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JSES International Jan 2024
PubMed: 38312292
DOI: 10.1016/j.jseint.2023.08.012 -
Schweizer Archiv Fur Tierheilkunde Feb 2024The patient histories, findings from clinical examinations, diagnostic imaging techniques, the surgical procedures, complications, necropsy findings and the outcomes...
The patient histories, findings from clinical examinations, diagnostic imaging techniques, the surgical procedures, complications, necropsy findings and the outcomes from five male or castrated male alpacas with scapulohumeral sub-/luxation are presented. These alpacas each had a history of severe forelimb lameness for one week (n: 1), four weeks (n: 2) and for two-to-three months (n: 2). Two of the five alpacas were euthanized due to severe osteoarthritic changes that developed during the two-to-three months of scapulohumeral luxation. Three alpacas were treated with open reduction and internal stabilisation by placing tension band sutures between one 4,5 mm cortical screw anchored in the scapular neck and two 4,5 mm cortical screws anchored in the greater humeral tubercle, all of them provided with washers. Post-surgery a carpal flexion sling was applied to avoid postoperative weight-bearing. An exercise programme was started after removal of the carpal sling and continued for 12 weeks. In one of the three alpacas an additional non-displaced fracture of the acromion occurred two weeks after surgery. In conclusion, all three treated alpacas had good-to-excellent long-term outcomes and are still alive 123, 15 and 12 months after surgical repair of the scapulohumeral sub-/luxation. As four weeks, or even up to three months elapsed in four of these five alpacas until a definitive diagnosis was made, more education should be provided to alpaca owners that severely lame animals should be presented to a veterinarian with adequate diagnostic possibilities and expertise as soon as possible in order not to compromise treatment success.
Topics: Male; Animals; Camelids, New World; Treatment Outcome
PubMed: 38299928
DOI: 10.17236/sat00417 -
Applied Ergonomics May 2024Increasing chair recline during seated computer work may reduce the load placed on the upper trapezius (UT), a common location of pain for those with idiopathic chronic...
Increasing chair recline during seated computer work may reduce the load placed on the upper trapezius (UT), a common location of pain for those with idiopathic chronic neck pain. This study determined the effect of increasing chair recline on UT stiffness and muscle activity during computer work in people with and without idiopathic chronic neck pain. Surface electromyography and ultrasound shear wave elastography were collected from three subdivisions of the UT in 15 individuals with idiopathic chronic neck pain and 15 sex-matched healthy controls. Participants sat in a standardized computer-work setup while chair recline (0°, 25°, 45°) and head and neck position (self-selected, neutral, flexed) were systematically adjusted and maintained for 2.5-min intervals. Repeated-measures ANOVAs were completed for each sex, muscle, and data type, with group (chronic neck pain, control), chair recline (0°,25°,45°), head and neck position (self-selected, flexed, neutral), and side of collected data (dominant, non-dominant) as fixed factors. Men with idiopathic chronic neck pain demonstrated greater UT stiffness in the cranial subdivision when compared to healthy men. Additionally, the 25° and 45° recline levels increased the stiffness of men's dominant UT compared to men's non-dominant UT. Women's UT was more affected by head and neck position, and a neutral head and neck position resulted in lower UT activation, but higher UT stiffness for the cranial subdivision and midway between C-7 and the acromion process. Overall, our findings suggest that the commonly suggested neutral position may not be a beneficial prompt when positioning someone during seated computer work.
Topics: Male; Humans; Female; Neck Pain; Superficial Back Muscles; Sitting Position; Head; Electromyography; Neck Muscles
PubMed: 38290318
DOI: 10.1016/j.apergo.2024.104227 -
Frontiers in Medicine 2023The incidence and diagnostic rate of rotator cuff tears (RCTs) have increased significantly. The purpose of this study was to investigate and analyze the risk factors...
BACKGROUND
The incidence and diagnostic rate of rotator cuff tears (RCTs) have increased significantly. The purpose of this study was to investigate and analyze the risk factors for symptomatic RCTs to provide a basis for their prevention and treatment.
METHODS
We retrospectively analyzed the relevant clinical indicators of 193 randomized clinical trial (RCT) patients and 161 non-RCT patients hospitalized with shoulder pain as the main complaint from January 1, 2017, to August 31, 2021. Univariate analysis and multivariate regression analysis were used to analyze the differences in potential risk factors between the two groups.
