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Orthopedics Jan 2013The purpose of this study was to investigate deltoid compartment pressures during arthroscopic rotator cuff repair using modern pressure pumps to achieve visualization....
The purpose of this study was to investigate deltoid compartment pressures during arthroscopic rotator cuff repair using modern pressure pumps to achieve visualization. Twelve patients undergoing arthroscopic rotator cuff repairs were monitored for deltoid compartment pressure changes intraoperatively. Pre-, intra-, and postoperative intramuscular pressures were recorded. All patients demonstrated varying degrees of swelling due to fluid extravasation. Swelling was qualified as mild, moderate, or severe by clinical assessment and quantified objectively using a pressure monitor to record deltoid compartment pressures. Clinically, severe swelling occurred in 4 patients, all of whom underwent procedures lasting longer than 90 minutes. Objectively, no patient had evidence of dangerously elevated pressure measurements. The mean increase in compartment pressures was 9 mm Hg. All patients were treated and discharged as outpatients. No patient required more than oral narcotic analgesics for postoperative pain control beyond the postanesthesia care unit stay. Arthroscopic rotator cuff repair may lead to clinically impressive swelling, but within the current study group, no evidence existed of clinically significant, persistent elevation of deltoid compartment measures using current arthroscopic techniques and arthroscopic pump systems. However, caution should be observed with regard to extended operative times and elevation of pump pressures.
Topics: Adult; Aged; Aged, 80 and over; Arthroscopy; Deltoid Muscle; Female; Humans; Male; Middle Aged; Pressure; Prospective Studies; Rotator Cuff
PubMed: 23276349
DOI: 10.3928/01477447-20121217-15 -
Arthroscopy, Sports Medicine, and... Oct 2020The aim of this study was to assess the nature of the middle deltoid muscle insertion onto the lateral acromion by macroscopic, MRI and histologic examination and to,...
PURPOSE
The aim of this study was to assess the nature of the middle deltoid muscle insertion onto the lateral acromion by macroscopic, MRI and histologic examination and to, therefore, assess the potential impact of a vertical lateral acromioplasty on the deltoid origin.
METHODS
We assessed the acromial origin of the deltoid in 6 cadaver shoulders by macroscopic, MRI and histologic examination. The cadavers were scanned with T1 and proton density-weighted sequences. H&E- and Masson trichrome-stained histologic sections through the acromion were taken and visualized under polarized microscopy.
RESULTS
The enthesis of the deltoid muscle consisted of dense birefringent bundles of collagen that blended with the bony endplate of the acromion at all points on its lateral wall. A prominent band of collagen was seen on both MRI and histologic slices, traversing the superior surface of the acromion. It was continuous with the deltoid origin and blended with the superficial fascia of the deltoid laterally.
CONCLUSIONS
The middle deltoid muscle occupies the entire lateral acromion.
CLINICAL RELEVANCE
A high critical shoulder angle is associated with rotator cuff tears. A lateral acromioplasty resects the lateral acromion and aims to normalize the critical shoulder angle. However, a vertical lateral acromioplasty may release the middle deltoid origin from the lateral acromion. The superior band of collagen may anchor the middle deltoid to the superior acromion and prevent retraction.
PubMed: 33134993
DOI: 10.1016/j.asmr.2020.06.014 -
The American Journal of Sports Medicine Jul 2018Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols.
BACKGROUND
Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols.
HYPOTHESES
(1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces.
STUDY DESIGN
Controlled laboratory study.
METHODS
Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used. The supraspinatus and anterior, middle, and posterior deltoid tendons were attached to individual shoulder simulator actuators. Deltoid forces and maximum abduction were recorded for the following tear patterns: intact, isolated subscapularis (SSC), isolated supraspinatus (SSP), anterosuperior (SSP + SSC), posterosuperior (infraspinatus [ISP] + SSP), and massive (SSC + SSP + ISP). Optical triads tracked 3-dimensional motion during dynamic testing. Fluoroscopy and computed tomography were used to measure critical shoulder angle, acromial index, and superior humeral head migration with massive tears. Mean values for maximum glenohumeral abduction and deltoid forces were determined. Linear mixed-effects regression examined changes in motion and forces over time. Pearson product-moment correlation coefficients ( r) among deltoid forces, critical shoulder angles, and acromial indices were calculated.
RESULTS
Shoulders with an intact cuff required 193.8 N (95% CI, 125.5 to 262.1) total deltoid force to achieve 79.8° (95% CI, 66.4° to 93.2°) of maximum glenohumeral abduction. Compared with native shoulders, abduction decreased after simulated SSP (-27.2%; 95% CI, -43.3% to -11.1%, P = .04), anterosuperior (-51.5%; 95% CI, -70.2% to -32.8%, P < .01), and massive (-48.4%; 95% CI, -65.2% to -31.5%, P < .01) cuff tears. Increased total deltoid forces were required for simulated anterosuperior (+108.1%; 95% CI, 68.7% to 147.5%, P < .01) and massive (+57.2%; 95% CI, 19.6% to 94.7%, P = .05) cuff tears. Anterior deltoid forces were significantly greater in anterosuperior ( P < .01) and massive ( P = .03) tears. Middle deltoid forces were greater with anterosuperior tears ( P = .03). Posterior deltoid forces were greater with anterosuperior ( P = .02) and posterosuperior ( P = .04) tears. Anterior deltoid force was negatively correlated ( r = -0.89, P = .01) with critical shoulder angle (34.3°; 95% CI, 32.0° to 36.6°). Deltoid forces had no statistical correlation with acromial index (0.55; 95% CI, 0.48 to 0.61). Superior migration was 8.3 mm (95% CI, 5.5 to 11.1 mm) during testing of massive rotator cuff tears.
