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Background: Data on molecular allergy diagnostics in adults with grass pollen allergy with regard to conjunctival and nasal provocation test outcome and specific immunotherapy are lacking to date., Objective: To assess whether molecular allergy diagnostics for grass pollen allergens could help with predicting provocation test outcomes and serve as a basis for future component-resolved specific immunotherapy., Methods: Sera of 101 adults with grass pollen allergy was analysed for IgE against timothy grass pollen (Phleum pratense), rPhl p 1, rPhl p 2, nPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11 and rPhl p12 and correlated with the individuals' outcome in the nasal and conjunctival provocation tests and investigated in regard to a potential component-resolved specific immunotherapy., Results: An increasing number of sensitizations to timothy grass allergens was correlated to a positive reaction in the conjunctival (4.9 vs. 3.6, P = 0.003) and nasal provocation tests (4.5 vs. 2.2, P = 0.0175). In molecular sensitization profiles, a substantial heterogeneity was detected, with none of the patients exactly matching the allergen composition of a previously published component-resolved specific immunotherapy containing Phl p 1, Phl p 2, Phl p 5a/b and Phl p 6. The results indicate that in 95% of the patients, a proportion of 50% of timothy-IgE would be targeted with such a specific immunotherapy, while in 50% and 10% of patients, 80% and 90% of timothy-IgE would be targeted, respectively., Conclusion and Clinical Relevance: Molecular allergy diagnostics is a prerequisite for future component-resolved specific immunotherapy due to the high heterogeneity of sensitization profiles. However, of current clinical relevance is the observed correlation between the number of sensitizations and provocation test outcome., (© 2014 John Wiley & Sons Ltd.)

The aim of this study was to evaluate whether a fracture of the proximal humerus is associated with an increased prevalence of preceding fractures or a risk of subsequent fractures. All patients who were treated at the Malmö General Hospital in 1987 for a fresh fracture of the proximal humerus were identified, representing practically all fractures of the proximal humerus in Malmö city (250,000) that year. Two hundred fifty-three adult patients, 54 men with an average age of 66 (24-90) and 199 women with a mean age of 74 (22-98) years, were included in the study together with 475 age- and gender-matched control persons. In 1999, fracture prevalence of patients and controls were rated by a survey at the Dept. of Radiology. There was a significantly increased prevalence of previous fractures before 1987 in the humerus fracture group with an odds ratio (OR) of 3.5 [95% confidence interval (95% CI), 2.2-5.5] for a spinal fracture, OR 1.8 (95% CI, 1.3-2.6) for a previous fracture to the upper extremity, and OR 1.8 (95% CI, 1.2-2.6) for a preceding fracture of the lower limb. The proximal humerus fracture also predicted a significantly increased risk of a subsequent fracture. The hazard ratio (HR) was 2.5 (95% CI, 1.7-3.7) for a forthcoming spinal fracture, HR 2.8 (95% CI, 2.0-3.7) for a future fracture of the upper extremity, and HR 2.0 (95% CI, 1.2-3.5) for a lower limb fracture. In a subgroup of male patients, an almost five times increased risk of sustaining subsequent extremity fractures was observed. In summary, a fracture of the proximal humerus is associated both with increased prevalence of previous fractures of the spine and extremities and also predicting an increased risk of future fractures.

According to the experiences of the Malmö Haemophilia Centre, the best way to avoid recurrent joint bleedings and synovitis in haemophilic patients and to prevent progressive joint disease is prophylactic factor treatment. If prophylaxis is impracticable and also in patients with factor inhibitors, radioactive synoviorthesis seems to be a good treatment option if started early.

We evaluated the incidence and clinical significance of postfracture shortening of the clavicle in 85 patients. There were 71 mid-clavicular fractures and 14 of the lateral end of the clavicle. 46 fractures were primarily undisplaced and 39 displaced. All fractures were nonoperatively treated with sling immobilization. All patients were reexamined 5 years after the fracture. 35 clavicles had healed with at least 5 mm shortening. Clavicles with originally displaced fractures were shorter and radiologically more frequently malunited. Mobility, strength and the functional Constant score were similar in the injured and normal shoulders. Our findings suggest that permanent shortening of the clavicle is common after fracture, but has no clinical significance.

We recorded prospectively all adult patients with a fracture of the proximal end of the humerus, clavicle and scapula or a primary shoulder or acromioclavicular dislocation in the city of Malmö in 1987. Altogether there were 413 injures. The hospital records from the Department of Alcohol Diseases were searched for these patients and for 2 age- and gender-matched controls for each patient. 12% of all patients with a shoulder injury were recorded as alcohol abusers. This number was significantly greater than that of the controls. The difference was more obvious in men than in women. In men between 30 and 64 years, almost half of the proximal humerus fractures and shoulder dislocations, one third of mid-clavicular fractures and two thirds of all lateral clavicle fractures were sustained by alcohol abusers. Our findings emphasize the significance of alcohol abuse in the etiology of shoulder injuries, especially in men. Most of the men with a fracture of the lateral clavicle are registered at the Department of Alcohol Diseases, making this injury a marker of alcohol abuse.

