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Archives of Orthopaedic and Trauma... Aug 2020Although the deltoid represents the main motor muscle after reverse shoulder arthroplasty (RSA), its standardized preoperative assessment regarding morphology and...
INTRODUCTION
Although the deltoid represents the main motor muscle after reverse shoulder arthroplasty (RSA), its standardized preoperative assessment regarding morphology and function is still not established. Its clinical relevance and interactions with major biomechanical parameters like the medialization of the center of rotation (COR) regarding shoulder function after RSA are yet unknown. We evaluated contrast-enhanced ultrasound (CEUS) of the deltoid as possible surrogate marker for individual deltoid properties of patients receiving an RSA, and its predictive value for postoperative shoulder function.
MATERIALS AND METHODS
35 patients were prospectively assessed. Before and 6 months after RSA, dynamic deltoid perfusion, caliber and a combination of both (PE*caliber, named DeltoidEfficacy) was quantified by CEUS. Changes of deltoid properties and the predictive value of preoperative CEUS-based deltoid properties for shoulder function after RSA were assessed. To analyze interrelating effects with deltoid properties, COR-medialization and deltoid lengthening were quantified.
RESULTS
Deltoid caliber and perfusion significantly increased after RSA (p = 0.0004/p = 0.002). Preoperative deltoid caliber, perfusion and the combined value DeltoidEfficacy significantly correlated with shoulder function after RSA within the whole study cohort (caliber: r = 0.445, p = 0.009; perfusion: r = 0.593, p = 0.001; DeltoidEfficacy: r = 0.66; p = 0.0002). The predictive value of DeltoidEfficacy for shoulder function after RSA varied among patient subgroups: Multivariate regression analysis revealed the strongest prediction in patients with either very high or very low deltoid properties (Beta = 0.872, r = 0.84, p = 0.0004), independent from COR-medialization or deltoid lengthening. Contrary, in patients with intermediate deltoid properties, COR-medialization revealed the strongest predictive value for shoulder function after RSA (Beta = 0.660, r = 0.597; p = 0.024).
CONCLUSION
Deltoid CEUS seems to allow an assessment of individual deltoid properties and deltoid adaptations after RSA. Deltoid CEUS seems to predict shoulder function after RSA and might support an identification of patients requiring special attention regarding COR positioning.
Topics: Arthroplasty, Replacement, Shoulder; Contrast Media; Deltoid Muscle; Humans; Pilot Projects; Preoperative Care; Prospective Studies; Shoulder; Ultrasonography
PubMed: 31624864
DOI: 10.1007/s00402-019-03281-w -
Techniques in Hand & Upper Extremity... Sep 2015Obtaining adequate exposure of the proximal humerus for anatomic reduction of complex intra-articular fractures or in the surgical treatment of tumor may be difficult.... (Review)
Review
Obtaining adequate exposure of the proximal humerus for anatomic reduction of complex intra-articular fractures or in the surgical treatment of tumor may be difficult. Here we describe a novel approach to the proximal humerus: the deltoid lift, and perform a cadaveric analysis objectively quantifying the exposure. The deltoid lift offers significantly greater exposure to the proximal humerus as compared with the deltopectoral approach.
Topics: Cadaver; Deltoid Muscle; Dissection; Fracture Fixation, Internal; Humans; Shoulder Fractures
PubMed: 26197155
DOI: 10.1097/BTH.0000000000000091 -
The Journal of Foot and Ankle Surgery :... 2017Deltoid ligament repair can be challenging, and implementation of an arthroscopic method can be useful in terms of minimizing morbidity associated with open dissection,...
Deltoid ligament repair can be challenging, and implementation of an arthroscopic method can be useful in terms of minimizing morbidity associated with open dissection, as long as the repair is effective and durable. In this brief report, we describe a method of arthroscopic deltoid ligament repair that we have found to be useful.
Topics: Ankle Fractures; Arthroscopy; Cadaver; Deltoid Muscle; Female; Humans; Ligaments, Articular; Male; Sampling Studies; Sensitivity and Specificity; Suture Anchors
PubMed: 28843548
DOI: 10.1053/j.jfas.2017.07.009 -
Journal of Shoulder and Elbow Surgery Jun 2023The deltopectoral approach is well accepted for shoulder arthroplasty procedures. The extended deltopectoral approach with detachment of the anterior deltoid from the...