CONCLUSION
Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. Anterosuperior tears resulted in the largest motion loss despite the greatest increase in deltoid force.
CLINICAL RELEVANCE
Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction, regardless of tear size.
Topics: Acromion; Aged; Biomechanical Phenomena; Cadaver; Deltoid Muscle; Disease Progression; Humans; Humeral Head; Middle Aged; Range of Motion, Articular; Rotator Cuff; Rotator Cuff Injuries; Scapula; Shoulder; Shoulder Joint
PubMed: 29741391
DOI: 10.1177/0363546518768276 -
Movement Disorders : Official Journal... Jun 2012
Topics: Deltoid Muscle; Humans; Male; Middle Aged; Movement Disorders; Shoulder Pain
PubMed: 22499267
DOI: 10.1002/mds.24975 -
Journal of Science and Medicine in Sport Jun 2024
Topics: Humans; Swimming; Muscle Strength; Lower Extremity; Deltoid Muscle; Male; Shoulder; Female
PubMed: 38849160
DOI: 10.1016/j.jsams.2024.03.014 -
Arthroscopy : the Journal of... Jan 2019Since I reported clinical and biomechanical improvement after superior capsular reconstruction (SCR) for irreparable rotator cuff tears in 2012 and 2013, many shoulder...
Editorial Commentary: Superior Capsular Reconstruction-Improved Superior Stability and Functional Deltoid Reverse Pseudoparalysis in Patients With Irreparable Rotator Cuff Tears.
Since I reported clinical and biomechanical improvement after superior capsular reconstruction (SCR) for irreparable rotator cuff tears in 2012 and 2013, many shoulder surgeons around the world have started to perform SCR. However, most of these surgeons are still on the learning curve, and their clinical results are not consistent because clinical outcomes after SCR are correlated with graft healing, which is affected by the surgeon's skill. In cases in which the graft does heal, active shoulder elevation increases after SCR even in patients with pseudoparalysis before surgery. These patients can elevate the arm using the deltoid muscle when superior shoulder stability is restored after SCR. When patients whose grafts have healed cannot elevate the arm even after SCR, they may have concomitant cervical radiculopathy, which causes real paralysis.
Topics: Arthritis; Deltoid Muscle; Humans; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint
PubMed: 30611360
DOI: 10.1016/j.arthro.2018.08.026 -
Skeletal Radiology Apr 2019Leiomyomas are benign tumors of smooth muscle cells. Leiomyomas of somatic soft tissue are a specific class of leiomyoma believed to arise from the smooth muscle cells...
Leiomyomas are benign tumors of smooth muscle cells. Leiomyomas of somatic soft tissue are a specific class of leiomyoma believed to arise from the smooth muscle cells found in the walls of blood vessels and represent less than 4% of benign, somatic soft tissue tumors. Of the somatic soft tissue tumors, approximately one-third will become calcified. We report an intramuscular, calcified leiomyoma arising from the left deltoid of a 47-year-old Caucasian male. To the best of the authors' knowledge, this is the first reported case of a calcified, intramuscular leiomyoma of the deltoid. Imaging studies and patient presentation were initially suggestive of tumoral calcinosis or myositis ossificans. It was not until pathologic examination that the correct diagnosis of the calcified leiomyoma was made. Leiomyoma should be included in the differential diagnosis of calcified soft tissue masses. If excised with adequate margins, recurrence is unlikely.
Topics: Calcinosis; Contrast Media; Deltoid Muscle; Diagnosis, Differential; Humans; Leiomyoma; Magnetic Resonance Imaging; Male; Middle Aged
PubMed: 30187111
DOI: 10.1007/s00256-018-3053-y -
Dermatologic Therapy Nov 2021With the increasing demand for body contouring, botulinum toxin (BTX) injection is being widely used off-label for muscular hypertrophy. However, to the best of our...
With the increasing demand for body contouring, botulinum toxin (BTX) injection is being widely used off-label for muscular hypertrophy. However, to the best of our knowledge, no study has investigated the clinical efficacy of BTX type A (BTX-A) in deltoid muscle hypertrophy. This study was conducted to evaluate the efficacy and safety of intramuscular injection of BTX in reducing deltoid muscle hypertrophy. Overall, 10 patients with bilateral deltoid muscle hypertrophy were treated with an intramuscular injection of prabotulinum toxin A, with a total of 50 units [U] administered per patient. As measured by ultrasonography, the thickness of the deltoid muscles was significantly decreased at weeks 2 and 12. In addition, the clinical assessment score by blinded investigators was improved after the treatment; however, patients' satisfaction scores were relatively low. No major complications were reported. Therefore, intramuscular injection of BTX-A seems to be a candidate for novel treatment option for deltoid muscle hypertrophy. Further larger clinical studies are warranted to confirm the efficacy of BTX-A.
