Bilateral snapping triceps syndrome:A case report

BACKGROUND Snapping triceps syndrome(STS)is a rare disease,while occurrence of bilateral STS is extremely rare.It is usually accompanied by dislocation of the ulnar nerve and double snapping is a clinically important feature.However,to the best of our knowledge,there has been no report of bilateral STS in young active patient.CASE SUMMARY A 23-year-old male presented with a complaint of discomfort and snapping on the medial side of both elbows while performing push-ups.On physical examination,two distinct snaps that were both palpable and audible were detected on additional clinical examination.Dynamic ultrasonography showed that the ulnar nerve and the medial head of the triceps were dislocated anteriorly over the medial epicondyle of the elbow during flexion motion.Finally,he was diagnosed as dislocation of the ulnar nerve and STS.Staged anterior subcutaneous transposition of the ulnar nerve combined with partial resection of the snapping portion of the triceps was performed.The patient’s pain and snapping symptoms were resolved immediately after surgery.Three months later,the patient was completely asymptomatic and returned to normal activity.CONCLUSION STS should be included in the differential diagnosis for active young patients who present with painful snapping on the medial side of the elbow joint,particularly when dislocation of the ulnar nerve is detected.Dynamic sonography is used to assist in accurate diagnosis and differentiation between isolated dislocation of the ulnar nerve and STS.

Bilateral dislocation of the long head of biceps tendon with intact rotator cuff tendon:A case report

BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.However,to the best of our knowledge,there has been no report of bilateral dislocation of the LHBT without rotator cuff pathology.CASE SUMMARY A 23-year-old male presented to our outpatient clinic with left side dominant pain in both shoulders.The patient had no history of trauma or overuse.The patient underwent intra-articular injection and physical therapy,but his symptoms aggravated.Based on preoperative imaging,the diagnosis was bilateral dislocation of the LHBT.Dysplasia of the bicipital groove was detected in both shoulders.Active dislocation of the biceps tendon over an intact subscapularis tendon was identified by diagnostic arthroscopy.Staged biceps tenodesis was performed and continuous passive motion therapy was administered immediately after surgery.The patient’s pain was resolved,and full functional recovery was achieved,and he was satisfied with the condition of his shoulders.CONCLUSION This study describes a rare case of bilateral dislocations of the LHBT without rotator cuff injury due to dysplasia of the bicipital groove.

Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report

BACKGROUND Acromial and scapular spine fractures after reverse total shoulder arthroplasty(RTSA)are a well-known complication that may negatively impact the effects of long-term outcomes.However,to the best of our knowledge,there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA.CASE SUMMARY A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration.Based on plain radiographs and magnetic resonance images,the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair.This patient was treated with staged bilateral RTSA at a two-month interval.At 5 and 3 mo after right and left side surgery,the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event.A computed tomography scan revealed nondisplaced acromial base fractures of both shoulders.Considering bilateral involvement,fracture location,and patient’s demand,open reduction and internal fixation(ORIF)using plate for bilateral acromial base fractures were performed.At 2 years after ORIF,the fracture was completely healed,and the patient was satisfied with shoulder status.CONCLUSION This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a precontoured plate designed for distal clavicle fractures.Although acromial fracture after RTSA can be treated conservatively,simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

Knot impingement after arthroscopic rotator cuff repair mimicking infection:A case report

BACKGROUND Knot impingement as a complication after arthroscopic rotator cuff repair(ARCR)has been suggested as a cause of persistent pain with limited motion.We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion,which was confused with infection.CASE SUMMARY A 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room.Passive range of motion could not be evaluated due to the patient’s severe pain.The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder.An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder,and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging.Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils.The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed.Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials.The patient’s symptoms subsided immediately after the surgical procedure.CONCLUSION Although the incidence of knot impingement is rare,the possibility of knot impingement after ARCR should be a consideration.

Development of real-time onion disease monitoring system using image acquisition

In this study, real-time disease monitoring was conducted on onion which is the most representative crop in Republic of Korea, using an image acquisition system newly developed for the mobile measurement of phenotype. The purpose of this study was to improve the accuracy of prediction of disease and state variables by processing images acquired from monitoring. The image acquisition system was consisted of two parts, a motorized driving system and a PTZ(pan, tilt and zoom) camera to take images of the plants. The acquired images were processed as follows. Noise was removed through an image filter and RGB(red, green and blue) colors were converted to HSV(hue, saturation and value), which enabled thresholding of areas with different colors and properties for image binarization by comparing the color of onion leaf with ambient areas. Four objects with the most significant browning in the onion leaf to the naked eye were selected as the samples for data acquired. The thresholding method with image processing was found to be superior to the naked eye in identifying accurate disease areas. In addition, it was found that the incidence of disease was different in each disease area ratio. As a result, the use of image acquisition system in image processing analysis will enable more prompt detection of any changes in the onion and monitoring of disease outbreaks during the crop lifecycle.