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Shoulder pain.

A review of conditions producing shoulder pain in the adult indicates the diverse nature of the various processes. Particularly important are diseases leading to articular abnormalities of the glenohumeral, acromioclavicular, and sternoclavicular articulations as well as surrounding structures such as the rotator cuff. Accurate diagnosis of the conditions requires careful radiographic examination supplemented with specialized techniques, including fluoroscopy, arthrography, and conventional or computed tomography.

Acromioclavicular Joint↗

Diagnosis of post-traumatic syringohydromyelia presenting as neuropathic joints. Report of two cases and review of the literature.

Two paraplegic men with post-traumatic syringohydromyelia presented initially with neuropathic arthropathy of the elbow and shoulder, respectively. Both patients had sustained spinal trauma years earlier and had been lost to orthopedic and neurosurgical follow-up study. Characteristic history and physical findings were present in both patients. Conventional myelography failed to demonstrate the lesion in the first patient. The diagnosis in the second patient was confirmed by lumbar injection of low-dose metrizamide followed by immediate and delayed computerized axial tomography in the supine and lateral positions. Both patients were treated by surgical decompression and subarachnoid shunts with arrest of the neurologic deterioration. To the authors' knowledge, this is the first report of patients with post-traumatic syringohydromyelia presenting with neuropathic joints. The present case reports illustrate the need for long-term follow-up studies of patients with spine injury in specialty clinics. The use of computerized axial tomography and low-dose intrathecal metrizamide is advocated for diagnosing post-traumatic syringohydromyelia.

Adult↗

Tears of the rotator cuff.

The diagnosis of a torn rotator cuff can be readily established by arthrography. It must be suspected in any patient with should pain with or without a history of injury. Under circumstances in which spontaneous healing cannot be expected, early surgical repair should provide consistent satisfactory results. Late reconstruction now can yield good results with either the free biceps graft or the freeze dried cadaver graft.

Humans↗