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Instructional Course Lectures 2024It is important to discuss the importance of synchronous balance between periscapular muscles for scapulothoracic motion and resultant scapulohumeral rhythm....
It is important to discuss the importance of synchronous balance between periscapular muscles for scapulothoracic motion and resultant scapulohumeral rhythm. Abnormalities in this balance can lead to scapular dyskinesia and winging, affecting shoulder motion and leading to impingement. Strategies exist to diagnose and differentiate between pathologies such as muscle paralysis (eg, trapezius or serratus anterior) or overactivity (eg, pectoralis minor). The physician should be aware of the role of diagnostic imaging, as well as the unique considerations for patients with Ehlers-Danlos syndrome. Overall, a comprehensive physical examination to accurately diagnose and treat scapular pathologies is particularly important.
Topics: Humans; Electromyography; Scapula; Shoulder; Muscle, Skeletal; Dyskinesias
PubMed: 38090928
DOI: No ID Found -
Radiographics : a Review Publication of... Dec 2023Overhead throwing, particularly in baseball, subjects the shoulder and elbow to various unique injuries. Capsular contracture following repetitive external rotation...
Overhead throwing, particularly in baseball, subjects the shoulder and elbow to various unique injuries. Capsular contracture following repetitive external rotation shifts the humeral head posterosuperiorly, predisposing to glenohumeral internal rotation deficit (GIRD), Bennett, posterosuperior internal impingement (PSI), and superior labrum anterior-posterior (SLAP) lesions. GIRD represents loss of internal rotation at the expense of external rotation. Bennett lesion represents ossification of the posteroinferior glenohumeral ligament due to repetitive traction. PSI manifests with humeral head cysts and "kissing" tears of the posterosuperior cuff and labrum. Scapular dysfunction contributes to symptoms of PSI and predisposes to labral or rotator cuff disease. "Peel-back" or SLAP lesions occur when torsional forces detach the biceps-labral anchor from the glenoid. Finally, disorders of the anterior capsule, latissimus dorsi, teres major, and subscapularis are well recognized in overhead throwers. At the elbow, injuries typically involve the medial-sided structures. The ulnar collateral ligament (UCL) is the primary static restraint to valgus stress and can be thickened, attenuated, ossified, and/or partially or completely torn. Medial epicondylitis can occur with tendinosis, partial tear, or complete rupture of the flexor-pronator mass and can accompany UCL tears and ulnar neuropathy. Posteromedial impingement (PMI) and valgus extension overload syndrome are related entities that follow abundant valgus forces during late cocking or acceleration, and deceleration. These valgus stresses wedge the olecranon into the olecranon fossa, leading to PMI, osteophytes, and intra-articular bodies. Other osseous manifestations include olecranon stress fracture and cortical thickening of the humeral shaft. RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Topics: Humans; Adult; Shoulder; Elbow Injuries; Rotator Cuff; Shoulder Joint; Scapula; Shoulder Injuries; Rotator Cuff Injuries; Athletic Injuries
PubMed: 37917538
DOI: 10.1148/rg.230094 -
Applied Ergonomics Sep 2023While the biomechanical effects of exoskeletons are well studied, research about potential side-effects and adverse events are limited. The aim of this systematic review... (Review)
Review
INTRODUCTION
While the biomechanical effects of exoskeletons are well studied, research about potential side-effects and adverse events are limited. The aim of this systematic review was to provide an overview of the side-effects and adverse events on shoulder- and back-support exoskeletons during work tasks.
METHODS
Four in-field studies and 32 laboratory studies were included in this review, reporting on n = 18 shoulder exoskeletons, n = 9 back exoskeletons, n = 1 full body with a supernumerary arm, and n = 1 combination of shoulder and back exoskeleton.
RESULTS
The most frequent side-effect reported is discomfort (n = 30), followed by a limited usability of the exoskeleton (n = 16). Other identified side-effects and adverse events were changes in muscle activity, mobility, task performance, balance and posture, neurovascular supply, gait parameters and precision. An incorrect fit of the exoskeleton and the decreased degrees of freedom are most often reported as causes of these side-effects. Two studies did not find any side-effects. This review also showed that there are differences in the occurrence of side-effects in gender, age, and physical fitness. Most studies (89%) were conducted in a laboratory setting. Most studies (97%) measured short-term effects only. Psychological and social side-effects or adverse events were not reported. Side-effects and adverse events for active exoskeletons were understudied (n = 4).
CONCLUSION
It was concluded that the evidence for side-effects and adverse events is limited. If available, it mainly consists of reports of mild discomfort and limited usability. Generalisation is limited because studies were conducted in lab settings and measured short term only, and most participants were young male workers.
