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JBJS Essential Surgical Techniques Jun 2016Arthroscopic subacromial decompression with acromioplasty is among the most commonly performed arthroscopic shoulder procedures and is an important aspect of any...
Arthroscopic subacromial decompression with acromioplasty is among the most commonly performed arthroscopic shoulder procedures and is an important aspect of any orthopaedic surgeon's armamentarium. This procedure is indicated for refractory subacromial bursitis and subacromial impingement. It is also a routine portion of rotator cuff repair exposure. The procedure aims to remove the subacromial bursa, which can serve as a pain generator, as well as any osteophytes on the undersurface of the acromion, which can lead to impingement and, in some circumstances, bursal-sided rotator cuff tears. Multiple randomized clinical trials have demonstrated no benefit for this procedure as an initial treatment in patients with subacromial bursitis, and thus this procedure is indicated only for patients with refractory subacromial bursitis. The steps of this procedure include (1) placement of the arthroscope in the subacromial space and establishment of a lateral working portal, (2) performance of a thorough subacromial bursectomy, (3) achievement of hemostasis and subperiosteal exposure of the undersurface of the acromion, and (4) smoothing of the undersurface of the acromion and removal of any anterolateral osteophytes. Outcomes after this procedure have shown significant increases in UCLA (University of California at Los Angeles), Constant, visual analog pain scale, and Simple Shoulder Test scores over the preoperative status. Complications, while infrequent, are mostly related to overresection or underresection of the acromion.
PubMed: 30237923
DOI: 10.2106/JBJS.ST.O.00011 -
Orthopaedic Journal of Sports Medicine Jan 2021A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise...
BACKGROUND
A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise correlations between the morphologic features underneath the acromion and the surrounding structures including the attachment of the coracoacromial ligament (CAL) and the origin of the deltoid middle head have not yet been determined in the absence of artifacts on the bony surface caused by dissection techniques. Moreover, anatomic findings in previous studies using only older-aged cadavers or dried bones may not reflect the morphologic features of younger and healthy specimens.
PURPOSE
To characterize the anterolateral structures morphologically in the inferior aspect of the acromion, assess the relationships of these structures with surrounding structures without dissection artifacts on the bony surface, and verify the cadaveric data in the asymptomatic shoulders of living middle-aged patients.
STUDY DESIGN
Descriptive laboratory study.
METHODS
We initially analyzed the relationship between the morphology of the anterolateral structures and surrounding structures in 18 cadaveric shoulders (mean age, 81.8 years), 15 of which were subjected to macroscopic investigation of the CAL attachment and 3-dimensional micro-computed tomography investigation with radiopaque markers and 3 of which were subjected to histologic examination. We also analyzed the morphology underneath the anterolateral acromion in 24 asymptomatic shoulders of middle-aged patients (mean age, 54.8 years) to verify the cadaveric data. In both the cadaveric shoulders and the asymptomatic shoulders of live patients, the long axis, width, and height of the anterolateral prominence were measured by use of 3-dimensional CT imaging.
RESULTS
In cadavers, the anterolateral prominence underneath the acromion corresponded to the attachment of the CAL. Histologic evaluation revealed that the CAL was continuous to the deep layer of the deltoid middle head in the lateral acromion. The study in asymptomatic shoulders of middle-aged patients revealed bony prominences similar to those observed in cadavers.
CONCLUSION
The anterolateral prominence, which corresponds to the attachment of the CAL below the acromion, may be a native structure below the acromion. Moreover, the CAL is continuous to the deep layer of the deltoid middle head in the lateral acromion.
PubMed: 33553456
DOI: 10.1177/2325967120977485 -
Journal of Clinical Medicine Jan 2022Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments.... (Review)
Review
BACKGROUND
Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments. The purpose of this study was to review factors associated with increased acromial and scapular spine strain after RTSA from a biomechanical standpoint.
METHODS
A systematic review of the literature was conducted based on PRISMA guidelines. PubMed, Embase, OVID Medline, and CENTRAL databases were searched and strict inclusion and exclusion criteria were applied. Each article was assessed using the modified Downs and Black checklist to appraise the quality of included studies. Study selection, extraction of data, and assessment of methodological quality were carried out independently by two of the authors. Only biomechanical studies were considered.
