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Magnetic Resonance Imaging Clinics of... May 2020This article discusses the most common tumor and tumor-like lesions arising at the shoulder. Osseous tumors of the shoulder rank second in incidence to those at the knee... (Review)
Review
This article discusses the most common tumor and tumor-like lesions arising at the shoulder. Osseous tumors of the shoulder rank second in incidence to those at the knee joint and include benign osteochondromas and myeloma or primary malignant lesions, such as osteosarcoma or chondrosarcomas. Soft tissue tumors are overwhelmingly benign, with lipomas predominating, although malignant lesions, such as liposarcomas, can occur. Numerous tumor-like lesions may arise from the joints or bursae, due to either underlying arthropathy and synovitis (eg, rheumatoid arthritis and amyloid) or related to conditions, including tenosynovial giant cell tumor and synovial osteochondromatosis.
Topics: Animals; Bone Neoplasms; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Shoulder; Soft Tissue Neoplasms; Ultrasonography
PubMed: 32241665
DOI: 10.1016/j.mric.2019.12.011 -
The Orthopedic Clinics of North America Jan 2023The proximal humerus is a common location for primary tumors, benign lesions, and metastatic disease. Advances in neoadjuvant and adjuvant therapy have allowed for... (Review)
Review
The proximal humerus is a common location for primary tumors, benign lesions, and metastatic disease. Advances in neoadjuvant and adjuvant therapy have allowed for limb-salvage surgery in most of the cases. There are numerous of options for surgical management of proximal humerus lesions and the decision to pursue one over another depends on factors such as age, comorbidities, pathology, location within the proximal humerus, planned resection margins/size of defect, and bone quality. Long-term outcomes for these techniques tend to be retrospective comparative studies, with recent studies highlighting the improved outcomes of reverse total shoulders.
Topics: Humans; Shoulder; Retrospective Studies; Bone Neoplasms; Humerus; Epiphyses
PubMed: 36402514
DOI: 10.1016/j.ocl.2022.08.008 -
Arthroscopy : the Journal of... Mar 2021One of the most-read articles published in the history of Arthroscopy: The Journal of Arthroscopic and Related Surgery is "Evolving Concept of Bipolar Bone Loss and the...
One of the most-read articles published in the history of Arthroscopy: The Journal of Arthroscopic and Related Surgery is "Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion: From 'Engaging/Non-Engaging' Lesion to 'On-Track/Off-Track' Lesion" by Di Giacomo, Itoi, and Burkhart. This 2014 article is a modern classic and has inspired a plethora of recent research as well as infographics published in Arthroscopy. We now understand, to the great benefit of patients, that proper evaluation of bone loss determines shoulder instability surgical indications and outcomes.
Topics: Arthroscopy; Bankart Lesions; Humans; Joint Instability; Orthopedics; Recurrence; Shoulder; Shoulder Dislocation; Shoulder Joint
PubMed: 33673960
DOI: 10.1016/j.arthro.2021.01.004 -
Medical Ultrasonography Sep 2023Peripheral nerve blocks have long been established as a crucial part of the enhanced recovery pathways after surgery. Interscalene brachial plexus block (ISB) is mainly...
Peripheral nerve blocks have long been established as a crucial part of the enhanced recovery pathways after surgery. Interscalene brachial plexus block (ISB) is mainly indicated for anaesthesia and analgesia during shoulder and proximal arm surgery. Ultrasound technology has remarkably improved the efficacy and success rates of the ISB while limiting its potential complications.
Topics: Humans; Brachial Plexus Block; Anesthetics, Local; Ultrasonography; Shoulder; Ultrasonography, Interventional
PubMed: 36780597
DOI: 10.11152/mu-3885 -
The Journal of the American Academy of... May 2022We aimed to determine whether preoperative shoulder strength predicts postoperative values and improvement in strength, range of motion (ROM), and outcome scores after...
INTRODUCTION
We aimed to determine whether preoperative shoulder strength predicts postoperative values and improvement in strength, range of motion (ROM), and outcome scores after primary reverse total shoulder arthroplasty (rTSA).
METHODS
We retrospectively reviewed 264 shoulders with a minimum of 2-year follow-up after primary rTSA. Preoperative external rotation (ER) strength, supraspinatus strength, and abduction strength were analyzed to establish their correlation with postoperative values and improvement in strength, ROM, and outcome scores (Constant score, American Shoulder and Elbow Surgeons Shoulder score, Shoulder Pain and Disability Index, Simple Shoulder Test, and the University of California, Los Angeles score). Multiple linear regression models were used to identify the preoperative shoulder strength measures that most affected postoperative outcomes and improvement in outcomes.