BACKGROUND
The deltopectoral approach is well accepted for shoulder arthroplasty procedures. The extended deltopectoral approach with detachment of the anterior deltoid from the clavicle allows increased joint exposure and can protect the anterior deltoid from traction injury. The efficacy of this extended approach has been demonstrated in anatomic total shoulder replacement surgery. However, this has not been shown in reverse shoulder arthroplasty (RSA). The primary aim of this study was to evaluate the safety of the extended deltopectoral approach in RSA. The secondary aim was to evaluate the performance of the deltoid reflection approach in terms of complications and surgical, functional, and radiologic outcomes up to 24 months after surgery.
METHODS
A prospective, nonrandomized comparative study was performed between January 2012 and October 2020 including 77 patients in the deltoid reflection group and 73 patients in the comparative group. The decision for inclusion was based on patient and surgeon factors. Complications were recorded. Patients were followed up for ≥24 months to evaluate their shoulder function and undergo ultrasound evaluation. Functional outcome measures included the Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, pain intensity (rated on visual analog scale [VAS] from 0 to 100), and range of motion (forward flexion, abduction, and external rotation). A regression analysis was performed to evaluate any factors of influence on the VAS score.
RESULTS
There were no significant differences in the complication rate between the 2 groups (14.5% in deltoid reflection group and 13.8% in comparative group, P = .915). Ultrasound evaluation was available in 64 patients (83.1%), and no proximal detachment was observed. In addition, there were no significant differences in functional outcome measures both preoperatively and at 24 months after surgery between the groups assessed based on the mean VAS pain score, Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, forward flexion, abduction, and external rotation. Adjustment for possible confounders in a regression model indicated that only prior surgery significantly influenced the VAS pain score after surgery (P = .031; 95% confidence interval, 0.574-11.67). Deltoid reflection (P = .068), age (P = .466), sex (P = .936), use of glenoid graft (P = .091), prosthesis manufacturer (P = .382), and preoperative VAS score (P = .362) were not of influence.
DISCUSSION
The results of this study show that an extended deltopectoral approach for RSA is safe. Selected reflection of the anterior deltoid muscle improved exposure and prevented anterior deltoid muscle injury followed by reattachment. Patients had similar functional scores preoperatively and at 24 months postoperatively compared with a comparative group. Furthermore, ultrasound evaluation showed intact reattachments.
Topics: Humans; Arthroplasty, Replacement; Arthroplasty, Replacement, Shoulder; Deltoid Muscle; Pain; Prospective Studies; Range of Motion, Articular; Retrospective Studies; Shoulder; Shoulder Joint; Treatment Outcome
PubMed: 36849027
DOI: 10.1016/j.jse.2023.01.029 -
Folia Morphologica 2024The shoulder and arm region has numerous morphological variations. The deltoid muscle usually consists of three parts: anterior, middle and posterior. This case report...
The shoulder and arm region has numerous morphological variations. The deltoid muscle usually consists of three parts: anterior, middle and posterior. This case report describes a very rare deltoid muscle variant, an addition to the spinal part that is attached proximally at the infraspinatus fascia and the spine of the scapula. The distal attachment transforms directly into the brachialis muscle. Additional parts can affect the biomechanics and function of the joints significantly.
Topics: Humans; Deltoid Muscle; Shoulder; Scapula; Arm; Muscle, Skeletal
PubMed: 36967626
DOI: 10.5603/FM.a2023.0018 -
American Journal of Physical Medicine &... Oct 2013
Topics: Adult; Axilla; Brachial Plexus Neuritis; Deltoid Muscle; Edema; Electrodiagnosis; Humans; Magnetic Resonance Imaging; Male; Muscular Atrophy; Neurologic Examination
PubMed: 23739273
DOI: 10.1097/PHM.0b013e318296e348 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2017To review the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury. (Review)
Review
OBJECTIVE
To review the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury.
METHODS
Recent literature concerning the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury was reviewed.
RESULTS
Misdiagnosis is common for ankle fractures combined with acute deltoid ligament injury. A diagnosis is given based on patients' complaints, symptoms, and imaging examination, even surgical exploration is necessary. Whether to repair the deltoid ligament remains controversial.
CONCLUSION
Deltoid ligament is an important structure to stabilize the medial ankle joint. However, treatment of different kinds of ankle fractures combined with acute deltoid ligament injury should be standardized; whether or not repair deltoid ligament is determined by the intraoperative ankle stability.
Topics: Ankle Fractures; Ankle Injuries; Ankle Joint; Deltoid Muscle; Humans; Ligaments; Ligaments, Articular
PubMed: 29798555
DOI: 10.7507/1002-1892.201701053 -
Orthopaedics & Traumatology, Surgery &... Apr 2019To investigate the evidence of deltoid-split approach (DS) versus deltopectoral approach (DP) in treatment of proximal humerus fractures from current RCT and prospective... (Meta-Analysis)
Meta-Analysis
PURPOSE
To investigate the evidence of deltoid-split approach (DS) versus deltopectoral approach (DP) in treatment of proximal humerus fractures from current RCT and prospective literatures.
