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PM & R : the Journal of Injury,... Jun 2020Various active recording electrode positions for the trapezius motor nerve conduction study have been suggested.
BACKGROUND
Various active recording electrode positions for the trapezius motor nerve conduction study have been suggested.
OBJECTIVE
To determine the optimal recording site of the trapezius muscles in a spinal accessory nerve conduction study.
DESIGN
Retrospective descriptive study.
SETTING
Department of physical medicine and rehabilitation in a tertiary clinic center.
PARTICIPANTS
Thirty-four patients between 33 and 82 years of age with preoperative head and neck cancer (68 upper and middle trapezius muscles).
INTERVENTIONS
Analysis of compound muscle action potentials (CMAPs) of upper and middle trapezius.
MAIN OUTCOME MEASUREMENTS
CMAP latency and amplitudes were obtained at five and four recording points with constant intervals on the horizontal line of the upper and middle trapezius, respectively.
RESULTS
The maximum CMAP amplitude of the upper trapezius was (mean ± SD) 8.5 ± 1.4 mV with the recording at the midpoint between the C7 spinous process and the lateral margin of the acromion. The maximum CMAP amplitude of the middle trapezius was 4.2 ± 1.4 mV, recorded on the horizontal line at the junction of the middle and lateral thirds between the root of the scapular spine and the vertebral spinous process.
CONCLUSION
The optimal recording site in motor nerve conduction study of the trapezius is the midpoint between the C7 spinous process and the acromion for the upper trapezius, and the junction of middle and lateral thirds of the line between the root of scapular spine and the vertebral spine for the middle trapezius.
Topics: Adult; Aged; Aged, 80 and over; Electrodes; Electromyography; Head and Neck Neoplasms; Humans; Middle Aged; Rehabilitation Centers; Retrospective Studies; Spine; Superficial Back Muscles; Tertiary Care Centers
PubMed: 31677234
DOI: 10.1002/pmrj.12278 -
Archives of Orthopaedic and Trauma... Sep 2023There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition... (Review)
Review
INTRODUCTION
There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition and the confusion of terminology.
MATERIALS AND METHODS
PubMed and Scopus were searched using "scapular fracture" and "acromion fracture" or "scapular spine fracture" as search terms. The inclusion criteria were English full-text articles concerning acromion/scapular spine fracture nonunion that described patient characteristics and presented appropriate images. The exclusion criteria were cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using our newly proposed classification system.
RESULTS
Twenty-nine patients (19 men, 10 women) with 29 nonunions were identified. There were four type I, 15 type II, and 10 type III fracture nonunions. Only 11 fractures were isolated. The mean period from initial injury to final diagnosis was 35.2 ± 73.2 months (range 3-360 months) (n = 25). The most frequent cause of delayed diagnosis was conservative treatment for fracture in 11 patients, followed by oversight by the physician in 8. The most common reason for seeking medical advice was shoulder pain. Six patients received conservative therapy, and 23 received operative treatment. Fixation materials included various plates in 15 patients, and tension band wiring in 5. Bone grafting was performed in 16 patients (73%, 16/22). Of the 19 surgically treated patients with adequate follow-up, the outcome was rated excellent in 79%.
CONCLUSIONS
Isolated acromion/scapular spine fracture nonunion is rare. Fracture type II and III, arising in the anatomical scapular spine, accounted for 86% of the fractures. Computed tomography is required to prevent fracture oversight. Surgical therapy produces good stable results. However, it is important to select the appropriate surgical fixation method and material after considering the anatomical characteristics of the fracture and stress on the fractured portion.
LEVEL OF EVIDENCE
V.
Topics: Male; Humans; Female; Acromion; Spinal Fractures; Fractures, Bone; Scapula; Fracture Fixation, Internal; Fractures, Ununited; Shoulder Fractures; Treatment Outcome
PubMed: 37314525
DOI: 10.1007/s00402-023-04912-z -
Folia Morphologica 2022Due to its many variations, the scapula is among the most frequently examined bones. Especially the acromion can be of different shapes and sizes. Measurements of the...
