Tehran University Medical Journal

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Background: Simple bone cyst is a common benign lesion in the proximal humerus, especially in prepubertal children. Up to 75 percent of patients with the bone cyst have a pathologic fracture and the most significant complication is recurrent pathologic fracture. Since the process of spontaneous healing of these fractures is rare, treatment is required. Ideal treatment for simple bone cyst should stabilize pathologic fractures, assist healing and provide a quick return to normal activity with reduced complication and recurrence.
Methods: In this descriptive case series study, 24 patients with simple bone cysts of the humerus were selected for retrograde flexible intramedullary nailing from the lateral cortex of the distal humerus, since 2000 to 2005 at Imam Khomeini Hospital, Tehran. The mean age of the patients was 14.4 years, ranging from 6-39 years. Results were evaluated by plain radiography using the classification system of Capanna et al.
Results: The mean duration of follow up for 23 of the patients was 31 (9-51) months. One patient with short-term of follow-up was excluded. Of these patients, 91.3% were healed either completely (65.2%) or with residual minor defect (26.1%). Only one cyst (4.3%) persisted with no response to treatment and one patient (4.3%) had a recurrence of the cyst. However, there was no instance of recurrent pathologic fracture among these patients.
Conclusion: This study shows that flexible intramedullary nailing is an effective treatment for humeral simple bone cysts that reduces the chance of complication, recurrence of cyst or pathologic fracture. This technique provides sufficient stability for quick return to normal activity.

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Background: Frozen shoulder is a debilitating disease characterized by pain and progressive loss of motion in shoulder secondary to fibrotic inflammation of the joint capsule. The incidence is 2% in the general population, mostly affecting women 40 to 70 years of age. Therapeutic measures include physiotherapy, shoulder manipulation, corticosteroid injection and arthroscopic release. The purpose of this study was to compare the results of manipulation under anesthesia with or without concomitant intra-articular injection of corticosteroid.

Methods: Twenty-six patients (21 females, 5 males) with the clinical diagnosis of idiopathic frozen shoulder were evaluated in a randomized clinical trial. The average age of the patients was 55.7 years. Twelve cases had diabetes mellitus, which is considered a strong predisposing factor and has a poor prognosis. Thirteen patients received intra-articular corticosteroid injection just before manipulation. The outcome was assessed by evaluating functional score (Constant scoring system) at the six-month follow-up.

Results: The average score before manipulation was 28.7 out of 100, which significantly improved to 84.8 at six months after the procedure (p<0.05). The results were slightly better in the group who received corticosteroid injection, but the difference was not statistically significant (p=0.1). The outcome in the diabetic group was less favorable than in the non-diabetic patients (p<0.05).

Conclusions: Manipulation under anesthesia is a very effective method of treatment for idiopathic frozen shoulder. Concomitant intra-articular injection of corticosteroid does not seem to improve significantly the final outcome. Diabetes mellitus can negatively affect the results of this treatment method.