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International Journal of Surgery Case... Apr 2024This study delves into the management of acromion fractures and acromioclavicular (AC) joint dislocations-orthopedic injuries with significant implications for shoulder...
INTRODUCTION
This study delves into the management of acromion fractures and acromioclavicular (AC) joint dislocations-orthopedic injuries with significant implications for shoulder function. Despite their infrequency, these injuries present challenges due to potential persistent pain and functional limitations. Current treatment strategies span from conservative measures to surgical interventions, yet there exists a notable gap in comprehensive data on specific surgical approaches.
PRESENTATION OF CASE
We present a compelling case involving a 38-year-old male athlete who sought medical attention following a motor vehicle accident due to severe right shoulder pain. Upon admission to the emergency ward, the patient reported an inability to move the affected shoulder. Radiographic evaluations, comprising X-ray and computerized tomography scans, revealed a displaced fracture at the base of the acromion coupled with an AC dislocation. A novel surgical technique was employed, featuring coracoid fixation with mersilene thread and a 2-hole reconstruction plate-a distinctive approach in the field.
DISCUSSION
The systematic rehabilitation plan yielded successful healing and the restoration of normal shoulder function, offering promising insights into potential advancements in orthopedic practices.
CONCLUSION
This case contributes valuable knowledge to the understanding of these complex injuries, paving the way for further exploration and refinement in their management. The innovative surgical approach showcased underscores the importance of continued research and exploration to enhance the overall treatment landscape for acromion fractures and AC joint dislocations.
PubMed: 38458019
DOI: 10.1016/j.ijscr.2024.109446 -
Scientific Reports Mar 2024Chronic rotator cuff injuries (CRCIs) still present a great challenge for orthopaedics surgeons. Many new therapeutic strategies are developed to facilitate repair and...
Chronic rotator cuff injuries (CRCIs) still present a great challenge for orthopaedics surgeons. Many new therapeutic strategies are developed to facilitate repair and improve the healing process. However, there is no reliable animal model for chronic rotator cuff injury research. To present a new valuable rat model for future chronic rotator cuff injuries (CRCIs) repair studies, and describe the changes of CRCIs on the perspectives of histology, behavior and MRI. Sixty male Wistar rats were enrolled and underwent surgery of the left shoulder joint for persistent subacromial impingement. They were randomly divided into experimental group (n = 30, a 3D printed PEEK implant shuttled into the lower surface of the acromion) and sham operation group (n = 30, insert the same implant, but remove it immediately). Analyses of histology, behavior, MRI and inflammatory pain-related genes expression profiles were performed to evaluate the changes of CRCIs. After 2-weeks running, the rats in the experimental group exhibited compensatory gait patterns to protect the injured forelimb from loading after 2-weeks running. After 8-weeks running, the rats in the experimental group showed obvious CRCIs pathological changes: (1) acromion bone hyperplasia and thickening of the cortical bone; (2) supraspinatus muscle tendon of the humeral head: the bursal-side tendon was torn and layered with disordered structure, forming obvious gaps; the humeral-side tendon is partially broken, and has a neatly arranged collagen. Partial fat infiltration is found. The coronal T2-weighted images showed that abnormal tendon-to-bone junctions of the supraspinatus tendon. The signal intensity and continuity were destroyed with contracted tendon. At the nighttime, compared with the sham operation group, the expression level of IL-1β and COX-2 increased significantly (P = 0063, 0.0005) in the experimental group. The expression of COX-2 in experimental group is up-regulated about 1.5 times than that of daytime (P = 0.0011), but the expression of IL-1β, TNF-a, and NGF are all down-regulated (P = 0.0146, 0.0232, 0.0161). This novel rat model of chronic rotator cuff injuries has the similar characteristics with that of human shoulders. And it supplies a cost-effective, reliable animal model for advanced tissue engineered strategies and future therapeutic strategies.
Topics: Humans; Rats; Animals; Male; Rotator Cuff Injuries; Rats, Wistar; Cyclooxygenase 2; Rotator Cuff; Tendons; Interleukin-1beta
PubMed: 38438458
DOI: 10.1038/s41598-024-55281-5 -
Orthopaedic Journal of Sports Medicine Mar 2024One proposed mechanism of rotator cuff disease is scapular motion impairments contributing to rotator cuff compression and subsequent degeneration.
BACKGROUND
One proposed mechanism of rotator cuff disease is scapular motion impairments contributing to rotator cuff compression and subsequent degeneration.
PURPOSE
To model the effects of scapular angular deviations on rotator cuff tendon proximity for subacromial and internal mechanical impingement risk during scapular plane abduction.