BACKGROUND
Due to its many variations, the scapula is among the most frequently examined bones. Especially the acromion can be of different shapes and sizes. Measurements of the morphometric structures in the shoulder joint make it easier to explain the cause of the various shoulder problems. The objective of this study is putting emphasis on the importance of acromion types, os acromiale presence and acromial morphometric measurements in the aetiology and diagnosis of shoulder pain.
MATERIALS AND METHODS
A retrospective study, based on 100 patients of both genders who presented with the complaints of shoulder pain and underwent magnetic resonance imaging, was conducted. Within this scope, types of acromion, slope of acromion, length of acromion, length of coracoid process, the distance between acromion and coracoid process, lateral acromial angle (LAA), critical shoulder angle (CSA), acromial index (AI) and acromiohumeral distance were measured. The data were analysed considering the gender and acromion types and the presence of os acromiale is investigated.
RESULTS
The most common acromion was type II (curved) (frequency rate 62%) while the rate of type I (flat) and type III (hooked) acromions were 21% and 17%, respectively. The length of acromion and coracoid process were found to be significantly longer in males, while no significant difference between genders in terms of the distance between acromion and coracoid process were observed. Furthermore, while negative correlation between LAA and AI as well as LAA and CSA were observed; positive correlation between AI and CSA was found. In addition, there was negative correlation between slope of acromion and acromiohumeral distance. Besides, acromiohumeral distance was significantly higher in males. Regarding the presence of os acromiale, it was observed in 3 women out of 59 and 2 men out of 41, which indicated no significant difference between genders.
CONCLUSIONS
It is evaluated that the morphometric measurement is of importance in contributing clinically in distinguishing the problems that may occur according to gender and acromion types.
Topics: Female; Humans; Male; Shoulder; Retrospective Studies; Shoulder Pain; Acromion; Scapula
PubMed: 34545562
DOI: 10.5603/FM.a2021.0087 -
Journal of Shoulder and Elbow Surgery Sep 2023Scapular notching is a well-known postoperative complication of reverse total shoulder arthroplasty (RTSA). However, subacromial notching (SaN), a subacromial erosion...
BACKGROUND
Scapular notching is a well-known postoperative complication of reverse total shoulder arthroplasty (RTSA). However, subacromial notching (SaN), a subacromial erosion caused by repeated abduction impingement after RTSA, has not been previously reported in a clinical setting. Therefore, this study aimed to assess the risk factors and functional outcomes of SaN after RTSA.
METHODS
We retrospectively reviewed the medical records of 125 patients who underwent RTSA with the same design between March 2014 and May 2017 and had at least 2 years of follow-up. SaN was defined as subacromial erosion observed at the final follow-up but not on the X-ray 3 months after surgery. Radiologic parameters representing the patient's native anatomy and degrees of lateralization and/or distalization during surgery were evaluated using preoperative and 3 months postoperative X-rays. The visual analogue scale of pain, active range of motion, and American Shoulder and Elbow Surgeons score were assessed preoperatively and at the final follow-up to evaluate the functional outcomes of SaN.
RESULTS
SaN occurred in 12.8% (16/125) of enrolled patients during the study period. Preoperative center of rotation-acromion distance (P = .009) and postoperative humerus lateralization offset, which evaluated the degree of lateralization after RTSA (P = .003), were risk factors for SaN. The preoperative center of rotation-acromion distance and postoperative humerus lateralization cutoff values were 14.0 mm and 19.0 mm, respectively. The visual analogue scale of pain (P = .01) and American Shoulder and Elbow Surgeons score (P = .04) at the final follow-up were significantly worse in patients with SaN.
CONCLUSIONS
SaN might adversely affect postoperative clinical outcomes. As SaN correlated with patients' anatomical characteristics and degree of lateralization during RTSA, the implant's degree of lateralization should be adjusted according to the patient's own anatomical characteristics.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Retrospective Studies; Treatment Outcome; Pain; Range of Motion, Articular; Shoulder Prosthesis
PubMed: 37024040
DOI: 10.1016/j.jse.2023.03.009 -
The Indian Journal of Radiology &... Oct 2021Acromion is essential for stabilizing the shoulder complex. Tumors of the acromion are rare. We report the largest series of acromion tumor and tumor-like lesion....
