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[Diagnostic value of morphological change observed by ultrasonography from skin surface in patients with cervical esophagus carcinoma].

The ultrasonography of cervical esophagus from skin surface was performed in 35 healthy adults (HA) and 46 patients with esophageal carcinoma which consisted of upper segment (USEC, n = 24) and lower one (LSEC, n = 22) divided by the level of sternoclavicular joint. The changes of the thickness of anterior wall and the luminal dimensions in the upper region were observed before and after phonating, respectively. The wall of HA was less than 2mm in thickness and became markedly thick after phonation (P < 0.05); meanwhile the lumen was evidently dilated (P < 0.01). USEC showed an irregular wall which was more than 4mm and not altered with phonation (P > 0.05). The significant differences of the above two morphologic alterations existed between HA and USEC respectively (P < 0.05 or P < 0.01). The results of LSEC were similar to HA (P > 0.05). We, therefore, establish standards for abnormal cervical esophagus to assist in the diagnosis of cervical esophageal carcinoma.

Adult↗

Dislocations in the upper limb. Traps, tricks and treatment.

Dislocations in the upper limb are not always straightforward--they are often poorly diagnosed and managed. Careful examination to detect the total injury and awareness of the pitfalls should ensure that mistakes are avoided.

Acromioclavicular Joint↗

Sapho syndrome with femoral hyperostosis. Two case-reports.

A characteristic manifestation of SAPHO syndrome is hyperostosis, which most typically affects the sternoclavicular joints. Two cases of SAPHO syndrome with painful hyperostosis of the femur are reported. This misleading localization can lead to delays in the diagnosis and treatment.

Adult↗

Reactive arthritis induced by tonsillitis.

We describe 13 adult patients with reactive arthritis induced by tonsillitis. Arthritis occurred 710 days after tonsillitis and involved the wrists, knees, feet and sternoclavicular joints. Some cases had pain in the Achilles tendon areas. Synovial fluid examined in 4 patients was sterile. All patients except 3 showed unequivocal elevation of serum ASO and/or ASK. Streptococcus was isolated from tonsillar swabs in 7 patients. One had maculopapular erythema and 2 had abdominal pain of unknown origin, but none had cardiac involvement, chorea and subcutaneous nodule. HLA examination revealed that 4 had B39 (p <0.005). Eight cases were treated with antibiotics. Five cases underwent tonsillectomy. All tonsils had cryptic abscess. No exacerbation was seen thereafter. These cases probably represent reactive arthritis induced by tonsillitis and should be distinguished from other rheumatic diseases.

Adult↗

[Imaging of osteoarticular diseases of the anterior chest wall].

The purpose of this paper is to present a pictorial display of osseous and articular lesions of the anterior chest wall. The role of CT and MR imaging in such disorders is emphasized. Imaging of the anterior thoracic wall by plain films is particularly difficult. However numerous disorders may be encountered. They include inflammatory hyperostosis and sclerosis of the clavicle and the sternum, condensing osteitis and post-traumatic osteolysis of the clavicle, radiation osteitis of the sternum and the ribs, septic arthritis of the sternoclavicular joint, primary and secondary tumors of the sternum and the ribs. We illustrate a spectrum of such lesions in which CT and MR imaging provides acute evaluation of both soft tissue and bone details.

Clavicle↗

Pitfalls in the radiologic evaluation of extremity trauma: Part I. The upper extremity.

Family physicians often are required to evaluate patients who present with acute skeletal trauma. The first of this two-part series discusses the features and evaluation of some commonly missed fractures and dislocations of the upper limb, excluding the hand. Dislocations of the sternoclavicular joint are infrequent and often missed. Clavicular fractures in adults usually are not hard to diagnose. Acromioclavicular joint dislocations represent about 10 percent of all dislocation injuries to the shoulder girdle. Forty percent of all dislocations occur at the glenohumeral joint. Scapular fractures are often a result of significant force. Multiple views should be obtained in adults with a suspected fracture of the elbow. Complications in fractures of the wrist are strongly related to the location of the fracture.

Acromioclavicular Joint↗

Functional morphology of forelimb joints in the woolly monkey Lagothrix lagothricha.