METHODS
The electronic literature database of Pubmed, Embase, and Cochrane library was searched at December 2017. The data complications (including implant failure, humeral head necrosis, infection, radiological adverse events, nonunion rate, subacromial impingement, and damage of the axillary nerve), functional outcomes (including Constant, NEER, DASH, ADL, VAS score), operation time, hospital stay and intraoperative blood loss were extracted and analyzed by STATA 11.0 software.
RESULTS
Three RCTs and three prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the DS group had a significantly low humeral head necrosis rate and short operation time. No significant difference was found in total complication rate, functional outcome, and other Perioperative parameters between DS and DP groups.
CONCLUSION
The prospective evidence suggested that DS approach for proximal humerus fractures had less humeral head necrosis and short operation time than DP approach. Both DS and DP approach had similar results in functional outcomes, total complication, VAS, and hospital stay.
Topics: Bone Plates; Deltoid Muscle; Fracture Fixation, Internal; Humans; Operative Time; Radiography; Shoulder Fractures
PubMed: 30878231
DOI: 10.1016/j.otsr.2018.12.004 -
Musculoskeletal Surgery Dec 2017The reverse shoulder prosthesis (RSP) was developed to relieve pain and improve functional outcomes in patients with glenohumeral arthritis and deficiency of the rotator...
PURPOSE
The reverse shoulder prosthesis (RSP) was developed to relieve pain and improve functional outcomes in patients with glenohumeral arthritis and deficiency of the rotator cuff. Even if clinical and functional outcomes regarding the use of the RSP were reported by literature, data concerning progressive deltoid adaptation to this non-anatomic implant are still missing. The purpose of our study was to correlate clinical and functional outcomes with deltoid fibers activity and muscle fatigability in patients with reverse shoulder prosthesis at 2 years follow-up.
METHODS
Twenty patients with reverse shoulder prosthesis due to symptomatic deficient or nonfunctional rotator cuff associated with osteoarthritis were referred by Cervesi Hospital Shoulder and Elbow Surgery Unit. Exclusion criteria were: axillary nerve palsy, a nonfunctioning deltoid muscle, diabetes, previous trauma, malignancy. Furthermore patients who received the RSP for revision arthroplasty, proximal humerus fractures were excluded. All the patients underwent clinical and functional evaluation with the support of electromyography measurement focused on deltoid activity.
RESULTS
RSP surgical treatment in shoulder osteoarthritis confirms his good outcome in terms of pain relief. At 2 years anterior and lateral deltoid electromyographic activity was significantly lower compared with contralateral side (p < 0.001). Posterior deltoid activity was no detectable. Range of motion at 2 years of follow-up decreased in terms of forward flexion (p = 0.045), abduction (p = 0.03) and external rotation (p < 0.001).
CONCLUSIONS
Our study demonstrates that even if the patients remain pain-free, progressive deterioration of the deltoid activity is unavoidable and may lead to poor functional outcomes overtime.
Topics: Adaptation, Physiological; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Deltoid Muscle; Electromyography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Muscle Fatigue; Osteoarthritis; Range of Motion, Articular; Rotator Cuff Injuries; Rotator Cuff Tear Arthropathy; Shoulder Prosthesis; Treatment Outcome
PubMed: 29086336
DOI: 10.1007/s12306-017-0516-6 -
Skeletal Radiology Jun 2023Calcific tendinitis is a potentially symptomatic disorder characterized by calcium deposits in the substance of the tendon. Although this condition can occur in any...
Calcific tendinitis is a potentially symptomatic disorder characterized by calcium deposits in the substance of the tendon. Although this condition can occur in any tendinous tissue throughout the human body, calcium deposition commonly occurs at tendon insertions near the bone-tendon junction. The musculotendinous junction of the deltoid muscle has peculiarly dense intramuscular tendons to which muscle fibers attach obliquely to create muscular strength. Given that the intramuscular tendons themselves, which form the consecutive part from the insertion, are subjected to unpredictable stress load or microtrauma similar to tendon insertions, it is reasonable to assume that calcific tendinitis could also occur at the intramuscular tendons. Here we report a case of chronic symptomatic calcium deposition in the lateral part of the deltoid muscle between the origin and the insertion, which was eventually surgically removed and confirmed as intramuscular calcific tendinitis.
Topics: Humans; Deltoid Muscle; Calcium; Tendons; Tendinopathy; Myotendinous Junction; Calcinosis
PubMed: 36224399
DOI: 10.1007/s00256-022-04203-5