Case Report: A rare case of Giant Cell Tumor of Distal Ulna

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 19-20 | Soham R Chachcha, Ramavtar Saini, Anand Yadav

Authors: Soham R Chachcha [1], Ramavtar Saini [1], Anand Yadav [1].

[1] Dept. Of Orthopaedics, Geetanjali Medical College and Hospital Udaipur.

Address of Correspondence
Dr. Soham R Chachcha,
Dept. Of Orthopaedics, Geetanjali Medical College and Hospital Udaipur.
E-mail: ,


Background: Giant Cell tumor has a reported incidence of 30% in Indian population out of which only 10% cases occur in adults more than 65 years of age. Distal Femur and proximal Tibia are the most common sites followed by distal Radius . Distal Ulna Giant cell tumor is a rare presentation.
Methods: There are no clear-cut guidelines for treatment of Giant Cell Tumor. The treatment of choice in case of Giant Cell Tumor usually is wide block resection of tumor, and to prevent recurrence adjuvant procedures can be used such as cryotheryapy, phenol, cementing and bone grafting and burring. We used the en bloc resection method.
Result: After the en bloc resection of the tumor, the patient had relief in pain and the range of motion at wrist joint was restored.
Conclusion: Giant Cell tumor of distal Ulna is a rare entity and it is even rarer in Geriatric population. It can be treated with en bloc resection.
Keywords: Distal, Ulna, Giant Cell, Tumor, Geriatric.


1. Dr Ajay Puri, Dr. M. G. Agarwal and Dr. DinshawPardiwala in ‘Current concepts in bone and soft tissue tumors’ Chapter 6 Giant Cell Tumor Of Bone Page: 53-63.
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3. D. J. McDonald, F. H. Sim, R. A. McLeod, and D. C. Dahlin, “Giant-cell tumor of bone,” Journal of Bone and Joint Surgery. Series A, vol. 68, no. 2, pp. 235–242, 1986.
4. Cooney WP, Damron TA, Sim FH, Linscheid RL. En bloc resection of tumors of the distal end of the ulna. J Bone Joint Surg Am [Internet]. 1997 Mar [cited 2015 Aug 8];79(3):406–12. Available from:
5. B. J. Gainor and J. Schaberg, “The rheumatoid wrist after resection of the distal ulna,” Journal of Hand Surgery, vol. 10, no. 6 I, pp. 837–844, 1985.

How to Cite this article: Chachcha S R, Saini R, Yadav A. Case Report: A rare case of Giant Cell Tumor of Distal Ulna. Acta of Shoulder and Elbow Surgery Jan-June 2019;3(1):19-20.

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Suprascapular neuropathy in a young male handball player: case report

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 16-18 | Luís Henrique Barros, Claudia Rodrigues, Rui Claro

Authors: Luís Henrique Barros [1], Claudia Rodrigues [1], Rui Claro [1].

[1] Centro Hospitalar do Porto

Address of Correspondence
Dr. Luís Henrique Barros,
Avenida da República, 855, 1º direito, Vila Nova de Gaia, 4430-201, Portugal
Centro Hospitalar do Porto


Background: Suprascapular neuropathy is an uncommon but a very disabling condition. If not diagnosed early, it can lead to irreversible changes. Their prevalence is higher among males and active population, mainly in overhead athletes.
Methods: A 22-year-old male, who is a handball player, reported right shoulder pain, fatigue, and discomfort after one month holding a backpack during hiking in his vacations. He did not remember any trauma to the right shoulder. Clinically, he had a normal active and passive range of motion but the moderate weakness of the right shoulder external rotator muscles. At inspection, he had marked atrophy of supraspinatus and infraspinatus muscles. MRI demonstrated a superior labrum from anterior to the posterior lesion with large multiloculated Paralabral cyst and electromyography was consistent with compression of the suprascapular nerve.
Results: The patient was submitted to arthroscopic labral repair and decompression of the suprascapular nerve. Six months after surgery he has no pain and limitation and is recovering strength
Conclusions: Paralabral cysts are described in the literature as causing compression on spinoglenoid notch and thus coursing with infraspinatus atrophy. This case demonstrates an unusual presentation with both supra and infraspinatus muscles atrophy. Early recognition of these injuries is crucial because complication and morbidity rates are high with delayed diagnosis, mainly in the athlete population.
Keywords: suprascapular neuropathy, SLAP lesion, paralabral cyst, overhead athletes lesions, supraspinatus muscle atrophy, infraspinatus muscle atrophy.


