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Journal of Orthopaedic Surgery and... Apr 2022Because of the broad anatomic variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its...
BACKGROUND
Because of the broad anatomic variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fixation for proximal humerus fractures.
METHODS
The present prospective study involved 37 patients (15 female, 22 male; the mean age = 51 years, age range 19-76) with displaced proximal humerus fractures treated by open reduction and internal fixation. After anatomic reduction and fixation were achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of the axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index (ANI).
RESULTS
The mean AAND was 6 ± 0.36 cm (range 5.5-6.6), and the mean arm length was 32.91 ± 2.9 cm (range 24-38). The mean axillary nerve ratio was 0.18 ± 0.02 (range 0.16 to 0.23). There was a significant moderate positive correlation between AL and AAND (p = 0.006; r = 0.447). The axillary nerve location was predictable in only 18% of the patients.
CONCLUSION
During the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered a safe zone to prevent possible axillary nerve injury.
Topics: Acromion; Adult; Aged; Arm; Cadaver; Female; Fracture Fixation, Internal; Humans; Humerus; Male; Middle Aged; Prospective Studies; Shoulder Fractures; Young Adult
PubMed: 35462535
DOI: 10.1186/s13018-022-03085-6 -
Revista Brasileira de Ortopedia 2012To evaluate the clinical-radiographic subacromial disease symptoms correlated with adaptation of the measure of lateral acromion angle and its respective measuring...
OBJECTIVE
To evaluate the clinical-radiographic subacromial disease symptoms correlated with adaptation of the measure of lateral acromion angle and its respective measuring radiographic acromial index.
METHODS
In the period between october 2010 and february 2011 were evaluated 55 painful shoulders with Neer test and true anteroposterior radiography. Patients were divided into two groups, with Neer test positive and negative. The index measuring the acromion and the lateral acromion angle have been standardized, and compared using statistical averages of 0.7 and 75°, respectively.
RESULTS
The predominant symptom in the population, females (72.73%), age less than 59 years (62.5%) and dominant side (65.31%). The acromion index above 0.7 was found to be symptomatic in 66.67% and lateral acromion angle less than 75 ° in 82.61%. When associated methods, 62.5% had positive clinical (p<0.083).
CONCLUSION
The determination of radiographic acromial index and the lateral acromion angle together seem to be statistically associated with the disease of subacromial impingement.
PubMed: 27047892
DOI: 10.1016/S2255-4971(15)30030-6 -
BioMed Research International 2018The acromion is a small section of the scapula which extends anteriorly from the spine of the scapula and the acromial angle (AA) is a prominent bony point at the...
The acromion is a small section of the scapula which extends anteriorly from the spine of the scapula and the acromial angle (AA) is a prominent bony point at the junction of the lateral border of the acromion and the spine of the shoulder blade. As is well known, the morphology of the acromion and the acromial angle are important as their anatomical variation may contribute to shoulder pathologies. However, few people have studied the morphology and the association between the acromion and the acromial angle. The study explores the acromion and the acromial angle in the anatomical morphology and the association, providing an anatomical basis for clinical diagnosis and treatment. A total of 292 dry, intact scapulae (152 right, 140 left) were used in the study. Three types of the acromion were already measured, type I(flat shape), type II (curved shape), and type III (hooked shape), respectively. Three types of the acromial angles were also measured in this study, C shape, L shape, and Double Angle shape. The research result shows that C shape and L shape were the most common, while Double Angle shape was the least common. C shape was often related to type I (flat shape) and L shape was often related to type II (curved shape). The presented data provides precise and well-sorted information about the acromion and the acromial angle variation in Chinese population, contributing to diagnosis and treating in shoulder pathology.
Topics: Acromion; Asian People; Biomechanical Phenomena; Humans; Scapula
PubMed: 30534558
DOI: 10.1155/2018/3125715 -
Geriatric Orthopaedic Surgery &... 2021Previous clinical studies have reported associations between the acromion index, lateral acromion angle, and critical shoulder angle and the occurrence of rotator cuff...
INTRODUCTION
Previous clinical studies have reported associations between the acromion index, lateral acromion angle, and critical shoulder angle and the occurrence of rotator cuff tears. The objective of this study was to analyze the correlations of these different anatomic parameters in geriatric Chinese Population.
METHODS
Healthy geriatric Chinese participants (n = 66) and geriatric Chinese patients with rotator cuff tears (n = 70) identified between January 2019 and October 2020 were included in this study. Standardized true anteroposterior radiographs were used to measure the acromion index, lateral acromion angle, and critical shoulder angle in each study participant.