This gross anatomical study of embalmed forelimb joints of the South American woolly monkey Lagothrix lagothricha focuses on the problem of determining in osteoligamentous preparations how the disposition of the capsular apparatus and the geometry of the articular surfaces govern the amount and types of movement permitted at a joint, and then correlates these findings with the use of the forelimb in the positional capabilities of captive wooly monkeys observed by this author. Data collection was by dissection, quantitative range of motion studies on osteoligamentous preparations, and by qualitative manipulations of these preparations and of disarticulated bones. Supplemental evidence was obtained from radiographs and from an estimate of angular values of articular surfaces. Presented for the shoulder, elbow, radioulnar, and hand joint complexes are the functional anatomy of the capsular apparatus and articular surfaces, the quantitative range of motion data, and proposed mechanisms of movement that combine the functional morphology with the observed use of the forelimb in activities by the animal. The structurofunctional framework of MacConaill is the basis for the joint analysis. The evidence suggests that the functional anatomy of these joints correlates well with the possible positional capabilities of Lagothrix. The morphology of the capsular apparatus and joint surfaces reflect both the arboreal quadrupedalism and forelimb suspension of the woolly monkey. The positions of maximum congruency and close-pack approximate the forelimb's weight-bearing stance during palmigrade arboreal quadrupedalism. During forelimb suspension, the taut and twisted capsular apparatus of close-packed joints maintains the integrity of forelimb links in tension. This is the first known report of the internal band of the collateral ligament of the proximal interphalangeal joints of the second through fifth digits being incorporated into the terminal tendon of the extensor assembly. This author believes this is a mechanism not only for maintaining the integrity of these joints during forelimb suspensory activities when the body is supported by the middle phalanges, but also for helping to coordinate the flexion-extension actions of the phalanges for smooth grasping and release maneuvers in an arboreal environment. When sufficient comparative data have been collected, such correlations of the functional morphology of joints with positional behavior may be used to postulate positional capabilities of fossil primates.

Acromioclavicular Joint↗

Shoulder problems of adolescents. How they differ from those of adults.

The adolescent athlete with an open epiphyseal plate presents with different shoulder problems than does the adult. Most shoulder injuries in the adolescent athlete can be treated conservatively with a good prognosis for full return of function. The exception is a glenohumeral dislocation, which will probably recur and need a surgical reconstruction.

Acromioclavicular Joint↗

Functional anatomy of the shoulder complex.

Recent research findings are incorporated in this review of the functional anatomy of the shoulder complex. The scapulothoracic mechanism is described, including a review of scapular motion and the structure and function of the sternoclavicular and acromioclavicular joints. New information regarding the resting position of the scapula on the thorax and the effect of aging and spinal posture on position has been presented. In the second part of the paper, the anatomy of the glenohumeral joint is reviewed, with emphasis on the articular, periarticular, and muscular mechanisms responsible for stability of this articulation. The article concludes with a discussion of the integrated function of the scapulothoracic and glenohumeral articulations in upper extremity elevation.

Acromioclavicular Joint↗

Sternoclavicular grafts for temporomandibular joint reconstruction.

This study evaluated the long-term outcomes of 52 sternoclavicular grafts for temporomandibular joint (TMJ) reconstruction in 38 patients. Patients were divided into three groups according to preoperative diagnosis and evaluated an average of 45 months (range, 10 to 84 months) postsurgery. Group 1 consisted of 14 patients (24 joints) with previous Proplast/Teflon implants (P/T; Vitek, Inc, Houston, TX;); successful reconstruction was achieved in only four patients (29%) and seven joints (29%). Group 2 included 10 patients (14 joints) with inflammatory TMJ pathology (non-P/T); success occurred in five patients (50%) and eight joints (57%). Group 3 consisted of 14 patients (14 joints) with non-P/T and noninflammatory TMJ pathology. Success in this group occurred in 13 patients (93%) and 13 joints (93%), with only one failure. The results of this study support the use of the sternoclavicular graft for TMJ reconstruction in a select group of patients and demonstrate a high failure rate in patients with previous P/T implants.

Adolescent↗

The painful shoulder: diagnosis and treatment.

The shoulder is one of the most complex joints in the body requiring coordinated, functioning muscles and joints to have a fluid, rhythmic motion. The shoulder consists of the glenohumeral (GH) joint, the acromioclavicular (AC) joint, the scapulothoracic (ST) joint, and the sternoclavicular (SC) joint. This article will examine the shoulder anatomy, clinical syndromes, and treatment for common shoulder disorders.

Humans↗