RESULTS
Six biomechanical studies evaluated factors associated with increased acromial and scapular spine strain and stress. Significant increases in acromial and scapular spine strain were found with increasing lateralization of the glenosphere in four of the included studies. In two studies, glenosphere inferiorization consistently reduced acromial strain. The results concerning humeral lateralization were variable between four studies. Humeral component neck-shaft angle had no significant effect on acromial strain as analysed in one study. One study showed that scapular spine strain was significantly increased with a more posteriorly oriented acromion (55° vs. 43°; < 0.001). Another study showed that the transection of the coracoacromial ligament increased scapular spine strain in all abduction angles ( < 0.05).
CONCLUSIONS
Glenoid lateralization was consistently associated with increased acromial and scapular spine strain, whereas inferiorization of the glenosphere reduced strain in the biomechanical studies analysed in this systematic review. Humeral-sided lateralization may increase or decrease acromial or scapular spine strain. Independent of different design parameters, the transection of the coracoacromial ligament resulted in significantly increased strains and scapular spine strains were also increased when the acromion was more posteriorly oriented. The results found in this systematic review of biomechanical in-silico and in-vitro studies may help in the surgical planning of RTSA to mitigate complications associated with acromion and scapular spine fracture.
PubMed: 35054057
DOI: 10.3390/jcm11020361 -
Anatomy & Cell Biology Dec 2020Acromion is a major associated structure of subacromial impingement syndrome, one of the most common diagnoses in chronic shoulder pain world-wide. The aims of this...
Acromion is a major associated structure of subacromial impingement syndrome, one of the most common diagnoses in chronic shoulder pain world-wide. The aims of this study are to study morphometry of acromion and to find risk group using acromial morphometry. Total samples were 392 scapulae. The samples were of both sexes, ranging from the age of 31 to 90. Acromion type and osteophytes were observed. Acromial parameters were measured. The relationships were analyzed among acromion type, acromial osteophyte, acromial parameters, age group, sex and side. Curved acromion had the highest prevalence in all age groups. Hooked acromion had the second highest prevalence since the age of 41. Hooked acromion prevalence was higher in male than in female. The highest prevalence of acromial osteophytes was on anteroinferior surface in all age group. The prevalence of acromial osteophytes on anteroinferior surface and acromial facet increased with age. In addition, acromion type was associated with only osteophytes on anteroinferior surface of acromion. Anterior one-third acromial thickness in the age of 31 to 50 was different from those of 51 to 90. There are differences between all parameters and sexes, but not side. General population with age above 50 and concerned male group with age above 40 who have chronic shoulder pain should be investigated for subacromial impingement syndrome. Surgical treatment is recommended because hooked acromion and osteophytes are mostly the root of problem.
PubMed: 32963132
DOI: 10.5115/acb.20.166 -
Scientific Reports May 2023Korean water deer (Hydropotes inermis argyropus; Heude, 1884) and Siberian roe deer (Capreolus pygargus; Pallas, 1771) are Korean wild deer classified in the tribe...
Korean water deer (Hydropotes inermis argyropus; Heude, 1884) and Siberian roe deer (Capreolus pygargus; Pallas, 1771) are Korean wild deer classified in the tribe Capreolini. C. pygargus in Korea were previously considered a single species; however, it was recently suggested that roe deer living on Jeju Island (Jeju roe deer; Capreolus pygargus jejuensis) is a distinct subspecies from roe deer living on the Korean peninsula (mainland roe deer; Capreolus pygargus tianschanicus) based on several studies demonstrating genetic and morphological features. In this study, we suggests that the scapular morphology and osteometric data can be used for interspecies discrmination between Korean wild deer. To compare the morphological characteristics of scapula among the three groups of deer, we analyzed the features and nine osteomorphological measurements of 31 H. i. argyropus (14 males and 17 females), 18 C. p. jejuensis (4 males and 14 females), and 23 C. p. tianschanicus (16 females and 7 males). The estimated ages of the deer were over 32-35 months. Data were analyzed by one-way repeated measures analysis of variance with post hoc Duncan test and discriminant functional analysis (DFA). H. i. argyropus and C. p. tianschanicus had the smallest and largest scapulae, respectively. The scapulae of the three Korean wild deer had a similar triangular shape, which was obscured by the tuber of the scapular spine, pointed acromion, broad infraspinous fossa, narrow supraspinous fossa, and partial ossification of scapular cartilage in older deer. H. i. argyropus had certain distinctive features, including a caudally pointed acromion, a notch between the supraglenoid tubercle and glenoid cavity (NBSG), a glenoid notch, and no sexual dimorphism, except for the longest dorsal length (Ld) and the scapular index (SI). C. p. jejuensis had a larger scapular index (SI) (61.74 ± 0.74%), compared with the SIs of H. i. argyropus and C. p. tianschanicus. The unique features of the scapula in C. p. jejuensis include its S-shaped cranial border. The C. p. jejuensis had a cranially pointed acromion, less frequent presence of glenoid notch and NBSG, short length of supraglenoid tubercle, and no sexual dimorphism. The C. p. tianschanicus had elevated cranial margin of the glenoid cavity, and frequent presence of glenoid notch and NBSG, similar to the H. i. argyropus. Similar to C. p. jejuensis, C. p. tianschanicus had a cranially pointed acromion. However, sexual dimorphism was observed in C. p. tianschanicus. DFA using osteometric data showed 97.22% of specimens were classified correctly into their species, meaning the osteometric parameters can be used for interspecies discrimination of Korean wild deer. Our findings indicate that the scapular morphologies of the three Korean wild deer have certain similarities and differences, suggesting that C. p. jejuensis are distinct from C. p. tianschanicus.