RESULTS
Preoperative measures of shoulder strength were positively correlated with all measures of postoperative shoulder strength, active abduction and elevation, and all outcome scores studied. On multivariate analysis, greater preoperative ER, supraspinatus, and abduction strength were significantly associated with greater corresponding postoperative values (P = 0.009, P = 0.041, and P = 0.008, respectively); however, they were also associated with less respective improvement (P < 0.001 for all) because the weakest patients tended to see the largest improvements. Notably, preoperative values of ER and supraspinatus strength exceeding 17.5 and 20.5 lbs were associated with a decline in their respective values postoperatively, but no limit was identified for ROM or outcome score measures. On multivariate analysis, reduced preoperative abduction strength was markedly associated with greater improvement in 3 of 4 ROM measures and 4 of 5 outcome scores.
CONCLUSION
Preoperative shoulder strength, especially abduction strength, predicts superior postoperative outcomes and greater improvement in shoulder strength, ROM, and outcome scores after primary rTSA. However, a minority of patients with well-preserved strength may lose strength after surgery, and patients who are weaker preoperatively tend to see larger improvements in postoperative outcomes.
LEVEL OF EVIDENCE
Ⅳ, prognostic study.
Topics: Arthroplasty, Replacement, Shoulder; Humans; Range of Motion, Articular; Retrospective Studies; Shoulder; Shoulder Joint; Treatment Outcome
PubMed: 35171873
DOI: 10.5435/JAAOS-D-21-00945 -
PloS One 2020Positional information on the shoulder girdle (the clavicle and scapula) is important for a better understanding of the function of the upper limb in the locomotive...
Positional information on the shoulder girdle (the clavicle and scapula) is important for a better understanding of the function of the upper limb in the locomotive system as well as its associated disease pathogenesis. However, such data are limited except for information on the axial position of the scapula. Here, we describe a three-dimensional reconstruction of the shoulder girdle including the clavicle and scapula, and its relationship to different landmarks in the body. Thirty-six human fetal specimens (crown-rump length range: 7.6-225 mm) from the Kyoto Collection were used for this study. The morphogenesis and three-dimensional position of the shoulder girdle were analyzed with phase-contrast X-ray computed tomography and magnetic resonance imaging. We first detected the scapula body along with the coracoid and humeral head at Carnegie stage 18; however, the connection between the body and coracoid was not confirmed at this stage. During development, all landmarks on the shoulder girdle remained at the same axial position except for the inferior angle, which implies that the scapula enlarged in the caudal direction and reached the adult axial position in the fetal period. The scapula body was rotated internally and in the upward direction at the initiation of morphogenesis, but in the fetal period the scapula body was different than that in the adult position. The shoulder girdle was located at the ventral side of the vertebrae at the time of initial morphogenesis, but changed its position to the lateral side of the vertebrae in the late embryonic and fetal periods. Such a unique position of the shoulder girdle may contribute to the stage-specific posture of the upper limb. Adequate internal and upward rotation of the scapula could help in reducing the shoulder width, thereby facilitating childbirth. The data presented in this study can be used as normal morphometric references for shoulder girdle evaluations in the embryonic and fetal periods.
Topics: Fetal Development; Growth and Development; Humans; Range of Motion, Articular; Shoulder; Shoulder Joint; Upper Extremity
PubMed: 32915841
DOI: 10.1371/journal.pone.0238225 -
Clinical Anatomy (New York, N.Y.) Mar 2017The subacromial bursa (SAB) is the main bursa of the shoulder. It facilitates normal movement and is also commonly involved in shoulder disorders. Other shoulder bursae... (Review)
Review
The subacromial bursa (SAB) is the main bursa of the shoulder. It facilitates normal movement and is also commonly involved in shoulder disorders. Other shoulder bursae have been described but their anatomy has not been well studied. Anatomical variation of shoulder bursae has been suggested and this has implications for clinical practice. This article reviews current knowledge of the normal anatomy of the SAB and related shoulder bursae. A systematic review of the English and German literature was conducted using databases and a hand search of reference lists focusing on the clinical anatomy of the SAB, coracobrachial and subcoracoid bursae and subtendinous bursa of subscapularis. Twenty-four original sources and 13 textbooks were identified. Fifteen studies described the general morphology of the shoulder bursae using cadaveric specimens, eight examined innervation, and one provided information about the blood supply of the SAB. The literature agrees that the SAB is consistent and well innervated with a lateral subdeltoid part and a variable subcoracoid portion. There is variability regarding the consistency, location, and communications of the coracobrachial and subcoracoid bursae and the superior part of the subtendinous bursa of subscapularis, and little information on their nerve and blood supply. Several bursae are present around the shoulder joint. Further research is warranted to understand the precise attachments, dimensions, and communications of the bursae, as well as their nerve and blood supply. This information will improve understanding of the clinical relevance of these bursae and inform appropriate assessment and treatment. Clin. Anat. 30:213-226, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Humans; Shoulder; Shoulder Joint
PubMed: 28033656
DOI: 10.1002/ca.22823 -
Clinical Biomechanics (Bristol, Avon) Jul 2023There is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the...