Acromion is essential for stabilizing the shoulder complex. Tumors of the acromion are rare. We report the largest series of acromion tumor and tumor-like lesion. A retrospective review of the oncology and radiology database within our tertiary center for orthopaedic oncology was performed to identify all tumors of the acromion over the past 30 years and imaging was reviewed. We identified a total of 31 lesions arising in the acromion and chondrosarcoma was the commonest. One needs to be aware of tumor and tumor-like lesions of acromion.
PubMed: 35136496
DOI: 10.1055/s-0041-1735916 -
Arthroscopy : the Journal of... Jan 2022The intact rotator cuff provides dynamic stability for the glenohumeral joint through range of motion by compressing the humeral head to the center of the glenoid....
The intact rotator cuff provides dynamic stability for the glenohumeral joint through range of motion by compressing the humeral head to the center of the glenoid. Maintenance of articular congruity provides a stable fulcrum for the more forceful muscles of the shoulder girdle. Massive rotator cuff tears disrupt the concavity-compression mechanism and lead to unopposed superior pull of the deltoid. As a result, superior migration of the humerus, abutment of the acromion, and, in some cases, progression to cuff tear arthropathy occur. Arthroscopic superior capsular reconstruction has emerged as an effective treatment in select indications. Several potential biomechanical advantages to SCR have been described on the basis of cadaver studies. By tethering the greater tuberosity to the glenoid, superior migration is resisted, and the center of rotation is stabilized. The interpositional spacer effect describes reduced subacromial contact pressure, and the reduction is greater with thicker grafts. Side-to-side suturing of the graft to residual tendon and capsule achieves capsular continuity and may further improve the stabilizing function of the residual capsule and prevent medial-lateral elongation of the graft. Although these biomechanical principles overlap to some degree, their summation offers an explanation for the improved pain and function seen in patients who undergo superior capsular reconstruction.
Topics: Biomechanical Phenomena; Cadaver; Humans; Range of Motion, Articular; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint
PubMed: 34972555
DOI: 10.1016/j.arthro.2021.11.011 -
The major pain source of rotator cuff-related shoulder pain: A narrative review on current evidence.Musculoskeletal Care Jun 2023Rotator cuff-related shoulder pain (RCRSP) was proposed to have a complex pain mechanism, but the exact aetiology is still unclear. A recent review summarised the... (Review)
Review
BACKGROUND
Rotator cuff-related shoulder pain (RCRSP) was proposed to have a complex pain mechanism, but the exact aetiology is still unclear. A recent review summarised the updated research to analyse the traditional concept of shoulder impingement which may not be accurate. Current studies have demonstrated that mechanical factors including a reduction in subacromial space, scapular dyskinesia and different acromial shapes are unlikely directly contributing to RCRSP.
AIMS
Since the precise RCRSP pain mechanism remains unclear, the aim of this narrative review is to discuss possible sources of pain contributing to RCRSP according to the mechanisms-based pain classifications.
RESULTS AND DISCUSSION
Research findings on potential mechanical nociceptive factors of RCRSP are conflicting; investigations of neuropathic and central pain mechanisms of RCRSP are limited and inconclusive. Overall, available evidence has indicated moderate to strong correlations between RCRSP and chemical nociceptive sources of pain.
CONCLUSION
Results from current research may provide new directions for future studies on the aetiology of RCRSP and its clinical management towards a biochemical view instead of the traditional mechanical hypothesis.
Topics: Humans; Shoulder Pain; Rotator Cuff; Shoulder Impingement Syndrome; Acromion
PubMed: 37316968
DOI: 10.1002/msc.1719 -
International Orthopaedics Dec 2020Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and... (Review)
Review
PURPOSE
Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature.
METHODS
We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group.
RESULTS
Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor.
CONCLUSIONS
Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.