STUDY DESIGN
Descriptive laboratory study.
METHODS
Three-dimensional bone models were reconstructed from computed tomography scans obtained from 10 asymptomatic subjects and 9 symptomatic subjects with a clinical presentation of impingement syndrome. Models were rotated to average scapular orientations from a healthy dataset at higher (120°) and lower (subject-specific) humeral elevation angles to investigate internal and subacromial impingement risks, respectively. Incremental deviations in scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt were imposed on the models to simulate scapular movement impairments. The minimum distance between the rotator cuff insertions and potential impinging structures (eg, glenoid, acromion) was calculated. Two-way mixed-model analyses of variance assessed for effects of scapular deviation and group.
RESULTS
At 120° of humerothoracic elevation, minimum distances from the supraspinatus and infraspinatus insertions to the glenoid increased with ≥5° changes in upward rotation (1.6-9.8 mm, < .001) or external rotation (0.9-5.0 mm, ≤ .048), or with ≥10° changes in anterior tilt (1.1-3.2 mm, < .001). At lower angles, ≥20° changes in most scapular orientations significantly increased the distance between the supraspinatus and infraspinatus insertions and the acromion or coracoacromial ligament.
CONCLUSION
A reduction in scapular upward rotation decreases the distance between the rotator cuff tendon insertions and glenoid at 120° humerothoracic elevation. Interpretation is complicated for lower angles because the humeral elevation angle was defined by the minimum distance.
CLINICAL RELEVANCE
These results may assist clinical decision making regarding the effects of scapular movement deviations in patients with rotator cuff pathology and scapular dyskinesia and may help inform the selection of clinical interventions.
PubMed: 38435717
DOI: 10.1177/23259671231219023 -
Alternative Therapies in Health and... Mar 2024The coracoacromial ligament (CAL) connects the acromion and coracoid process of the scapula. This study aimed to explore the correlation between CAL degeneration and...
OBJECTIVE
The coracoacromial ligament (CAL) connects the acromion and coracoid process of the scapula. This study aimed to explore the correlation between CAL degeneration and shoulder pathology, specifically focusing on the efficacy of acromioplasty in treating shoulder impingement in patients with varying degrees of CAL degeneration.
METHODS
49 patients diagnosed with bursal-side partial rotator cuff tear were assessed for CAL degeneration and categorized into three grades. They were then randomized into acromioplasty and non-acromioplasty groups to compare the outcomes. Acromiohumeral distance (AHD) and fatty infiltration was evaluated on imaging examinations. American Shoulder and Elbow Score (ASES) and Visual Analogue Scale (VAS) was recorded to evaluate the shoulder function before and two years after surgery.
RESULTS
Grade III CAL patients demonstrated significantly reduced AHD and increased VAS scores compared to Grades I and II. Post-acromioplasty, Grade III patients showed a statistically significant improvement in ASES scores compared to the non-acromioplasty group.
CONCLUSION
The study indicates that CAL degeneration is a significant indicator of shoulder impingement. Notably, acromioplasty significantly improves shoulder function in patients with severe CAL degeneration, suggesting its potential as a targeted treatment in managing shoulder impingement.
PubMed: 38430142
DOI: No ID Found -
Diagnostics (Basel, Switzerland) Feb 2024Despite numerous attempts to correct forward head posture (FHP), definitive evidence-based screening and diagnostic methods remain elusive. This study proposes a...
Despite numerous attempts to correct forward head posture (FHP), definitive evidence-based screening and diagnostic methods remain elusive. This study proposes a preliminary diagnostic methodology for FHP, utilizing a noninvasive body angle measurement system as a screening test for FHP and incorporating radiological parameters for sagittal alignment. We enrolled 145 adolescents for FHP screening. The forward neck tilt angle (FNTA), defined as the angle between the vertical line and the line connecting the participant's acromion and tragus, was measured using the POM-Checker (a noninvasive depth sensor-based body angle measurement system). A whole-spine standing lateral radiograph was obtained, and eight sagittal alignment parameters were measured. Statistical analyses of the association between the FNTA and eight sagittal alignment parameters were conducted. We used 70% of the participant data to establish a preliminary diagnostic model for FHP based on FNTA and each sagittal alignment parameter. The accuracy of the model was evaluated using the remaining 30% of the participant data. All radiological parameters of sagittal alignment showed weak statistical significance with respect to FNTA (best case: r = 0.16, = 0.0500; cranial tilt). The proposed preliminary diagnostic model for FHP demonstrated 95.35% agreement. Notably, the model using FNTA without radiological parameters accurately identified (100%) participants who required radiographic scanning for FHP diagnosis. Owing to the weak statistical significance of the association between radiological parameters and external body angle, both factors must be considered for accurate FHP diagnosis. When a clear and severe angle variation is observed in an external body angle check, medical professionals should perform radiographic scanning for an accurate FHP diagnosis. In conclusion, FNTA assessment of FNTA through the proposed preliminary diagnostic model is a significant screening factor for selecting participants who must undergo radiographic scanning so that a diagnosis of FHP can be obtained.