In a prospective population-based study of all shoulder injuries seen at Malmö General Hospital during 1987, the incidence and causes of major injuries involving fractures of the clavicle, scapula, or proximal humerus and glenohumeral or acromioclavicular dislocations were investigated in children, adults, and the elderly. Seventy-five shoulder injuries occurred in children. Sixty-five of them were fractures of the clavicle. In this age group no sex-related differences were seen in incidence, and 37 of 73 injuries were related to sports or playing. One hundred eighty-one injuries occurred in adults. Sixty fractures of the proximal humerus, 67 fractures of the clavicle, and 31 primary glenohumeral dislocations were seen. The injuries in this group were significantly more frequent in men, with most of them caused by traffic and sport injuries. Two hundred forty-eight injuries occurred in elderly people. Two hundred one were fractures of the proximal humerus. The incidence was significantly higher in women; 147 of 247 injuries were caused by an indoor fall. The variations among age groups are probably attributable to age-related differences in activity, mobility, and fragility.

The gleno-humeral joint space in standard antero-posterior images of 175 normal subjects was measured at three different sites. The average of the three measurements, the integral joint space, was calculated and was found to be between 4 and 5 mm. The value does not change with age, except in women, in whom it increases slightly. A narrow joint space in an elderly patient should not be expected simply because the patient is old. The measuring technique described is useful in population studies. In individual cases a simple measurement with a ruler serves the same purpose.

The subacromial space in standard anteroposterior radiographs of 175 normal shoulders was between 9 and 10 mm. The space was significantly greater in men, with a slight reduction with age. In middle age, a subacromial space less than 6 mm is pathological, possibly indicating supraspinatus tendon rupture.

The association between distally pointing osteophytes of the acromioclavicular joint and ruptures of the supraspinatus tendon was investigated by two different methods. In a radiologic study, 47 images of shoulders with arthrographically confirmed supraspinatus tendon ruptures were reviewed and compared with 50 images of shoulders without ruptures. Fifty-one percent of the shoulders with supraspinatus tendon ruptures had osteophytes, as compared with 14% of the normal shoulders. A series of 170 autopsy specimens of the shoulder were also examined in detail; partial supraspinatus tendon ruptures were found in 32 and full-thickness ruptures in 22 shoulders. Fifty-four percent of the shoulders with supraspinatus tendon ruptures had distally pointing acromioclavicular osteophytes, as compared with 10% of the normal shoulders. Bony spurs of the anterior acromial process were also encountered, but they were less frequent than the acromioclavicular osteophytes.

The acromioclavicular joint space in standard antero-posterior images of 151 normal subjects was measured. The joint space was significantly wider in men. There was a highly significant reduction of the joint space with age in both men and women and in persons past 60 a joint space of 0.5 mm or less is not pathological. A joint space wider than 7 mm in men and 6 mm in women is abnormal. The measuring technique described is useful in population studies. In individual cases a simple measurement with a ruler serves the same purpose.

Surgery was performed on 43 shoulders in 38 rheumatic patients with disabling pain. Fifteen of 22 synovectomized shoulders were available for examination an average of 2 years postoperatively. Twelve patients were satisfied with their operations and had painfree shoulders. Nine shoulders had almost normal mobility but four patients with an advanced shoulder arthropathy had gained little motion. Two patients with severe pain had been re-operated on with arthroplasty. In 15 patients with 18 shoulder replacements, the postoperative gain in motion was limited in all shoulders. Seven out of eleven shoulders had significant pain after hemi-arthroplasty, whereas five out of seven shoulders were painfree after total replacement. It seems that synovectomy can give results which are comparable with total arthroplasty if applied in early stages of rheumatoid disease.

Three series of experiments were performed to evaluate the effect of 20 microampère constant direct current on rabbit femora. Stainless steel cathodes were introduced into the medullary cavity and anodes were placed subcutaneously. Both femora were operated on in the same manner but only the right femur was stimulated electrically. The osteogenic effect was determined histomorphometrically in two of the series. No difference in osteogenic response between the right and the left femora was found. In the third series, the femora were divided into proportionally equal parts and bone volume, ash-weight and activity of 85Sr were determined. A non-significant increase in new bone formation in the cathodal region of the right femora was noted. Our conclusion is that direct cathodal current has a weak stimulating effect on new bone formation in rabbit femora.

Bimetallic devices composed of silver and platinum were placed in the periosteum of the right femora of 20 rats. In 40 additional rats silver or platinum rods were placed in the right femora. After six weeks there was an increase in ash weight and 85Sr activity in the femora from the animals with bimetallic rods as compared with those in which pure silver or platinum rods were implanted. After three months no differences were found between the groups.

One hundred and sixty-eight acromioclavicular joint dissections were performed on 85 cadavera, 46 men and 39 women, with an average age of 69, ranging from 18 to 92. The intra-articular discs and the joint cartilages were scrutinized and degenerative changes were graded macroscopically. An age related disintegration of the disc and the joint cartilages was found. After the age of 70 maximum degeneration was very common.