Topics: Female; Male; Animals; Deer; Skull; Scapula; Acromion; Republic of Korea
PubMed: 37165030
DOI: 10.1038/s41598-023-33730-x -
Shoulder & Elbow Aug 2021Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff... (Review)
Review
BACKGROUND
Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff pathology. The purpose of this paper is to investigate the published literature on influences of scapular morphology on the development of re-tears and patient-reported outcomes following rotator cuff repair.
METHODS
A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology and re-tear rates and patient-reported outcomes after rotator cuff repair. Studies were reviewed by two authors.
RESULTS
A total of 615 unique titles and 49 potentially relevant abstracts were reviewed, with eight published manuscripts identified for inclusion. Two of three papers reported no relationship between these acromion index and rotator cuff re-tear rate, while one paper found an increased re-tear rate. All three studies on critical shoulder angle found a significant association between critical shoulder angle and cuff re-tear rate. There was no clear relationship between any bony morphologic measurement and patient-reported outcomes after rotator cuff repair.
CONCLUSIONS
Rotator cuff re-tear rate appears to be significantly associated with the critical shoulder angle and glenoid inclination, while not clearly associated with acromial morphologic measurements.
PubMed: 34394734
DOI: 10.1177/1758573219895987 -
Journal of Shoulder and Elbow Surgery Dec 2023Acromial and scapular spine stress fractures are common complications post reverse shoulder arthroplasty. A systematic review with meta-analysis was conducted to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Acromial and scapular spine stress fractures are common complications post reverse shoulder arthroplasty. A systematic review with meta-analysis was conducted to evaluate the clinical outcomes of conservatively treated acromial and scapular spine stress fractures post reverse shoulder arthroplasty in comparison to nonfracture control.
METHODS
Embase, MEDLINE, and Web of Science were searched on September 9, 2022, using various terms related to fracture, acromion, scapula, and reverse shoulder arthroplasty. Meta-analysis using a random effects model was performed on common outcome scores. Risk of bias was assessed using the Joanna Briggs Institute tools for case-controlled studies. Sensitivity analysis was performed for imputed standard deviations and studies with <20 participants.
RESULTS
Thirteen studies with a total of 339 fracture and 3142 control patients were included in the systematic review. Meta-analysis was performed on 12 studies assessing active forward flexion, abduction, external rotation, Constant-Murley score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, pain score, Simple Shoulder Test, and Single Assessment Numeric Evaluation. Fracture patients experienced significantly poorer functional outcome compared with control patients when the fractures were managed conservatively. Levy III fractures tend to experience worse outcomes. Pain score did not demonstrate a statistically significant difference between the fracture and nonfracture cohort.
DISCUSSION
Currently, literature regarding surgical management is lacking, partially because of a dearth of high-quality literature but also hindered by a lack of standardized techniques. This review was limited by inclusion of studies of low evidence, small sample sizes, and inconsistency in outcome measurement and follow-up period. Overall, patients with acromial and scapular spine stress fractures treated conservatively are expected to have reduced shoulder function compared to nonfracture patients, with the spine of scapula fracture patients suffering the poorest outcomes. Future studies should aim to use the same sets of outcomes parameters to assess the patients at fixed time intervals and report outcomes stratified by Levy classification. This will enable interinstitutional collaboration and pooling of results.
Topics: Humans; Acromion; Fractures, Stress; Arthroplasty, Replacement, Shoulder; Conservative Treatment; Shoulder Joint; Retrospective Studies; Scapula; Pain; Treatment Outcome
PubMed: 37573934
DOI: 10.1016/j.jse.2023.07.011 -
International Journal of Surgery Case... 2017Acromion fractures are extremely rare. There are no common accepted treatment schemes and fixation methods We aimed to present a case which may contribute to the...