1. Schroeder AJ, Bedeir YH, Schumaier AP, Desai VS, Grawe BM. Arthroscopic Management of SLAP Lesions With Concomitant Spinoglenoid Notch Ganglion Cysts: A Systematic Review Comparing Repair Alone to Repair With Decompression. Arthroscopy. 2018. Epub 2018/03/05. doi: 10.1016/j.arthro.2018.01.031. PubMed PMID: 29501216.
2. Zehetgruber H, Noske H, Lang T, Wurnig C. Suprascapular nerve entrapment. A meta-analysis. International orthopaedics. 2002;26(6):339-43. Epub 2002/12/06. doi: 10.1007/s00264-002-0392-y. PubMed PMID: 12466865; PubMed Central PMCID: PMCPMC3620977.
3. Schroder CP, Lundgreen K, Kvakestad R. Paralabral cysts of the shoulder treated with isolated labral repair: effect on pain and radiologic findings. J Shoulder Elbow Surg. 2018;27(7):1283-9. Epub 2018/02/17. doi: 10.1016/j.jse.2017.12.022. PubMed PMID: 29449084.
4. Romeo AA, Rotenberg DD, Bach BR, Jr. Suprascapular neuropathy. J Am Acad Orthop Surg. 1999;7(6):358-67. Epub 2001/08/11. PubMed PMID: 11497489.
5. Pillai G, Baynes JR, Gladstone J, Flatow EL. Greater strength increase with cyst decompression and SLAP repair than SLAP repair alone. Clinical orthopaedics and related research. 2011;469(4):1056-60. Epub 2010/11/26. doi: 10.1007/s11999-010-1661-5. PubMed PMID: 21104358; PubMed Central PMCID: PMCPMC3048282.

How to Cite this article: Barros L H, Rodrigues C, Claro R. Suprascapular neuropathy in a young male handball player: case report. Acta of Shoulder and Elbow Surgery Jan – June 2019;3(1):16-18.

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Surgical treatment of shoulder instability using transsubscapularis transfer of the long biceps tendon

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 13-15 | Yonder Archanjo Ching San Junior, Max RogÃcrio Freitas Ramos, Settings Luiz, Diogo Fagundes Henrique Pereira Alves, Paulo RogÃcrio Moritz Postigo

Authors: Yonder Archanjo Ching San Junior[1], Max RogÃcrio Freitas Ramos[1], Settings Luiz[1], Diogo Fagundes Henrique Pereira Alves[1], Paulo RogÃcrio Moritz Postigo [1].

[1] Consultório: Av. Paisagista José Silva de Azevedo Neto, 200 – Bloco 7
(Ecology) Sala 330 – Barra da Tijuca
Clínica Le Sage: Rua da Assembléia, 10 – Sala 1215 – Centro – Rio de

Address of Correspondence
Dr. Yonder Archanjo Ching San Junior,
Ortopedia e Traumatologia – Cirurgia do Ombro e Cotovelo


Objectives: To describe the long bicepstendon transfer technique for the treatment of anterior shoulder instability.
Method: The long tendon of the biceps brachiiwas detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity using subscapularis tenotomy, reproducing the slingeffect and increasing the anterior bone block.
Results: The technique is easy to perform and minimises the risks of coracoid process transfer.
Conclusion: Transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.
Keywords: Joint instability/pathology, Joint instability/surgery, Shoulder joint/pathology, Shoulder joint/surgery, Cadaver


1. Lech O, Freitas JR, Piluski P, Severo A. LuxaçãoRecidivante do Ombro: do papiro de Edwin Smith à capsuloplastiatérmica. Rev Bras Ortop 2005;40(11/12):625-37
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15. Karlsson J. In reparable rotator cuff tears with lesions of the long head of the biceps brachii tendon, tenotomy did not differ from tenodesis in terms of function or pain. JBJS. 2017; 99(4):351.
16. JC Garcia Jr, Nunes CV, Raffaelli MDP, Sasaki AD, Salem SH, Rowinski S, Pina M. Long Head of Biceps- a Vestigial Structure? Acta of Shoulder and Elbow Surgery Jan – June 2017;2(1):22-27
17. Taylor SA, Ramkumar PN, Fabricant PD, Dines JS, Gausden E, White A, Conway JE, O’Brien SJ. The clinical impact of bicipital tunnel decompression during long head of the biceps tendon surgery: a systematic review and meta-analysis. Arthroscopy. 2016; 32(6):1155-64.
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19. JC Garcia Jr, AM Cardoso Jr, MB D. Mello. Arthroscopic Long Head Biceps Tenodesis in Coracoid associated with its Transfer to the Conjoined Tendon. Acta of Shoulder and Elbow Surgery Jan – June 2017;2(1):7-10