The present paper describes an experimental model where union was delayed in an osteotomy gap of the rabbit fibula by means of a silicone rubber spacer during 48 days. After the silicone spacer had been removed, electrical transistor regulated direct current of 20 microampères delivered through stainless steel electrodes was used to stimulate osteogenesis on the right side during 62 days. On the left side a sham operation inserting stainless steel electrodes without current was performed. In one out of six animals overbridging callus was received on the stimulated side. In the rest of the animals a high frequency of synostoses between the fibular ends and the tibia was found. There was no significant difference in synostosis formation between the right and the left side. No adverse effect of the current could be detected histologically.

Medial displacement of the tendon of the long biceps brachii muscle was analyzed in a dissection study on autopsy in 77 subjects, 42 men and 35 women. The tendon was found to be medially displaced in five shoulders in five different subjects (6.5%). Medial displacement of the tendon was always found in connection with full-thickness supraspinatus tendon ruptures. It is a common belief that the tendon is always displaced medially to the lesser tubercle riding over the subscapularis tendon. In the present series, this condition was found only in one case; in the other shoulders the tendon had slipped medially to the lesser tubercle under the subscapularis tendon, which was partially internally ruptured. In patients with rotator cuff lesions, medial displacement of the long biceps tendon might be one reason for pain over the front of the shoulder.

One hundred and fifty-one shoulder dissections were performed on 76 cadavera, 41 men and 35 women, with an average age of 68 (range 18-92). Before the age of 60 no degenerative changes were encountered but after 60, degeneration and full thickness ruptures of the rotator cuff, cartilage degeneration and degeneration and ruptures of the long biceps tendon appeared in an increasing frequency with age. A highly significant relationship between cuff degeneration and cartilage degeneration was found. Measurement of the thickness of normal joint cartilage of the caput humeri did not show any changes with time. Gleno-humeral degeneration was encountered bilaterally in 82 per cent and was more frequent in women, and there is little evidence that occupation is of major importance for the development of shoulder joint degeneration.

Studies on 574 subjects demonstrated the prevalence of shoulder pain and its relationship to occupational work load and psychosocial factors. The prevalence of shoulder pain was 14% (13% men, 15% women). Women had more often myalgias with a tenderness on palpation of the shoulder muscles and rhizopathia-brachialgia type of pain, whereas men had mainly intraarticular pain. Three percent had been on sick leave because of shoulder pain in the year preceding the examination and 5% had a reduced range of shoulder joint motion. The subjects with shoulder pain were less satisfied with their jobs and had been less successful in a childhood intelligence test. No difference could be demonstrated between subjects with or without shoulder pain in estimated overall work load, but women with signs of supraspinatus tendinitis more often had jobs with physical demands.

In patients with rheumatoid arthritis, shoulder problems are very common. In the present study, 96 of 105 patients, i.e., 91%, reported shoulder problems. Thirty-one percent of the patients had such severe shoulder disability that they considered it to be their main rheumatic problem. With increasing duration of the rheumatic shoulder disease, there are progressive destructive changes and a decrease in the range of motion and functional capacity even with conservative treatment, indicating that intervention with surgical procedures may be warranted. In the early effusive stages of rheumatic shoulder disease, radiological synovectomy with beta-emitting radionuclides may be indicated. In proliferative synovitis, surgical synovectomy gives good pain relief and increased shoulder mobility and function. In shoulders with more advanced painful shoulder arthropathy, shoulder replacement is gaining in popularity. However, it is mandatory that candidates must be selected very carefully for shoulder replacement and in patients with severe fibrotic capsulitis, muscular atrophy or mutilation with severe loss of bone, the results after shoulder replacement surgery are often less successful.

Fifty patients, operated on with resection of the clavicle, were evaluated postoperatively after an average of 9 years. There was no significant difference between the traumatic and non-traumatic group. The initial results did not alter significantly with time. Nearly half of the patients with poor outcome had psychiatric or alcoholic problems. Radiographic examination of 30 shoulders showed newly formed bone at the resected clavicle in one third and radio-opaque deposits in the resection gap in another third. These findings were consistent with good outcome.

Ninety-nine shoulders from 50 decreased with an average age of 73 years were dissected. There was a significant decrease in the thickness of the supraspinatus tendons with full thickness ruptures but not in partial ruptures. A highly significant increase in the length of the extramuscular supraspinatus tendon in shoulders with partial or full thickness supraspinatus ruptures was found. However, the total length of the supraspinatus aponeurosis was the same in shoulders with ruptures as in normal shoulders of the same age. This might indicate that the increase in length of the extramuscular portion of the tendon in ruptures is not caused by elongation of the tendon but is the result of muscular decay.

The acromioclavicular (AC) joint was clinically and roentgenographically examined in 49 rheumatic patients with painful shoulders. Clinically, the AC joint was tender and painful in about one-third of the shoulders. Roentgenographically, AC changes were encountered in 85% of the shoulders. The AC joint destruction was frequently associated with the glenohumeral joint disease. There was a time-dependent progression of subchondral bone erosion, tapering, and osteolysis of the acromial end of the clavicle corresponding to the duration and/or severity of the rheumatoid disease.