RESULTS
Univariate analysis revealed that age ( < 0.001), body mass index (BMI) ( = 0.036), hypertension ( < 0.001), coronary heart disease ( = 0.028), history of shoulder trauma ( < 0.001), hyperlipidemia ( = 0.025), type III acromion ( = 0.012) and critical shoulder angle (CSA) ( < 0.001) increased the risk of RCTs. Multivariate logistic regression analysis revealed that age ≥ 60 years (OR = 2.61, 95% CI = 1.23 to 5.12), CSA ≥ 35° (OR = 4.24, 95% CI = 1.60 to 11.22), hypertension (OR = 2.34, 95% CI = 1.33 to 4.11) and history of shoulder trauma (OR = 5.20, 95% CI = 2.87 to 9.45) were independent risk factors for symptomatic RCTs.
CONCLUSION
The results of this study showed that age ≥ 60 years, CSA ≥35°, hypertension and history of shoulder trauma are independent risk factors for symptomatic RCTs and can provide directions for further development of prevention and treatment strategies. Future studies need to clarify the mechanism underlying the association between these risk factors and symptomatic RCTs.
PubMed: 38239617
DOI: 10.3389/fmed.2023.1321939 -
Arthroscopy, Sports Medicine, and... Feb 2024To investigate the gliding resistance dynamics between the supraspinatus (SSP) tendon and the coracoacromial arch, both before and after subacromial decompression...
PURPOSE
To investigate the gliding resistance dynamics between the supraspinatus (SSP) tendon and the coracoacromial arch, both before and after subacromial decompression (anterolateral acromioplasty) and acromion resection (acromionectomy).
METHODS
Using 4 fresh-frozen cadaveric shoulders, acromion shapes were classified (2 type I and 2 type III according to Bigliani). Subacromial bursa and coracoacromial ligament maintenance replicated physiologic sliding conditions. Gliding resistance was measured during glenohumeral abduction (0° to 60°) in internal rotation (IR) and external rotation (ER). Peak gliding resistance between the SSP tendon and the coracoacromial arch was determined and compared between intact, anterolateral acromioplasty, and acromionectomy.
RESULTS
Peak SSP gliding resistance during abduction in an intact shoulder was significantly higher in IR than in ER (4.1 vs 2.1 N, < .001). The mean peak SSP gliding resistance during 0° to 60° glenohumeral abduction in IR in the intact condition was significantly higher compared with the subacromial decompression condition (4.1 vs 2.8 N, = .021) and with the acromionectomy condition (4.1 vs 0.9 N, < .001). During 0° to 60° glenohumeral abduction in ER, mean peak SSP gliding resistance in the intact condition was not significantly different compared with the subacromial decompression condition (2.1 vs 2.0 N, = .999). The 2 specimens with a hooked (i.e. type III) acromion showed significantly higher mean peak SSP gliding resistance during glenohumeral abduction in IR and ER when compared with the 2 specimens with a flat (i.e. type I) acromion (IR: 5.8 vs 3.0 N, = .006; ER: 2.8 vs 1.4 N, = .001).
CONCLUSIONS
In this cadaveric study, peak gliding resistance between the SSP tendon and the coracoacromial arch during combined abduction and IR was significantly reduced after anterolateral acromioplasty and was significantly higher in specimens with a hooked acromion.
CLINICAL RELEVANCE
The clinical benefit of subacromial decompression remains unclear. This study suggests that anterolateral acromioplasty might reduce supraspinatus gliding resistance in those with a hooked acromion and in the typical "impingement" position.
PubMed: 38226343
DOI: 10.1016/j.asmr.2023.100845 -
Diagnostics (Basel, Switzerland) Jan 2024Shoulder pain is a common issue often linked to conditions such as subacromial impingement or rotator cuff lesions. The role of the acromion in these symptoms remains a...