How to Cite this article: Junior Y A C S, Ramos M R F, Luiz S, Alves D F P, Postigo P R M. Surgical treatment of shoulder instability using transsubscapularis transfer of the long biceps tendon. Acta of Shoulder and Elbow Surgery Jan – June 2019;3(1):13-15

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Evaluation of Complications of Shoulder Arthroscopy in the Treatment of Sub acromial Pathologies

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 7-12 | Alexandre de Almeida, Nayvaldo Couto de Almeida, Rafael Filipini Carraro, Samuel Pante, Ana Paula Agostini, Daniel C Agostini

Authors: Alexandre de Almeida [1], Nayvaldo Couto de Almeida [1], Rafael Filipini Carraro [2], Samuel Pante [1], Ana Paula Agostini [3], Daniel C Agostini [4].

[1] Department of Orthopaedic, Pompeia Hospital, Caxias do Sul, RS, Brazil
[2] Second Year Fellowship Resident at Pompeia Hospital, Caxias do Sul, RS, Brazil
[3] Department of Pediatrics, Caxias do Sul University, Caxias do Sul, RS, Brazil
[4] Department of Radiology, General Hospital, Caxias do Sul, RS, Brazil

Address of Correspondence
Dr. Alexandre de Almeida,
Rua Vitório Buzelatto, 222/601. Caxias do Sul, RS, Brazil.
Zip: 95020290.


Objectives: to analyze the prevalence of complications of arthroscopic shoulder surgery for the treatment of sub acromial pathologies and verify if it is affected by sex, age, obesity, smoking habit or by the surgeon’s learning curve.
Methods: from Aug 2001 to Oct 2017, 1322 shoulders were treated for sub acromial pathologies by arthroscopic technique. One surgeon operated all the cases of subacromial pathologies. Exclusion criteria were revision surgeries and insufficient medical records, resulting in a total of 1246 patients.
Results: The analysis of the sample showed a significant predominance (p<0.0001) of the female patients (60.5%). The group of female patients had the highest age (p<0.001). There were complications in 197 patients. The prevalence of complications was 15.8%. Analyzing the female patients separately, a prevalence of complications of 16.5% was verified, while the male patients had 14.8% (p=0.432). Statistical analysis showed a higher prevalence of complications in younger patients (p=0.036). Obese patients (25.8% of the sample) had 13.4% of complications, while non-obese patients had 16.7% (p=0.161). The analysis of complications according to smoking habits did not show a higher prevalence of complications when comparing smokers and nonsmokers (p=0.492). The most frequent complication found in the study was stiffness, with 63 cases (32.5% of the complications). We found 36 cases of stiffness (6.3%) in the immobilized group with a common sling, while the immobilized group with a neutral rotation cushion of the MS presented 27 cases of stiffness (4%). The reduction of 2.3% with the use of sling in neutral rotation was not considered significant (p = 0.066). We analyzed the first 400 arthroscopic cases with the last 400 cases operated. 20.8% of complications were found in the first 400 cases operated and 10.5% in the last 400 cases (p<0.001).
Conclusion: The prevalence of complications of arthroscopic shoulder surgery for the treatment of sub acromial disorders was 15.8%. It was not possible to demonstrate sex, obesity and smoking as risk factors for shoulder arthroscopy complications. It was possible to demonstrate that the age under 65 years and the surgeon’s learning curve significantly affect the prevalence of complications after shoulder arthroscopy.
Keywords: shoulder, arthroscopy, complications.


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How to Cite this article: Almeida A, Almeida N, Carraro R F, Pante S, Agostini A P, Agostini D C. Evaluation of Complications of Shoulder Arthroscopy in the Treatment of Sub acromial Pathologies. Acta of Shoulder and Elbow Surgery Jan- June 2019;3(1):7-12.

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A brachial artery pseudoaneurysm in the form of a “malignant tumour” as a complication of a proximal humerus exostosis

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 3-6 | Michał Górecki, Piotr Czarnecki

Authors: Michał Górecki [1], Piotr Czarnecki [2].