INTRODUCTION
Acromion fractures are extremely rare. There are no common accepted treatment schemes and fixation methods We aimed to present a case which may contribute to the diagnosis and treatment of acromion fracture in a patient with polytrauma.
PRESENTATION OF CASE
Acromion fracture associated with scapula and clavicle fractures was diagnosed in 40 years old patient and treated with open reduction and cannulated screw fixation. The fracture healing was completed without causing subacromial impingement.
DISCUSSION
In patients with polytrauma, diagnosis and treatment of acromion fractures can be delayed or overlooked. In improperly treated acromion fractures; pain, movement restriction, subacromial impingement, rotator cuff injury and symptomatic nonunion can occur.
CONCLUSION
We recommend early surgical treatment for displaced acromion fractures, reduction of subacromial space and disruption of the superior shoulder suspensory complex.
PubMed: 28898793
DOI: 10.1016/j.ijscr.2017.08.051 -
SAGE Open Medicine 2022Dislocations and periarticular fractures of the acromioclavicular joint are common injuries of the shoulder girdle. When surgical intervention is indicated, subacromial...
OBJECTIVES
Dislocations and periarticular fractures of the acromioclavicular joint are common injuries of the shoulder girdle. When surgical intervention is indicated, subacromial support is one option to restore the alignment between scapula and the distal/lateral clavicle. Devices used for subacromial support rely on a form of subacromial 'hook'. The shape, inclination and orientation of which is often mismatched to the anatomy of the inferior surface of the acromion, which may lead to painful acromial osteolysis and rotator cuff abrasion causing impingement. The primary goal of this study was to characterize the geometrical parameters of the acromion and distal clavicle, and their orientation at the acromioclavicular joint.
METHODS
Computed tomography scans of 120 shoulders were converted into digital three-dimensional models. Measurements of the acromion inclination and acromion width relative to the torsional angle as well as the clavicle depth were taken. A numerical optimization of the anatomical parameters (including torsional and inclination angles, height and width) was performed to find the combination of those parameters with the lowest interpatient variability.
RESULTS
The mean clavicle depth was found to be 11.1 mm. The mean acromion width was 27 mm. The combination of torsional and inclination angles with lowest interpatient variability was found at 80° and 16°, respectively.
CONCLUSION
There is a high interpatient variability in the morphology of the inferior surface of the acromion. Subacromial support using a 'hook' can be optimized for contact surface area, which should lead to fewer complications after the restoration of acromioclavicular orientation using acromial support strategies.
PubMed: 35492883
DOI: 10.1177/20503121221091395 -
Medicina (Kaunas, Lithuania) Apr 2023Anatomical variations in the head, neck and chest are common, and are observed as occasional findings on computed tomography (CT). Although anatomical variations are...
Anatomical variations in the head, neck and chest are common, and are observed as occasional findings on computed tomography (CT). Although anatomical variations are mostly asymptomatic and do not cause any negative influence on the body function, they may jeopardize diagnosis and may be confused with pathological conditions. The presence of variations may also limit surgical access during tumor removal. The aim of this study was to investigate the prevalence of six anatomical variations-os acromiale, episternal ossicles, cervical rib, Stafne bone cavity, azygos lobe and tracheal bronchus-in an open-access computed tomography dataset obtained from oropharyngeal cancer patients. A total of 606 upper-chest and neck computed-tomography scans (79.4% male and 20.6% female) were retrospectively investigated. Sex difference was evaluated using the z-test for two proportions. Os acromiale, episternal ossicles, cervical rib, Stafne bone cavity, azygos lobe, and tracheal bronchus were present in 3.1%, 2.2%, 0.2%, 0%, 0.3% and 0.5%, respectively, of all patients. Os acromiale was identified as meso-acromion in 86.6%, and as pre-acromion in 17.4%, of all acromia. Episternal ossicles were present unilaterally in 58.3%, and bilaterally in 41.7%, of all sterna. Only the cervical rib showed a sex difference in prevalence. awareness of these variations is important for radiologists interpreting head, neck and chest CTs; for example, those of oropharyngeal cancer patients. This study also illustrates the applicability of publicly available datasets in prevalence-based anatomical research. While most of the variations investigated in the present study are well-known, the episternal ossicles are not well explored, and need further investigation.
Topics: Humans; Male; Female; Acromion; Retrospective Studies; Tomography, X-Ray Computed; Oropharyngeal Neoplasms; Bronchial Diseases; Carcinoma
PubMed: 37109665
DOI: 10.3390/medicina59040707