PubMed: 38396433
DOI: 10.3390/diagnostics14040394 -
Acta Ortopedica Mexicana 2023the acromion is a small portion of the scapula that extends towards the anterior region from the spine of the scapula. Traditionally, the acromion is classified by the...
INTRODUCTION
the acromion is a small portion of the scapula that extends towards the anterior region from the spine of the scapula. Traditionally, the acromion is classified by the shape of its inferior surface in a sagittal plane. Acromial morphology has been found to be related to rotator cuff injury.
OBJECTIVE
to determine the association between the type of acromion with a higher incidence of rotator cuff rupture. Study population: patients who come to the Traumatology and Orthopedics Service of a third level hospital at Monterrey, Mexico, due to a painful shoulder and who have undergone a simple magnetic resonance of the shoulder.
MATERIAL AND METHODS
a cross-sectional, retrospective and descriptive study was carried out, in which 273 magnetic resonance studies were reviewed in patients who met the inclusion criteria. The type of acromion was reported according to the morphological classification in type I to IV and the state of the rotator cuff: without rupture, partial rupture or complete rupture, making a comparison between right and left shoulder.
RESULTS
in this study we found a value of p = 0.473 which concludes that there is no relation between the type of acromion and the injury of the rotator cuff.
CONCLUSION
in the present study, unlike what has been published in the literature, it was found that type II acromion was the one that was associated in most cases with a rotator cuff tear.
Topics: Humans; Rotator Cuff; Acromion; Retrospective Studies; Cross-Sectional Studies; Shoulder Joint; Rotator Cuff Injuries; Rupture; Magnetic Resonance Spectroscopy
PubMed: 38373729
DOI: No ID Found -
Revista Espanola de Cirugia Ortopedica... Feb 2024Controversy exists in the literature about the best treatment for type III acromioclavicular dislocations. The aim of this study is to compare functional results between...
INTRODUCTION
Controversy exists in the literature about the best treatment for type III acromioclavicular dislocations. The aim of this study is to compare functional results between surgical and conservative treatment in type III acromioclavicular joint dislocations.
MATERIAL AND METHOD
We retrospectively evaluated the records of 30 patients from our area with acute type III acromioclavicular dislocations that were treated from January 1st, 2016 to December 31st, 2020. Fifteen patients were treated surgically and 15 conservatively. Follow-up mean time was 37.93 months in operative group and 35.73 months in non-operative group. Results obtained on the Constant score was the main variable analysed and results obtained on the Oxford score and the Visual Analogue Scale for pain were the secondary variables. Epidemiological variables were analysed, as well as range of mobility in injured shoulder and subjective and radiological variables (distance between the superior border of the acromion and the superior border of the clavicle's distal end and presence of osteoarthritis in the acromioclavicular joint).
RESULTS
Functional evaluation scores did not show differences between the two groups (Constant: operative 82/non-operative 86.38, p 0.412; Oxford: operative 42/non-operative 44.80, p 0.126) nor did Visual Analogue Scale (operative 1/non-operative 0.20, p 0.345). Subjective evaluation of the injured shoulder was excellent or good in 80% of the patients in both groups. Measurement of the distance between the superior border of the acromion and the superior border of the clavicle's distal end were significantly higher in non-operative group (operative 8.95/non-operative 14.21, p 0.008).
CONCLUSIONS
Although radiographic results were better in the surgical treatment group, functional evaluation scores did not show significant differences between the two groups. These results do not support the routine use of surgical treatment for grade III acromioclavicular dislocations.
PubMed: 38325567
DOI: 10.1016/j.recot.2024.01.021 -
Asia-Pacific Journal of Oncology Nursing Feb 2024Unilateral mastectomy is known to induce postural alterations, yet the temporal development pattern of these changes remains elusive. This study aimed to explore the...
OBJECTIVE
Unilateral mastectomy is known to induce postural alterations, yet the temporal development pattern of these changes remains elusive. This study aimed to explore the impact of unilateral mastectomy on body posture.