[1] Student Research Group of Hand Surgery, University of Medical Sciences Poznań, Poland
[2] Department of Traumatology, Orthopaedics and Hand Surgery of Viktor Dega Orthopedic and Rehabilitation Clinical Hospital

Address of Correspondence
Dr. Michał Górecki,
Mścibora 74, 61-062 Poznań, Poland


Background: Osteochondromas are the most common form of benign bone tumour. They are mostly asymptomatic, but sometimes they can irritate surrounding structures, like vessels or nerves, and cause complications. More often they apply to the lower extremities, especially around the knee joint. Osteochondromas which cause complications in the upper extremities are much less common. This paper presents a rare case of a brachial artery pseudoaneurysm as a complication of a proximal humerus exostosis, which was initially described and treated as malignant tumour of the arm. A comprehensive review of the literature has also been carried out.
Methods: A 19-year-old male patient was admitted with acute pain of the left arm. Eight years earlier he had been diagnosed with hereditary multiple osteochondromas. Examination revealed a palpable, non-painful tumour of the axilla’s area and the posterior part of the left arm. An magnetic resonance imaging (MRI) with contrast demonstrated three osteochondromas in the area of the proximal humerus. From the free end of one of these, a big, nodular structure was spreading. From the MRI, a chondrosarcoma was suspected. Samples were taken for histopathological examination. After the surgery, increased pulsations were observed around the operative area. A ultrasonography (USG) revealed a fibrotic pseudoaneurysm of the left brachial artery. Histopathological examination showed deposits of heamosiderin without any cancer cells. With the change in diagnosis, the next stage of treatment was planned – artery reconstruction using a saphenous vein graft and an osteochondroma excision.
Results: A few weeks after surgery, the patient recovered full function of the upper extremity and did not report any discomfort. A control USG showed proper flow through the brachial artery and venous graft.
Conclusion: In the case of a tumour in the area of an osteochondroma, caused by trauma, a pseudoaneurysm should be suspected. Diagnostic and therapeutic treatment must be properly planned, as unrecognised it could cause a severe, life-threatening haemorrhage during the operation.
Keywords: pseudoaneurysm, osteochondroma, malignant transformation, brachial artery, chondrosarcoma.


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How to Cite this article: Górecki M, Czarnecki P. A brachial artery pseudoaneurysm in the form of a “malignant tumour” as a complication of a proximal humerus exostosis. Acta of Shoulder and Elbow Surgery Jan- June 2019;3(1):3-6.

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Training by Publishing

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan-June 2019 | Page 1-2 | Ashok Shyam

Author: Ashok Shyam [1,2].

[1] Indian Orthopaedic Research Group, Thane, India
[2] Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India

Address of Correspondence
Dr. Ashok Shyam.
IORG House, A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane, India. 400604

This is a digital world we live in. In last 20 years technology has changed the face of this world specially the way in which the data is shared and interaction is improved. This has accelerated things especially scientific inquiry and distribution of scientific concepts. In field of orthopaedics this has lead to better implants and more literature. Increased numbers of journals and articles have led to increased awareness about the results of particular surgery and implant. Also it has improved the propagation of awareness about a new technique / implant and its results. In last century, a new technique would simply remain with a single surgeon or country for a long time [Ilizarov ring fixator for example], but now with advent of the online tools and websites, distribution of knowledge is simply amazing.
One of the areas where technology can be successfully used is area of Training in surgical skills. We are currently having video websites like Vu-medi and many more videos on you tube etc, however I believe journals can play a very active part in this area. Surgical training of highest quality can reach each and every corner of the world simply by combining a format which will include text, pictures as well as videos. We all have basic surgical skill sets and to step up our training we would simply need to conceptualise and visualise different methods. This can easily be gained from the above format. Of course the learning curve for such training would be much longer and at times there will be unforeseen complications and difficulties. For this reason such articles should have a continued thread of comment and discussions which can be compiled over a period of time and better a list of frequently asked questions. This can provide answers to queries for a new trainee or even for an experienced surgeon. I believe the techniques should be open peer reviewed and not undergo a blinded peer review. The reviewers should be openly allowed to ask the surgeons questions and doubts that the reader will have. A post publication review of the technique is one of the most important part of this initiative where readers and peers can comment on the published technique. The goal of this entire exercise should be improvement of technique and to impart correct surgical principles to the trainees.
Acta of Shoulder and Elbow Surgery wants to pioneer in this area of surgical training by publishing and will be inviting several surgeons on our special editorial board where techniques can be invited and published. I believe this will help surgeons from all across the world to learn new techniques and also improve older techniques. Innovations and tricks and tops in older techniques can easily be demonstrated by using the online tools. Open access will allow much better outreach and more audience for the author too. I sincerely hope that this idea will take firm root and will grow over a period of time

If you have any further opinions about this idea, please write to me. With this I leave you to enjoy this issue.

Dr. Ashok Shyam
Co-Editor in chief- Acta of Shoulder and Elbow Surgery

How to Cite this article:. Shyam A. Training by Publishing. Acta of Shoulder and Elbow Surgery Jan- June 2019;3(1):1-2.

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