Shoulder pain is a common issue often linked to conditions such as subacromial impingement or rotator cuff lesions. The role of the acromion in these symptoms remains a subject of debate. This study aims to establish standardized values for commonly used acromion dimensions based on whole-body MRI scans of a large and healthy population and to investigate potential correlations between acromion shape and influencing factors such as sex, age, BMI, dominant hand, and shoulder pain. The study used whole-body MRI scans from the Study of Health in Pomerania, a German population-based study. Acromion index, acromion tilt, and acromion slope were measured. Interrater variability was tested with two independent, trained viewers on 100 MRI sequences before actual measurements started. Descriptive statistics and logistic regression were used to evaluate the results. We could define reference values based on a shoulder-healthy population for each acromion parameter within the 2.5 to 97.5 percentile. No significant differences were found in acromion slope, tilt, and index between male and female participants. No significant correlations were observed between acromion morphology and anthropometric parameters such as height, weight, or BMI. No significant differences were observed in acromion parameters between dominant and non-dominant hands or stated pain intensity. This study provides valuable reference values for acromion-related parameters, offering insight into the anatomy of a healthy shoulder. The findings indicate no significant differences in acromion morphology based on sex, weight, BMI, or dominant hand. Further research is necessary to ascertain the clinical implications of these reference values. The establishment of standardized reference values opens new possibilities for enhancing clinical decision making regarding surgical interventions, such as acromioplasty.
PubMed: 38201416
DOI: 10.3390/diagnostics14010107 -
Frontiers in Immunology 2023The objective of this study was to evaluate the appropriate vaccination needle penetration depth into the deltoid muscle to avoid injection-site complications from an...
OBJECTIVE
The objective of this study was to evaluate the appropriate vaccination needle penetration depth into the deltoid muscle to avoid injection-site complications from an inappropriate injection depth and/or injection site in the Thai population.
METHODS
This was a retrospective study using axial proton density-weighted images of MRI shoulders at the level of 2 fingerbreadths below the acromion process to measure the combined thickness of the skin, subcutaneous fat pad and deltoid muscle to evaluate the percentage of injections into the deltoid muscle with various needle penetration depths.
RESULTS
There were 509 MRI shoulder images of 222 males and 287 females (265 right shoulders and 244 left shoulders). The average body mass index and age were 24.54 ± 3.54 kg/m and 64.81 ± 10.20 years, respectively. Using a needle penetration depth of 12.7 mm (0.5 inches) achieved 100% of injections into the deltoid muscle.
CONCLUSION
We recommend advancing the entire length of a 0.5-inch needle perpendicular to the skin at 2 fingerbreadths below the acromion process for adult intradeltoid vaccinations. This approach ensures optimal vaccine delivery and minimizes the risk of injection-related injuries.
Topics: Male; Female; Humans; Thailand; Injections, Intramuscular; Retrospective Studies; Vaccination; Muscles; Magnetic Resonance Imaging; Vaccines
PubMed: 38162663
DOI: 10.3389/fimmu.2023.1302891 -
In Vivo (Athens, Greece) 2024Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm that typically occurs in the ends (epiphyses) of long bones of young adults. Flat bones are uncommon... (Review)
Review
BACKGROUND/AIM
Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm that typically occurs in the ends (epiphyses) of long bones of young adults. Flat bones are uncommon sites of involvement. Herein, we describe an unusual case of pathologically proven GCT of the acromion.
CASE REPORT
The patient was a 39-year-old woman with no history of trauma who presented with a 3-month history of right posterior shoulder pain. Physical examination revealed mild swelling and tenderness in the posterior aspect of the right shoulder. Plain radiograph showed a purely lytic lesion, suggestive of a bone tumor. Computed tomography demonstrated an intraosseous lytic lesion with associated cortical thinning and lack of periosteal reaction. On magnetic resonance imaging, the lesion exhibited slightly higher signal intensity compared to skeletal muscle on T1-weighted sequences and heterogeneous high signal intensity on T2-weighted sequences. Strong enhancement was observed following gadolinium administration. The lesion was treated by extensive curettage with adjuvant therapy comprising ethanol and the remaining cavity was filled with polymethylmethacrylate bone cement. Histologically, the lesion was composed of round or spindle-shaped mononuclear cells admixed with numerous osteoclast-like giant cells. Immunohistochemically, the mononuclear neoplastic cells were diffusely positive for H3.3 G34W. The patient was asymptomatic and there was no evidence of local recurrence or distant metastasis 5 months after surgery.
CONCLUSION
Although rare, acromial GCTB should be considered in the differential diagnosis of posterior shoulder pain, especially in young and early middle-aged adults.
Topics: Female; Middle Aged; Young Adult; Humans; Adult; Acromion; Shoulder Pain; Giant Cell Tumor of Bone; Bone Neoplasms; Radiography
PubMed: 38148094
DOI: 10.21873/invivo.13467 -
Journal of Orthopaedic Surgery and... Dec 2023While ultrasound (US) measures of the subacromial space (SAS) have demonstrated excellent reliability, measurements are typically captured by experts with extensive...
