Tuesday, May 24, 2011

Deltoid fibrosis

Fibrosis is the deltoid muscle deltoid contracture forcing fibers in the abduction of the shoulder strain. It is a clinical entity first described in India. It is a localized fibrosis of the deltoid fibers del medium more often with the abduction contracture of the shoulder as a result. He demonstrated a causal relationship between intramuscular injections of certain drugs such as tetracycline, quinina, paraldehida in deltoid muscle fibrosis in childhood and adolescence.
Usually patients complain of inability adductiei arm. The most frequently observed abnormal prominence of the scapula when the elbow near the body tries to maintain. Exam arm is maintained in 30 degrees abduction and apparent emancierea deltoid. It describes one or more of the contracture band. The scapula is prominent adductia arm.
Treatment includes surgical release of the joint.
Deltoid muscle has three areas of Origin: clavicle, acromion and scapula. There is only one place of insertion, deltoid tubercle of the humerus. Anterior and posterior portions are joined at the site of insertion, while the middle portion is multipenata. Middle portion has four intramuscular septa that extend from the acromion. The main role of the deltoid is abduction arm. Previous Deltoid assist and flexion and internal rotation earlier. Attend the posterior extension and external rotation.
Deltoid contractures are reported in all three sections. They are seen mostly in middle portion and then in the rear. These areas are most affected due to frequent injections in these anatomical areas to avoid the previous cephalic vein.Electromyogram showed no activity in affected muscles, but nerve conduction is normal. EMG abnormalities are described and unaffected muscle suggesting an initial anomaly that makes succeptibil muscle to develop fibrosis.
I proposed three possible mechanisms for the development of deltoid contracture:-Direct disruption of the muscle by injection or injections associated miotoxicitateMioischemia due to an injection-swelling volume, compression and destruction of vascular fibrosis (fibroblast activity produces tissue edema and collagen production)-Subdivision fibrotic tissue and muscle determine mioischemie neuropathy.
Injuries caused by repeated injections are considered miotoxicitatea deltoidiene triggers contraction by determining the fibrotic myopathy myositis and secondary degeneration.Denervation occurs simultaneously by fibrotic compression or ischemia. Lesions appear in connective tissue. This may be caused by an enzyme deficiency in collagen degradation, increased rates of collagen production, genetic defects in the regulation of collagen biosynthesis and fibroblast enzyme defect.
Causes and risk factors:Deltoid fibrosis is most often associated with changes postinjectionale. Many drugs have been implicated as causative agents: dramamina, iron, penicillin, lincomycin, pentazocine, streptomycin, tetracycline, vitamins and antipireticele.Why do some children develop deltoid fibrosis and others do not is not yet known.
Signs and symptoms
Deltoid fibrosis is a disorder characterized by the formation of intramuscular fibrous bands within the deltoid muscle. These bands lead to secondary contractures that affect the shoulder joint function. Scapula swing and secondary scoliosis may be associated with this condition. Deltoid fibrosis was associated with fibrous contractures of the quadriceps and gluteal muscles and is probably a similar process.
Deltoid fibrosis spectrum belongs dintrun fibrotic conditions affecting the upper and lower extremities. These may affect a single extremity or in rare cases all four extremities. A muscle contracture may limit limb function or its appearance. Deltoid fibrosis is described in people of all ages, but it has been reported especially in children.
Patient history includes the following:History-injections in or around the affected site-Like contractions in other parts of the body-Family history of similar contractions-Significant limitation of daily activities.
Physical examination:Will examine the neck motion will seek other congenital deformation SprengelWill examine the shoulder and upper extremity to assess movement and glenohumeral stability and scapulotoracicaEvaluate the free scapular movementsThe search for signs of contractures in other areas of the upper and lower extremitiesComplete neurological examination is performedExamines the thoracic and lumbar column to highlight scoliosis or chest wall abnormalities.
Contracted portion of the deltoid determine the patient's medical problems. The shoulder is abducted is involved only when the middle portion of muscle. If the affected arm is flexed and the anterior portion in the abduction position. If it affected the posterior arm is extended and abducted. Be progressively extended or flexed arm, humeral head subluxation may occur. Most contractures are severe and profound. However, a small group of patients shows only the surface of contracture bands.Recurrent dislocation has been reported in these patients.Radiological assessment of glenohumeral joint stability may be difficult due to changes in forcing subduction scapular humeral head position. CT scan may be needed to adequately assess the glenohumeral joint status.
In patients who are skeletally immature, humeral head flattening and morphological changes can be described acromiale. As the contraction increases in abduction, medial rotation of the lead arm weight lower edge of the scapula with the scapula sliding.Common skin may be nodular and can feel a fibrous band. Muscle cramps often accompany the clinical picture over the shoulder.Scoliosis secondary severe contraction in abduction was reported.Those affected usually present with inability to move the arm beside the body. Arm abduction fibrous bands releases tension and allows body movements besides.
Imaging Studies:Radiological assessment of glenohumeral joint stability may be difficult due to changes in forcing subduction scapular humeral head position. CT scan may be needed to adequately assess the glenohumeral joint status.

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