tear group was significantly greater than that in the partial-thickness tear group. Patients with partial-thickness tear also had greater WAG than those without tear. However, WAG was not significantly correlated with the fibrotic size or age of the patient.

CONCLUSION

In patients with deltoid contracture, age and WAG are associated with the development of rotator cuff tear. To prevent the occurrence of rotator cuff tear, early surgical release of deltoid contracture is highly recommended, especially in patients with greater WAG.

Contracture of the Deltoid Muscle: Sonographic Evaluation with MRI Correlation

OBJECTIVE

This article evaluates the sonographic features of deltoid contracture (DC) with MRI correlation.

MATERIAL AND METHODS

Two reviewers evaluated the imaging features in 22 painful shoulders of 20 patients with a sonographic diagnosis of DC and a subsequent confirming MRI study. The sonographic and MRI findings with regard to the lesion extent (assessed by a 3-point scale: 1 = less than or equal to one third of the longitudinal deltoid length involved, 2 = greater than one third and less than or equal to two thirds involved, and 3 = greater than two thirds involved), transverse lesion morphologic appearance, and maximal transverse diameter measured were compared with kappa statistics and Wilcoxon's signed rank test, respectively.

RESULTS

Compared with MRI, there were two false-positive diagnoses of DC on sonography. Among the 20 true-positive diagnoses, sonography showed good agreement with MRI in assessing the lesion extent (kappa = 0.796, p < 0.001). Three sonographic lesion morphologic patterns for hyperechoic lesions (I = with multiple < 8-mm hypoechoic spots, II = heteroechoic lesions with predominant 8-15-mm hypointense areas, and III = > 15-mm calcified nodules, respectively) showed excellent agreement with three MRI lesion patterns (I = multiple < 8-mm hypointense spots, II = predominant 8-15-mm hypointense areas, and III = > 15-mm hypointense nodules, respectively) (kappa = 0.921, p < 0.001). However, the maximum lesion diameters appeared significantly larger on sonography than on MRI (2.8 +/- 0.6 cm vs 2.0 +/- 0.8 cm, mean +/- SD; p < 0.001), which was plausibly ascribed to the better sonographic delineation of hyperechoic immature fibrotic tissues.

CONCLUSION

Sonography is helpful for evaluating DC and correlates well with MRI.