Clin Orthop Surg.  2016 Sep;8(3):339-344. 10.4055/cios.2016.8.3.339.

Bilateral Scapulohumeral Ankylosis after Prolonged Mechanical Ventilation

• van Lotten ML
• Schreinemakers JR
• van Noort
• Rademakers MV

• KMID: 2374283
• DOI: http://doi.org/10.4055/cios.2016.8.3.339

Abstract

This case demonstrates a rarely reported bilateral scapulohumeral bony ankylosis. A young woman developed extensive heterotopic ossifications (HOs) in both shoulder joints after being mechanically ventilated for several months at the intensive care unit in a comatose status. She presented with a severe movement restriction of both shoulder joints. Surgical resection of the bony bridges was performed in 2 separate sessions with a significant improvement of shoulder function afterwards. No postoperative complications, pain, or recurrence of HOs were noted at 1-year follow-up. Mechanical ventilation, immobilization, neuromuscular blockage, and prolonged sedation are known risk factors for the development of HOs in the shoulder joints. Relatively early surgical resection of the HOs can be performed safely in contrary to earlier belief. Afterwards, nonsteroidal anti-inflammatory drugs and/or radiation therapy can be possible treatment modalities to prevent recurrence of HOs.

Keyword

Heterotopic ossification; Ankylosis; Shoulder joint; Artificial respiration

MeSH Terms

Adult
*Ankylosis/diagnosis/diagnostic imaging/etiology/physiopathology
Female
Humans
Magnetic Resonance Imaging
Range of Motion, Articular
Respiration, Artificial/*adverse effects
*Shoulder Joint/diagnostic imaging/physiopathology
Tomography, X-Ray Computed

Figure

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  Fig. 1 Preoperative range of motion of the arms. (A) Neutral position. (B) Maximal abduction. (C) Maximal anteflexion.

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  Fig. 2 Preoperative roentgenogram of the right shoulder joint (A) and the left shoulder joint (B).

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  Fig. 3 Magnetic resonance imaging showing avascular necrosis of the humeral head and isolated ossifications in the subscapularis muscle (red arrow) in the coronal plane (A) and a complete bony bridge located in the teres minor muscle (blue arrow) in the transverse plane (B).

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  Fig. 4 Three-dimensional computed tomography reconstruction image showing isolated ossifications in the subscapularis muscle (red arrow) and the complete bony bridge in the teres minor muscle (blue arrow).

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  Fig. 5 (A) Resection of the bony bridge via posterior approach with an osteotome. (B) Identification of the radial nerve in close proximity to the bony bridge (arrow).

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  Fig. 6 Postoperative shoulder function in the sagittal plane (A) and in the coronal plane (B), maximal exorotation.

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  Fig. 7 One-year postoperative roentgenogram of the right shoulder (A) and the left shoulder (B) without recurrence of heterotopic ossifications.

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