Topics: Botulinum Toxins, Type A; Deltoid Muscle; Humans; Hypertrophy; Injections, Intramuscular; Treatment Outcome
PubMed: 34676643
DOI: 10.1111/dth.15168 -
The anterior deltoid's importance in reverse shoulder arthroplasty: a cadaveric biomechanical study.Journal of Shoulder and Elbow Surgery Mar 2013Frequently, patients who are candidates for reverse shoulder arthroplasty have had prior surgery that may compromise the anterior deltoid muscle. There have been...
BACKGROUND
Frequently, patients who are candidates for reverse shoulder arthroplasty have had prior surgery that may compromise the anterior deltoid muscle. There have been conflicting reports on the necessity of the anterior deltoid thus it is unclear whether a dysfunctional anterior deltoid muscle is a contraindication to reverse shoulder arthroplasty. The purpose of this study was to determine the 3-dimensional (3D) moment arms for all 6 deltoid segments, and determine the biomechanical significance of the anterior deltoid before and after reverse shoulder arthroplasty.
METHODS
Eight cadaveric shoulders were evaluated with a 6-axis force/torque sensor to assess the direction of rotation and 3D moment arms for all 6 segments of the deltoid both before and after placement of a reverse shoulder prosthesis. The 2 segments of anterior deltoid were unloaded sequentially to determine their functional role.
RESULTS
The 3D moment arms of the deltoid were significantly altered by placement of the reverse shoulder prosthesis. The anterior and middle deltoid abduction moment arms significantly increased after placement of the reverse prosthesis (P < .05). Furthermore, the loss of the anterior deltoid resulted in a significant decrease in both abduction and flexion moments (P < .05).
CONCLUSION
The anterior deltoid is important biomechanically for balanced function after a reverse total shoulder arthroplasty. Losing 1 segment of the anterior deltoid may still allow abduction; however, losing both segments of the anterior deltoid may disrupt balanced abduction. Surgeons should be cautious about performing reverse shoulder arthroplasty in patients who do not have a functioning anterior deltoid muscle.
Topics: Aged; Arthroplasty, Replacement; Biomechanical Phenomena; Cadaver; Deltoid Muscle; Female; Humans; Joint Prosthesis; Male; Middle Aged; Models, Biological; Rotation; Shoulder Joint
PubMed: 22608931
DOI: 10.1016/j.jse.2012.02.002 -
European Journal of Pediatrics Apr 2018We hypothesised that extremely premature infants would have decreased muscle mass at term-corrected age compared to term-born infants and that the degree of reduced...
UNLABELLED
We hypothesised that extremely premature infants would have decreased muscle mass at term-corrected age compared to term-born infants and that the degree of reduced muscle mass acquisition would correlate with the duration of invasive mechanical ventilation. The MRI brain scans of infants admitted in the neonatal unit at King's College Hospital between 1 January 2010 and 1 June 2016 were retrospectively reviewed. The coronal cross-sectional area of the left deltoid muscle (DCSA) was measured in 17 infants born < 28 weeks of gestation and in 20 infants born at term. The prematurely born infants had a median (IQR) gestation age of 25 weeks (24-27) and the term infants 40 weeks (38-41). The duration of invasive mechanical ventilation for the prematurely born infants was 39 days (14-62) and that for the term infants 4 days (2-5), p < 0.001. DCSA was smaller in prematurely born infants (median 189, IQR 176-223 mm) compared to term-born infants (median 302, IQR 236-389 mm), p < 0.001. DCSA was related to gestation age (r = 0.545, p = 0.001), weight z-score at MRI (r = 0.658, p < 0.001) and days of invasive mechanical ventilation (r = - 0.583, p < 0.001). In conclusion, extremely premature infants studied at term had a lower muscle mass compared to term-born infants.
CONCLUSION
Our results suggest that prolonged mechanical ventilation in infants admitted in neonatal intensive care is associated with reduced skeletal muscle mass acquisition. What is Known: • Prolonged mechanical ventilation in adult intensive care patients has been associated with skeletal muscle dysfunction and atrophy. • The cross-sectional area of the deltoid muscle has been used to evaluate muscle atrophy in infants with a previous branchial plexus birth injury. What is New: • Premature infants studied at term exhibit lower cross-sectional area of the deltoid muscle than their term counterparts. • Prolonged mechanical ventilation could be associated with skeletal muscle impairment.
Topics: Deltoid Muscle; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Magnetic Resonance Imaging; Male; Muscular Atrophy; Respiration, Artificial; Retrospective Studies
PubMed: 29350333
DOI: 10.1007/s00431-018-3090-5