OKOJ, Volume 9, No. 5

Peripheral Nerve Sheath Tumors

Peripheral nerve sheath tumors (PNSTs) are soft-tissue tumors that arise from the supportive elements of the peripheral nerves. Benign PNSTs, including neurofibromas and schwannomas, typically present as painless, slow-growing masses. MRI is an important component of the evaluation of these tumors. Neurofibromas and schwannomas have distinct histologic features and show characteristic immunohistochemical staining. Different variants of these tumors have histologic features that distinguish them from one another. Benign PNSTs are treated by surgical excision. Although certain general principles apply to the surgical treatment of all benign PNSTs, modified surgical techniques are required for each type.

    • Keywords:
    • neurofibromatosis

    • neurofibromatosis 1

    • neurofibromatosis type 1

    • NF1

    • neurofibromatosis 2

    • neurofibromatosis type 2

    • NF2

    • schwannoma

    • neurilemoma

    • schwannomatosis

    • malignant peripheral nerve sheath tumor

    • benign peripheral nerve sheath tumor

    • Subspecialty:
    • Musculoskeletal Oncology

Adhesive Capsulitis: Current Concepts

Adhesive capsulitis, commonly known as "frozen shoulder," affects from 2% to 5% of the general population, causing global loss of motion of the shoulder. Although the precise pathobiology of adhesive capsulitis remains unknown, this disease is marked by contraction of the shoulder capsule and an abundance of fibroblasts and myofibroblasts within the collagen matrix, accompanied by synovitis, inflammation, and pain. It can occur idiopathically, postoperatively, or following trauma. Diagnosis is based on a presentation of pain with absent or limited shoulder mobility. Although radiography fails to show any pathology, MRI reveals a reduced capsular volume, a small or absent inferior pouch, and thickened ligaments, especially in the rotator interval. The mainstay of treatment for adhesive capsulitis has been physical therapy with or without intra-articular injection of corticosteroids. However, manipulation can damage the shoulder and is unlikely to release adhesion of the rotator interval. Arthroscopic capsular release is a safe and reliable treatment option for recalcitrant adhesive capsulitis. The additional use of continuous regional anesthesia for up to 72 hours after arthroscopic surgery is a safe and reliable addition to this already proven technique, allowing patients to begin physical therapy without pain.

    • Keywords:
    • adhesive capsulitis

    • frozen shoulder

    • arthroscopic capsular release

    • arthroscopy

    • shoulder manipulation under anesthesia

    • collagenase injection therapy

    • indwelling interscalene catheter

    • brachial plexopathy

    • shoulder dislocation

    • rotator cuff tear

    • complex regional pain syndrome

    • Subspecialty:
    • Shoulder and Elbow

Arthroscopic Management of Chondral Lesions of the Hip Associated With Femoroacetabular Impingement

Chondral lesions of the hip may result from direct trauma or from underlying intra-articular hip disorders. Such lesions rarely occur in isolation and are found in conjunction with other hip pathology, such as labral tears, loose bodies, hip dysplasia, or femoroacetabular impingement. Advances in arthroscopic techniques and a better understanding of articular cartilage biomechanics and physiology have lead to less invasive methods of treating chondral lesions, thereby improving pain and disability while avoiding the morbidity associated with open surgery. This article provides information on current methods of diagnosing and treating chondral lesions of the hip caused by femorocetabular impingement, with a focus on arthroscopic procedures and techniques.

    • Keywords:
    • articular cartilage

    • acetabular labral tear

    • acetabular chondral lesion

    • hip arthroscopy

    • acetabular cartilage

    • osteoarthritis

    • femoroacetabular impingement

    • FAI

    • cam lesion

    • cam impingement

    • pincer lesion

    • pincer impingement

    • watershed lesion

    • hip disease

    • degenerative joint disease

    • Outerbridge classification

    • chondrolabral dysfunction

    • Subspecialty:
    • Sports Medicine