Topics: Acromion; Aged; Arthroplasty, Replacement, Shoulder; Fractures, Bone; Humans; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Spinal Fractures
PubMed: 32995915
DOI: 10.1007/s00264-020-04813-5 -
Journal of Clinical Medicine Jun 2023We intended to determine if an acromion or distal clavicle bone graft could restore large glenoid defects using two novel, screw-free graft fixation techniques.
BACKGROUND
We intended to determine if an acromion or distal clavicle bone graft could restore large glenoid defects using two novel, screw-free graft fixation techniques.
METHODS
Twenty-four sawbone shoulder models were divided into four groups (n = 6 per group) according to fixation technique and bone graft: (1) modified buckle-down technique with clavicle graft, (2) modified buckle-down technique with acromion graft, (3) cross-link technique with acromion graft, (4) cross-link technique with clavicle graft. Testing was performed sequentially in (1) intact models, (2) after creation of a 30% by-width glenoid defect and (3) after repair. The shoulder joint was translated anteriorly, and glenohumeral contact pressures and load were measured to quantify the biomechanical stability.
RESULTS
Maximum contact pressures were restored to 42-56% of intact glenoid using acromion and clavicle grafts with novel fixation techniques. Acromion grafts attained higher maximum contact pressures than clavicle grafts in all groups. Peak translational forces increased by 171-368% after all repairs.
CONCLUSIONS
This controlled laboratory study on sawbone models found that both the acromion and distal clavicle are suitable autologous bone graft options for treating large anterior glenoid defects, having appropriate dimensions and contours for reconstructing the glenoid arc. The modified buckle-down and cross-link techniques are two graft fixation techniques that restore stability to the shoulder joint upon repairing a large glenoid defect and are advantageous in being screw-free and simple to execute.
PubMed: 37373728
DOI: 10.3390/jcm12124035 -
Journal of Shoulder and Elbow Surgery Jan 2023Postoperative fracture of the acromion is a complication uniquely more common after reverse shoulder arthroplasty (RSA) than other forms of shoulder arthroplasty. There...
INTRODUCTION
Postoperative fracture of the acromion is a complication uniquely more common after reverse shoulder arthroplasty (RSA) than other forms of shoulder arthroplasty. There is limited knowledge regarding the etiology of these fractures or the anatomic risk factors. The purpose of this study is to identify associations of the acromioclavicular (AC) joint and relative humeral and glenoid positioning on the occurrence of acromial fractures after RSA.
METHODS
A retrospective case-controlled study was performed on primary RSA patients treated by a single surgeon from September 2009 to September 2019. Patients with a postoperative acromion fracture were matched in a 3:1 ratio based on gender, indication, and age to those without a fracture and with a 2-year minimum follow-up. Preoperative and the immediate postoperative radiographs were reviewed by 2 investigators to measure critical shoulder angle, acromion-humeral interval, global lateralization, delta angle, preoperative glenoid height, and the level of inlay or onlay of the humeral stem. The morphology, width, and stigmata of osteoarthritis in the AC joint were assessed using computed tomography scans taken preoperatively.
RESULTS
Of a total of 920 RSAs performed, 47 (5.1%) patients suffered a postoperative acromion fracture. These patients were compared with a control group of 141 patients, with a mean age of 76.4 years and similar distributions of gender and surgical indication. Patients in both groups had similar preoperative glenoid height (P = .953) and postoperative degree of inset or offset of humeral implant relative to the anatomic neck (P = .413). There were no differences in critical shoulder angle, acromion-humeral interval, global lateralization, and delta angle both preoperatively and postoperatively between the fracture and nonfracture groups. Computed tomography analysis also showed no differences in AC joint morphology (P = .760), joint space (P = .124), and stigma of osteoarthritis (P = .161).
CONCLUSION
There was no relation between the features of the AC joint and the anatomic parameters of the humerus relative to the glenoid and acromion on postoperative acromion fractures after RSA.
Topics: Humans; Aged; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Retrospective Studies; Acromion; Shoulder Prosthesis; Fractures, Bone; Osteoarthritis; Treatment Outcome
PubMed: 35940534
DOI: 10.1016/j.jse.2022.06.020