METHODS
A prospective, longitudinal, observational study with a one-group repeated-measures design was conducted. Patients undergoing unilateral mastectomy were recruited from a university-affiliated hospital in Western China and monitored for 12 months post-surgery. A trained nurse assessed seven postural baseline parameters on the day of suture removal and at 3, 6, and 12 months after unilateral mastectomy. Two parameters were in the sagittal plane (forward head posture and trunk rotation angle), and five were in the coronal plane (neck tilt, shoulder asymmetry, scapular asymmetry, scapular asymmetry relative to the spine, and pelvic tilt).
RESULTS
The final analysis included 159 patients. Baseline prevalence of most postural abnormalities ranged from 50.94% to 59.75%, with mean deviations between 2.74 and 4.51 mm. At 12 months post-mastectomy, prevalence and mean deviations increased by more than 30% and 3.50 mm, respectively, compared to baseline. Postural abnormalities increased gradually in the first 3 months, notably between the 3rd and 6th months, and slowed between the 6th and 12th months. On the mastectomy side, coronal plane abnormalities significantly increased within 12 months: earlobe to acromion distance (Wald χ = 45.283, < 0.001), depressed shoulder height (Wald χ = 42.253, < 0.001), depressed scapula height (Wald χ = 31.587, < 0.001), scapula to spine distance (Wald χ = 45.283, < 0.001), and elevated pelvic height (Wald χ = 48.924, < 0.001).
CONCLUSIONS
Postural changes are common post-unilateral mastectomy, with prevalence and deviation increasing gradually, particularly between 3 and 6 months post-mastectomy. Early rehabilitation initiation is recommended to mitigate postural changes.
TRIAL REGISTRATION
ChiCTR2000040897.
PubMed: 38318426
DOI: 10.1016/j.apjon.2023.100336 -
JSES International Jan 2024
PubMed: 38312296
DOI: 10.1016/j.jseint.2023.10.002 -
JSES International Jan 2024Although substantial motion at the acromioclavicular joint (ACJ) occurs during overhead shoulder motion, the influence of ACJ arthritis on postoperative outcomes of...
BACKGROUND
Although substantial motion at the acromioclavicular joint (ACJ) occurs during overhead shoulder motion, the influence of ACJ arthritis on postoperative outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) is unclear. We assessed the influence of ACJ arthritis, defined by degenerative radiographic changes, and its severity on clinical outcomes after primary rTSA.
METHODS
We conducted a retrospective review of a prospectively collected shoulder arthroplasty database of patients that underwent primary rTSA with a minimum 2-year clinical follow-up. Imaging studies of included patients were evaluated to assess ACJ arthritis classified by radiographic degenerative changes of the ACJ; severity was based upon size and location of osteophytes. Both the Petersson classification and the King classification (a modified Petersson classification addressing superior osteophytes and size of the largest osteophyte) were used to evaluate the severity of degenerative ACJ radiographic changes. Severe ACJ arthritis was characterized by large osteophytes (≥2 mm). Active range of motion (ROM) in abduction, forward elevation, and external and internal rotation as well as clinical outcome scores (American Shoulder and Elbow Surgeons Shoulder, Constant, Shoulder Pain and Disability Index, simple shoulder test, University of California, Los Angeles scores) were assessed both preoperatively and at the latest follow-up; outcomes were compared based on severity of ACJ arthritis. Multivariable linear regression models were used to determine whether increasing severity of ACJ arthritis was associated with poorer outcomes.
RESULTS
A total of 341 patients were included with a mean age of 71 ± 8 years and 55% were female. The mean follow-up was 5.1 ± 2.4 years. Preoperatively, there were no differences in outcomes based on the severity of ACJ pathology. Postoperatively, there were no differences in outcomes based upon the severity of ACJ arthritis except for greater preoperative to postoperative improvement in active internal rotation in patients with normal or grade 1 ACJ arthritis vs. grade 2 and 3 (3 ± 2 vs. 1 ± 2 and 1 ± 3, = .029). Patients with ACJ arthritis and osteophytes ≥2 mm had less favorable Shoulder Pain and Disability Index scores, corresponding to greater pain (-49.3 ± 21.5 vs. -41.3 ± 26.8, = .015). On multivariable linear regression, increased severity of ACJ arthritis was not independently associated with poorer postoperative ROM or outcome scores.
CONCLUSION
Overall, our results demonstrate that greater ACJ arthritis severity score is not associated with poorer outcome scores and has minimal effect on ROM. However, patients with the largest osteophytes (≥2 mm) did have slightly worse pain postoperatively. Radiographic presence of high-stage ACJ arthritis should not alter the decision to undergo rTSA.
PubMed: 38312293
DOI: 10.1016/j.jseint.2023.08.014