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The detoid extension lag sign a sensitive an specific sign for axillary nerve palsy
J. Shoulder Elbow Surg. January/February 1995
$48 Abstracts
SUBACROMIAL BURSA AS A REPAIRING FACTOR AT THE ROTATOR CUFF PATHOLOGY. A HISTOMORFOLOGIC STUDY. J. Armengol, C. Ardiaca *. G. Oliver and R. Barjau. Servei de Cirugia Ortopedica Traumatologia. Hospital de Bellvitge. *Quinta de Salut "la Alian(;a". Barcelona, Espanya. The histomorfology of twuenty bursas were studied in patients who had complete ruptures of the rotator cuff and underwent surgical repair. Through the procedure we took bursas from two places: 1- From an area with no evidence of cuff pathology but placed at the impingement area. 2- The second sample was harvested from an area just arround the edges of the torn cuff. Three samples as baseline examples were included in the study is to evaluate the histomorfologic differences between both areas. In ever}, case we recogniced histomorfologic differences between both areas studied and by comparing with control cases. The histomorfologic character of bursa from area 1 showed marked oedema0 stellate fibroblastes and hyaline fibrosis. At area 2 we found two well differenciated types of bursas: thouse around of not massive ruptures had synoviocitic hyperplasia, endothelial cell proliferation, oedema, lynphocytes, and neovascularization. Interestingly some masswe ruptures showed a pattern markedly necrotic with interstitial hemorrhage coagulative necrosis and stromal hyalinization. We conclude that in non massive ruptures and intensive reparative process is coming up from bursa and leave it on the suture may have a protective role. But in massive lessions if repaired, the histomorfologic picture of the bursa does not let us to rely on it as in the non massive.
118
THE DETOID EXTENSION LAG SIGN A SENSITIVE AN SPECIFIC SIGN FOR AXlLLARY NERVE PALSY R. Hertel M.D., F. Ballmer M.D., Upper Extremity Unit Department of Orthopedic Surgery Inselspital, University of Berne, Switzerland
Diagnosis of axillary nerve palsy is based on loss of sensation in the corresponding dermatoma and loss of deltoid function. Unfortunately compensation mechanisms by the rotator cuff can mask the deltoid disfunction. To overcome this problem we evaluated the new sign on 8 patients with posttraumatic deltoid palsy. The sign is tested with the patient sitting on the examination table. The examinator stands behind the patient and pulls the arm in full passive extension, carefully avoiding hyperextension. The patient is then asked to actively maintain this position. The sign is positive if the arm cannot be hold in the given position. The magnitude of the lag is recorded. The sign was positive in all complete and partial axillary nerve palsies. False positive or false negative signs did not occur. The sign could not be tested when passive extension range of motion was limited. The extension lag sign was more sensitive and more specific than the measurement of abduction power. Palpation of mucle fiber contractility was somewhat uncertain in the early and intermediate recovery phase, beeing masked by the activity of adiacent scapulo-humeral muscles The degree of the angular drop affords a reproducible and objective value which was very helpfull in the clinical followup of a recovering axillary nerve palsy.
$48 Abstracts
SUBACROMIAL BURSA AS A REPAIRING FACTOR AT THE ROTATOR CUFF PATHOLOGY. A HISTOMORFOLOGIC STUDY. J. Armengol, C. Ardiaca *. G. Oliver and R. Barjau. Servei de Cirugia Ortopedica Traumatologia. Hospital de Bellvitge. *Quinta de Salut "la Alian(;a". Barcelona, Espanya. The histomorfology of twuenty bursas were studied in patients who had complete ruptures of the rotator cuff and underwent surgical repair. Through the procedure we took bursas from two places: 1- From an area with no evidence of cuff pathology but placed at the impingement area. 2- The second sample was harvested from an area just arround the edges of the torn cuff. Three samples as baseline examples were included in the study is to evaluate the histomorfologic differences between both areas. In ever}, case we recogniced histomorfologic differences between both areas studied and by comparing with control cases. The histomorfologic character of bursa from area 1 showed marked oedema0 stellate fibroblastes and hyaline fibrosis. At area 2 we found two well differenciated types of bursas: thouse around of not massive ruptures had synoviocitic hyperplasia, endothelial cell proliferation, oedema, lynphocytes, and neovascularization. Interestingly some masswe ruptures showed a pattern markedly necrotic with interstitial hemorrhage coagulative necrosis and stromal hyalinization. We conclude that in non massive ruptures and intensive reparative process is coming up from bursa and leave it on the suture may have a protective role. But in massive lessions if repaired, the histomorfologic picture of the bursa does not let us to rely on it as in the non massive.
118
THE DETOID EXTENSION LAG SIGN A SENSITIVE AN SPECIFIC SIGN FOR AXlLLARY NERVE PALSY R. Hertel M.D., F. Ballmer M.D., Upper Extremity Unit Department of Orthopedic Surgery Inselspital, University of Berne, Switzerland
Diagnosis of axillary nerve palsy is based on loss of sensation in the corresponding dermatoma and loss of deltoid function. Unfortunately compensation mechanisms by the rotator cuff can mask the deltoid disfunction. To overcome this problem we evaluated the new sign on 8 patients with posttraumatic deltoid palsy. The sign is tested with the patient sitting on the examination table. The examinator stands behind the patient and pulls the arm in full passive extension, carefully avoiding hyperextension. The patient is then asked to actively maintain this position. The sign is positive if the arm cannot be hold in the given position. The magnitude of the lag is recorded. The sign was positive in all complete and partial axillary nerve palsies. False positive or false negative signs did not occur. The sign could not be tested when passive extension range of motion was limited. The extension lag sign was more sensitive and more specific than the measurement of abduction power. Palpation of mucle fiber contractility was somewhat uncertain in the early and intermediate recovery phase, beeing masked by the activity of adiacent scapulo-humeral muscles The degree of the angular drop affords a reproducible and objective value which was very helpfull in the clinical followup of a recovering axillary nerve palsy.