Topics: Humans; Male; Shoulder; Exoskeleton Device; Upper Extremity; Posture; Task Performance and Analysis; Biomechanical Phenomena; Electromyography
PubMed: 37146320
DOI: 10.1016/j.apergo.2023.104042 -
Journal of Shoulder and Elbow Surgery Oct 2023Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in... (Review)
Review
BACKGROUND
Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in order to achieve optimal component precision and joint alignment and stability, preserve implant longevity, and improve patient outcomes. Future advancements such as robotic-assisted surgeries, augmented reality, artificial intelligence, patient-specific instrumentation (PSI) and other peri- and preoperative planning tools will continue to revolutionize TSA. Robotic-assisted arthroplasty is a novel and increasingly popular alternative to the conventional arthroplasty procedure in the hip and knee but has not yet been investigated in the shoulder. Therefore, the purpose of this study was to conduct a narrative review of the literature on the evolution and projected trends of technological advances and robotic assistance in total shoulder arthroplasty.
METHODS
A narrative synthesis method was employed for this review, rather than a meta-analysis or systematic review of the literature. This decision was based on 2 primary factors: (1) the lack of eligible, peer-reviewed studies with high-quality level of evidence available for review on robotic-assisted shoulder arthroplasty, and (2) a narrative review allows for a broader scope of content analysis, including a comprehensive review of all technological advances-including robotics-within the field of TSA. A general literature search was performed using PubMed, Embase, and Cochrane Library databases. These databases were queried by 2 independent reviewers from database inception through November 11, 2022, for all articles investigating the role of robotics and technology assistance in total shoulder arthroplasty. Inclusion criteria included studies describing "shoulder arthroplasty" and "robotics."
RESULTS
After exclusion criteria were applied, 4 studies on robotic-assisted TSA were described in the review. Given the novelty of this technology and limited data on robotics in TSA, these studies consisted of a literature review, nonvalidated experimental biomechanical studies in sawbones models, and preclinical proof-of-concept cadaveric studies using prototype robotic technology primarily in conjunction with PSI. The remaining studies described the technological advancements in TSA, including PSI, computer-assisted navigation, artificial intelligence, machine learning, and virtual, augmented, and mixed reality. Although not yet commercially available, robotic-assisted TSA confers the theoretical advantages of precise humeral head cuts for restoration of proximal humerus anatomy, more accurate glenoid preparation, and improved soft-tissue assessment in limited early studies.
CONCLUSION
The evidence for the use of robotics in total hip arthroplasty and total knee arthroplasty demonstrates improved component accuracy, more precise radiographic measurements, and improved early/mid-term patient-reported and functional outcomes. Although no such data currently exist for shoulder arthroplasty given that the technology has not yet been commercialized, the lessons learned from robotic hip and knee surgery in conjunction with its rapid adoption suggests robotic-assisted TSA is on the horizon of innovation. By achieving a better understanding of the past, present, and future innovations in TSA through this narrative review, orthopedic surgeons can be better prepared for future applications.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Artificial Intelligence; Inventions; Shoulder; Surgery, Computer-Assisted; Arthroplasty, Replacement, Knee
PubMed: 37263482
DOI: 10.1016/j.jse.2023.04.022 -
Journal of Shoulder and Elbow Surgery Sep 2023The long head of the biceps tendon (LHBT) has different properties and characteristics that render it a valuable tool in the hands of shoulder surgeons. Its... (Review)
Review
ANATOMY AND FUNCTION
The long head of the biceps tendon (LHBT) has different properties and characteristics that render it a valuable tool in the hands of shoulder surgeons. Its accessibility, biomechanical strength, regenerative capabilities, and biocompatibility allow it to be a valuable autologous graft for repairing and augmenting ligamentous and muscular structures in the glenohumeral joint.
SHOULDER SURGERY APPLICATIONS
Numerous applications of the LHBT have been described in the shoulder surgery literature, including augmentation of posterior-superior rotator cuff repair, augmentation of subscapularis peel repair, dynamic anterior stabilization, anterior capsule reconstruction, post-stroke stabilization, and superior capsular reconstruction. Some of these applications have been described meticulously in technical notes and case reports, whereas others may require additional research to confirm clinical benefit and efficacy.
CONCLUSION
This review examines the role of the LHBT as a source of local autograft, with biological and biomechanical properties, in aiding outcomes of complex primary and revision shoulder surgery procedures.
Topics: Humans; Shoulder; Rotator Cuff Injuries; Tenodesis; Arthroscopy; Tendons; Shoulder Joint
PubMed: 37245621
DOI: 10.1016/j.jse.2023.04.009 -
The American Journal of Sports Medicine Nov 2023Although Hill-Sachs lesions (HSLs) are assumed to be influenced by glenoid characteristics in the context of bipolar bone loss, little is known about how glenoid...
BACKGROUND
Although Hill-Sachs lesions (HSLs) are assumed to be influenced by glenoid characteristics in the context of bipolar bone loss, little is known about how glenoid concavity influences HSL morphology.
PURPOSE
To investigate the relationship between the native glenoid depth and HSL morphological characteristics.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
Computed tomography images of bilateral shoulders from 151 consecutive patients with traumatic unilateral anterior shoulder instability were retrospectively reviewed. Patients were categorized into flat (<1 mm), moderate (1-2 mm), and deep (>2 mm) groups based on the native glenoid depth measured from the contralateral unaffected shoulder. The HSL morphological characteristics included size (depth, width, length, and volume), location (medial, superior, and inferior extent), and orientation (rim and center angle). The glenoid characteristics included diameter, depth, version, and bone loss. The patient, glenoid, and HSL morphological characteristics were compared among the 3 depth groups. Subsequently, the independent predictors of some critical HSL morphological characteristics were determined using multivariate stepwise regression.
