[THE BIOPSY OF THE DELTOID MUSCLE IN CHRONIC CHAGASIC MYOCARDITIS. ADDITIONAL OBSERVATIONS IN 3 ACUTE CASES].
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Three patients with four affected shoulders with spontaneous detachment of the deltoid origin are reported. In this group spontaneous detachment of the deltoid origin was associated with chronic massive rotator cuff defects. Detachment of the deltoid origin was associated with an acute, sudden onset of shoulder weakness. Pain was not a prominent complaint, and shoulder function was poor because of weakness. Spontaneous detachment of the deltoid origin can occur with chronic massive rotator cuff tears and can be responsible for an acute onset of shoulder weakness.
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.
The purpose of this study was to examine the differences in activation levels and times of activation for the pectoralis major and anterior deltoid when performing the concentric phase of 3 upper-body lifts. Twelve college-age men and women with various degrees of lifting experience performed 3 repetitions using the 6 repetition maximum in a barbell bench press, dumbbell bench press, and dumbbell fly while being monitored for electromyographic activity in both muscles. Motor unit activation of both muscles was not significantly different during all 3 lifts. However, dumbbell flys had significantly less relative time of activation than did barbell or dumbbell bench presses. Therefore, dumbbell flys may be better suited as an auxiliary lift, whereas barbell and dumbbell bench presses may be used interchangeably in training programs. The compatibility of the barbell and dumbbell bench presses may aid lifters in overcoming training plateaus by alternating exercises for the same muscle groups.
The course of the axillary n. is complex with three points of angulation that may be used to delineate four segments and a fifth segment that corresponds to the intramuscular ending of the nerve in the deltoid m. The purpose of this study was to determine the precise anatomy of the nerve and of its branches, and some morphologic features for each segment. Thirty-two shoulders from embalmed adult cadavers have been studied. The axillary n. was divided in five segments: 1) from its origin to the inferior border of the subscapularis m., 2) from the subscapularis m. to the anterolateral border of the tendon of the long head of the triceps brachii m., 3) from the triceps to the posteromedial part of the surgical neck of the humerus, 4) from the humerus to the entry into the deltoid m., 5) the intramuscular distribution of the nerve in the deltoid m. In each segment from 1 to 4 were noted the origins of the branches to the subscapularis and teres minor mm. and to the scapulohumeral joint, and the origins of the lateral cutaneous branchial n. and of the terminal motor branches to the deltoid m. The length and the diameter of the nerve in the segments and the distance from the segment S1 to the musculotendinous junction of the subscapularis m. were measured. The results showed that the mean diameters were about 4.1 mm in segment 1, 4.1 mm in segment 2 and 3.4 mm in segment 3. The mean distance to the musculotendinous junction was 7.7 mm. Many variations in the levels of origin of the different muscular, articular or cutaneous branches were found without symmetry between the right and left sides. The lateral cutaneous brachial n. was absent in four cases. The results are compared with those in the literature. The division into five segments is proposed to radiologists and surgeons for evaluation or operative procedures on the axillary n., and to provide a hypothesis about the variable aspects of injuries of the nerve.
AIM: The functional long-term results of reconstructions of massive rotator cuff tears (Bateman IV) were evaluated and analyzed. METHODS: 38 patients (6 female/32 male) had a clinical and sonographical assessment and an evaluation of the Constant score after a follow-up of 81 (60 - 160) months. Operative procedures were direct transosseous refixation in 16, local tendon shifts in 17 and deltoid flaps in 5 patients. RESULTS: The average age and sex related Constant score was 77 %. The 5 patients with the deltoid flap achieved a Constant score of 60 %, all had a sonographically detected re-tear and 4 of them rated their result as only moderate. 25/33 patients with reconstruction (76 %) rated their result as good or excellent, 5 (15 %) as satisfactory, 1 (3 %) as moderate and 2 (6 %) as poor. 12 (36 %) of the 33 patients met the sonographic criteria of a re-tear. These patients had a Constant score of 71 %, whereas 21 (64 %) patients with intact reconstruction achieved a score of 85 %. CONCLUSION: The reconstruction of massive rotator cuff tears achieves good clinical long-term results if the tendons remain intact. But even with a recurrent defect, the results have been better than in patients treated with a deltoid flap. In massive rotator cuff tears a thorough selection of the operative procedure regarding atrophy and fatty infiltration of the rotator cuff muscles as well as the tendon retraction and quality is mandatory.
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The results of this study demonstrate that standard techniques of conducting cardiopulmonary bypass produce low muscle oxygen and high muscle carbon dioxide tensions and, thus, little perfusion of skeletal muscle. Our findings also show that PmO2 and PmCO2 do not return to pre-bypass levels until the mean arterial blood pressure exceeds 12 kPa (90 torr) during bypass and that utilization of vasopressor drugs during bypass maintains the pressure; but at the expense of muscle blood flow. The data indicate that both high mean blood pressure and high flow are necessary during bypass to ensure skeletal muscle perfusion and suggest, when combined with preliminary animal findings, that this type of bypass perfusion may prove to be superior to standard techniques in hastening recovery after cardio-pulmonary bypass.
The results of this study demonstrate that skeletal muscle perfusion during bypass requires high flows and mean arterial pressures and that use of vasopressors during bypass impairs skeletal muscle blood flow. Our findings also indicate that skeletal muscle perfusion during bypass decreases metabolic acidosis after operation and prevents decreases in body temperature and poor skeletal muscle blood flow in the post-bypass and early postoperative periods. Our results suggest that perfusing to maintain normal Pmo2 during extracorporeal circulation is superior to more conventional techniques of conducting bypass.
We studied 25 patients who underwent an arthroscopic examination of the shoulder and in whom 20 had an arthroscopic acromioplasty. In all patients there was extravasation of fluid due to the use of pressure irrigation. The pressures rose from a baseline of 12 mm up as high as 120 mm of mercury. Within 4 min of the procedure, the pressures had returned to the baseline. No patients showed evidence of muscle damage during electromyograms done at 4-6 weeks postoperatively. Pressure irrigation appears to be safe for subacromial decompression.
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Skeletal muscles are rare metastatic sites despite their rich blood supply and the fact that the muscular mass of the body accounts for a large percentage of the total body weight. They account for less than 1% of all malignant metastases of haematogenous origin. Menard and Parache, Ann Med Interne Paris 1991;142:423-428. Skeletal muscle metastasis in cervical cancer have been infrequently reported. In this case report, we detail a case of cervical cancer who developed a painful swelling of the right shoulder which on investigation, was found to be skeletal muscle metastases.
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