BACKGROUND
There is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the changes in the scapulohumeral rhythm and shoulder kinematics over time after the reverse shoulder procedure.
METHODS
Nineteen patients with reverse shoulder arthroplasty (age: 65.8 ± 10.3 years) were included to the study. During arm elevation in the sagittal and scapular planes, operated shoulder kinematics (humerothoracic elevation, glenohumeral elevation, scapulohumeral rhythm, and scapular rotations) were assessed using an electromagnetic tracking system at the postoperative 3rd, 6th, and 18th months. Asymptomatic shoulder kinematics were also assessed at the postoperative 18th month. Shoulder function was assessed using The Disabilities of the Arm Shoulder and Hand score at the postoperative 3rd, 6th, and 18th months.
FINDINGS
Maximum humerothoracic elevation increased from 98° to 109° over the postoperative period (p = 0.01). The scapulohumeral rhythm was similar on the operated and asymptomatic shoulders at the final follow-up (p = 0.11). Both the operated and asymptomatic shoulder demonstrated similar scapular kinematics at the postoperative 18th month (p > 0.05). The Disabilities of the Arm Shoulder and Hand score decreased over time in the postoperative period (p < 0.05).
INTERPRETATION
Shoulder kinematics may be improved after reverse shoulder arthroplasty in the postoperative period. Focusing on scapular stabilization and deltoid muscle control in the postoperative rehabilitation program may enhance the shoulder kinematics and upper extremity function.
Topics: Humans; Middle Aged; Aged; Shoulder; Biomechanical Phenomena; Shoulder Joint; Arthroplasty, Replacement, Shoulder; Range of Motion, Articular; Scapula
PubMed: 37267895
DOI: 10.1016/j.clinbiomech.2023.106013 -
Sports Medicine and Arthroscopy Review Dec 2018This article presents a retrospective comprehensive review of the history of anterior, posterior, and multidirectional shoulder instability and also reviews key concepts... (Review)
Review
This article presents a retrospective comprehensive review of the history of anterior, posterior, and multidirectional shoulder instability and also reviews key concepts such as open versus arthroscopic repair and glenoid and humeral head bone loss and associated treatments. The future of shoulder instability will continue to evolve as research and clinical experience will determine the direction of the future.
Topics: Arthroscopy; Humans; Joint Instability; Shoulder
PubMed: 30395061
DOI: 10.1097/JSA.0000000000000211 -
Journal of Biomechanical Engineering Nov 2022Mechanically passive exoskeletons may be a practical and affordable solution to meet a growing clinical need for continuous, home-based movement assistance. We designed,...
Mechanically passive exoskeletons may be a practical and affordable solution to meet a growing clinical need for continuous, home-based movement assistance. We designed, fabricated, and preliminarily evaluated the performance of a wearable, passive, cam-driven shoulder exoskeleton (WPCSE) prototype. The novel feature of the WPCSE is a modular spring-cam-wheel module, which generates an assistive force that can be customized to compensate for any proportion of the shoulder elevation moment due to gravity. We performed a benchtop experiment to validate the mechanical output of the WPCSE against our theoretical model. We also conducted a pilot biomechanics study (eight able-bodied subjects) to quantify the effect of a WPCSE prototype on muscle activity and shoulder kinematics during three shoulder movements. The shoulder elevation moment produced by the spring-cam-wheel module alone closely matched the desired theoretical moment. However, when measured from the full WPCSE prototype, the moment was lower (up to 30%) during positive shoulder elevation and higher (up to 120%) during negative shoulder elevation compared to the theoretical moment, due primarily to friction. Even so, a WPCSE prototype, compensating for about 25% of the shoulder elevation moment due to gravity, showed a trend of reducing root-mean-square electromyogram magnitudes of several muscles crossing the shoulder during shoulder elevation and horizontal adduction/abduction movements. Our results also showed that the WPCSE did not constrain or impede shoulder movements during the tested movements. The results provide proof-of-concept evidence that our WPCSE can potentially assist shoulder movements against gravity.
Topics: Biomechanical Phenomena; Exoskeleton Device; Humans; Shoulder; Upper Extremity; Wearable Electronic Devices
PubMed: 35599348
DOI: 10.1115/1.4054639