RESULTS
After exclusion of 55 patients, a total of 96 patients were enrolled and classified into the flat group (n = 31), moderate group (n = 35), and deep group (n = 30). Compared with those in the flat group, patients in the deep group were more likely to have dislocation (38.7% vs 93.3%; = .009) at the primary instability and had a significantly larger number of dislocations (1.1 ± 1.0 vs 2.2 ± 1.8; = .010); moreover, patients in the deep group had significantly deeper, wider, larger volume, more medialized HSLs and higher incidences of off-track HSLs (all ≤ .025). No significant differences were detected among the 3 groups in HSL length, vertical position, and orientation (all ≥ .064). After adjustment for various radiological and patient factors in the multivariate regression model, native glenoid depth remained the strongest independent predictor for HSL depth (β = 0.346; < .001), width (β = 0.262; = .009), volume (β = 0.331; = .001), and medialization (β = -0.297; = .003).
CONCLUSION
The current study sheds light on the association between native glenoid depth and the morphology of HSLs in traumatic anterior shoulder instability. Native glenoid depth was independently and positively associated with HSL depth, width, volume, and medialization. Patients with deeper native glenoids were more likely to have off-track HSLs and thus require more attention in the process of diagnosis and treatment.
Topics: Humans; Shoulder; Shoulder Joint; Shoulder Dislocation; Joint Instability; Retrospective Studies; Bankart Lesions; Cross-Sectional Studies; Joint Dislocations; Recurrence
PubMed: 37740546
DOI: 10.1177/03635465231200246 -
Instructional Course Lectures 2024A comprehensive review of scapular pathologies and their effect on shoulder function is necessary to determine the best treatment options. The coordinated motion between... (Review)
Review
A comprehensive review of scapular pathologies and their effect on shoulder function is necessary to determine the best treatment options. The coordinated motion between the scapulothoracic and glenohumeral joints is essential for shoulder motion and depends on the balanced activity of the periscapular muscles. Disruption in these muscles can cause abnormal scapular motion and compensatory glenohumeral movements, leading to misdiagnosis or delayed diagnosis. Scapular pathologies can arise from muscle overactivity or underactivity/paralysis, resulting in a range of scapulothoracic abnormal motion (STAM). STAM can lead to various glenohumeral pathologies, including instability, impingement, or nerve compression. It is important to highlight the critical periscapular muscles involved in scapulohumeral rhythm (such as the upper, middle, and lower trapezius; rhomboid major and minor; serratus anterior; levator scapulae; and pectoralis minor). A discussion of the different etiologies of STAM should include examples of muscle dysfunction, such as overactivity of the pectoralis minor, underactivity or paralysis of the serratus anterior or trapezius muscles, and dyskinesis resulting from compensatory mechanisms in patients with recurrent glenohumeral instability due to Ehlers-Danlos syndrome. The evaluation and workup of STAM has shown that patients typically present with radiating shoulder pain, especially in the posterior aspect of the shoulder and scapula, and limitations in active shoulder overhead motion associated with glenohumeral pain, instability, or rotator cuff pathologies.
Topics: Humans; Biomechanical Phenomena; Electromyography; Paralysis; Range of Motion, Articular; Scapula; Shoulder; Shoulder Joint; Superficial Back Muscles
PubMed: 38090927
DOI: No ID Found -
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 -
Radiologie (Heidelberg, Germany) Feb 2024
Topics: Shoulder; Shoulder Joint; Upper Extremity
PubMed: 38276991
DOI: 10.1007/s00117-024-01262-8 -
Sports Biomechanics Sep 2023The purpose of this study was to assess the effects of stroke rate and sex on trunk and shoulder kinematics of Olympic athletes during rowing on an ergometer....
The purpose of this study was to assess the effects of stroke rate and sex on trunk and shoulder kinematics of Olympic athletes during rowing on an ergometer. Fifty-eight participants (31 females and 27 males) from the Chinese National Rowing Team were recruited. Trunk (i.e., the pelvis, lumbar and thoracic spine) and shoulder kinematics were measured using an inertial measurement unit system for three stroke rates (18, 26, and 32 strokes/min). Range of motion and angles at the catch and finish were assessed using mixed model ANOVA and correlation analyses with rowing power. Range of motion increased significantly at higher rates for both female and male athletes. This may be a strategy used by athletes when dealing with higher demand for power during training, because a greater range of motion with a longer stroke length could reduce the demand for force generation and possibly delay fatigue. Female rowers exhibited greater range of motion in the lumbar spine, thorax and shoulders than males due to more extended positions at the finish. The sex-related kinematic differences may be attributed to differences in body size, muscle strength and endurance. Practitioners are recommended to consider these factors when developing rowing techniques and providing training suggestions.
Topics: Humans; Male; Female; Shoulder; Biomechanical Phenomena; Sports; Athletes; Water Sports
PubMed: 32677503
DOI: 10.1080/14763141.2020.1781238