BACKGROUND
While ultrasound (US) measures of the subacromial space (SAS) have demonstrated excellent reliability, measurements are typically captured by experts with extensive ultrasound experience. Further, the agreement between US measured SAS width and other imaging modalities has not been explored. This research evaluated the agreement between SAS measures captured by novice and expert raters and between US and magnetic resonance imaging (MRI). This study also evaluated the effect of US transducer tilt on measured SAS.
METHODS
Nine men and nine women participated in this study. US images were captured by a novice and expert with the participant in both seated and supine positions. An inclinometer was fixed to the US probe to measure transducer tilt. SAS width was measured in real time from freeze framed images. MRI images were captured, and the humerus and acromion manually segmented. The SAS width was measured using a custom algorithm.
RESULTS
Intraclass correlation coefficients (ICCs) between novice and expert raters were 0.74 and 0.63 for seated and supine positions, respectively. Intra-rater agreement was high for both novice (ICC = 0.83-0.84) and expert (ICC ≥ 0.94) raters. Agreement between US and MRI was poor (ICC = 0.21-0.49) but linearly related.
CONCLUSIONS
Moderate agreement between novice and expert raters was demonstrated, while the agreement between US and MRI was poor. High intra-rater reliability within each rater suggests that US measures of the SAS may be completed by a novice with introductory training.
Topics: Male; Humans; Female; Reproducibility of Results; Algorithms; Ultrasonography; Magnetic Resonance Imaging; Sitting Position
PubMed: 38135882
DOI: 10.1186/s13018-023-04482-1 -
Orthopaedic Surgery Feb 2024Arthroscopic surgery has been established as an efficacious intervention for the treatment of rotator cuff tears. The primary aim of this study was to analyze the... (Observational Study)
Observational Study
BACKGROUND
Arthroscopic surgery has been established as an efficacious intervention for the treatment of rotator cuff tears. The primary aim of this study was to analyze the modifications in the lateral acromial angle (LAA) subsequent to rotator cuff repair surgery using single-row rivet fixation and double-row rivet fixation techniques. Furthermore, we sought to investigate the influence of LAA on the prognosis of rotator cuff repair surgery.
METHOD
This observational study retrospectively enrolled 105 patients diagnosed with degenerative rotator cuff tears who underwent arthroscopic rotator cuff repair between 2016 and 2019. Following the exclusion of two patients with subscapularis or superior labrum anterior and posterior (SLAP) tears, as well as three patients who were lost to follow-up, a cohort of 100 patients was included for clinical and imaging evaluation. Among these individuals, 50 were assigned to the double-row repair group, whereas the remaining 50 comprised the single-row repair group. Bilateral shoulder magnetic resonance imaging (MRI) scans were conducted no less than 24 months post-surgery. Experienced arthroscopic surgeons, blinded to the LAA measurements, assessed the rotator interval (RI) using a control MRI. Functional assessment was performed using the University of California, Los Angeles (UCLA) quick disability of the shoulder and arm, shoulder and hand (qDASH) score. The Wilcoxon signed-rank test for dependent samples was employed to compare data between the pre- and post-intervention groups. Pearson correlation coefficients were calculated to evaluate the relationship between different parameters.
RESULTS
The study population consisted of 73 female patients and 27 male patients, with a mean age of 58.32 ± 5.29 years and a mean follow-up duration of 25.88 ± 8.11 months. Preoperatively, the mean LAA was 75.81° ± 11.28°, RI was 4.78 ± 0.62, UCLA score was 17.54 ± 2.44, and qDASH score was 2.45 ± 0.25. The average tear size was 8.95 ± 2.11 mm. A statistically significant difference in LAA was observed between the preoperative and postoperative measurements, with the double-row repair group exhibiting a greater LAA than the single-row repair group. Finally, a significant correlation was identified between LAA, RI, and qDASH scores after a 24-month follow-up period.
CONCLUSION
According to our findings, the utilization of double-row rivet fixation has a greater LAA angle than single-row rivet fixation. Moreover, this preservation of LAA is significantly associated with the functional recovery of the shoulder joint.
Topics: Humans; Male; Female; Middle Aged; Rotator Cuff Injuries; Acromion; Retrospective Studies; Rotator Cuff; Shoulder; Arthroscopy; Magnetic Resonance Imaging; Treatment Outcome
PubMed: 38112436
DOI: 10.1111/os.13965