RESULTS
The mean acromion index was significantly larger, the mean lateral acromion angle was significantly smaller, and the mean critical shoulder angle was significantly larger in geriatric patients with full-thickness rotator cuff tears compared with geriatric healthy participants.
CONCLUSION
There were a negative linear relationship between the acromion index and lateral acromion angle and a positive linear relationship between the acromion index and critical shoulder angle in geriatric patients with rotator cuff tear and geriatric healthy participants; we termed this phenomenon "Hypothesis of Acromion Index." The acromion index, lateral acromion angle, and critical shoulder angle are independent predictors of rotator cuff tears in a geriatric Chinese population.
PubMed: 34659869
DOI: 10.1177/21514593211043990 -
EFORT Open Reviews Aug 2019An os acromiale occurs when any of the primary ossification centres of the acromion fail to fuse with the basi-acromion. It is present in approximately 8% of... (Review)
Review
An os acromiale occurs when any of the primary ossification centres of the acromion fail to fuse with the basi-acromion. It is present in approximately 8% of individuals, and whilst the majority of these individuals are unaffected it can cause significant pain and disability. It can impact seemingly unrelated surgical intervention in the region such as subacromial decompression and reverse shoulder arthroplasty. A painful os acromiale can be both a diagnostic challenge, and difficult to manage. There remain a wide variety of surgical practices with variable outcomes achieved. We present an evidence-based discussion of the surgical techniques described to date in the literature, alongside a comprehensive review of the incidence and pathophysiology of os acromiale.This review was written after a comprehensive analysis of the literature to date relating to os acromiale. Particular focus was given to material examining surgical management techniques, and the condition's incidence across different population groups.Open reduction and internal fixation using cannulated screws, or tension band wiring have superior outcomes in the literature in the treatment of symptomatic os acromiale. There may be a biomechanical advantage of combining the two techniques. Preservation of large anterior deltoid attachment is necessary, with consideration being given to the local blood supply. There is likely no additional benefit from iliac crest vs local bone grafting. Research in this area remains of a low evidence level with small samples sizes. Appropriately powered clinical research of a higher-level evidence methodology is needed in order to differentiate further in the choice of surgical intervention. Cite this article: 2019;4:525-532. DOI: 10.1302/2058-5241.4.180100.
PubMed: 31538003
DOI: 10.1302/2058-5241.4.180100 -
Clinical Rheumatology Jan 2024The suprascapular notch lies in the superior border of the scapula and is a passageway for the suprascapular nerve that is sensory to the shoulder joint. Suprascapular...
INTRODUCTION
The suprascapular notch lies in the superior border of the scapula and is a passageway for the suprascapular nerve that is sensory to the shoulder joint. Suprascapular nerve block involves injection of local anaesthetic into the suprascapular notch, either ultrasound guided or blind, using the spine of scapula and/or the medial border of the acromion as surface landmarks.
AIM
To investigate the anatomic variations that exist between the distance of the notch from the spine of scapula and acromion.
METHOD
Ninety-two dry scapulae were measured with a digital calliper for their length of the spine, distance between the midpoint of the spine and base of the suprascapular notch and distance between the medial border of the acromion and the base of the suprascapular notch. These measurements were compared for variations in the scapular bony landmarks, the spine and the acromion to determine the site for the injection.
RESULTS
Measurement reliability was assessed by intraclass correlation, Cronbach's alpha being 0.99, 0.97 and 0.91 for length of spine, distance from spine and distance from acromion respectively. The distance from the acromion had less variation in measurement (3.73 ± 0.42 cm) but a flatter distribution when compared to distance from the spine of the scapula (3.32 ± 0.39 cm).
CONCLUSION
Length of the spine of the scapula appeared not to influence either distance from the acromion or distance from the spine of scapula. There is potential for greater variability in placement of nerve blocks that use acromion as the bony reference. Key Points • Dry scapular measurement using electronic Vernier callipers is accurate (0.91-0.97). • There is potential for greater variability in placement of blind nerve blocks that use acromion as the bony reference to locate the suprascapular notch.
Topics: Humans; Acromion; Reproducibility of Results; Scapula; Shoulder; Shoulder Joint
PubMed: 37935986
DOI: 10.1007/s10067-023-06807-1 -
Archives of Orthopaedic and Trauma... Feb 2024Surgical treatment options for acromioclavicular joint separations are varied. Frequently, suspension devices (SD) are inserted for stabilization under arthroscopic...
INTRODUCTION
Surgical treatment options for acromioclavicular joint separations are varied. Frequently, suspension devices (SD) are inserted for stabilization under arthroscopic view. This study investigates the feasibility and accuracy of three-dimensional (3D) digital-volume-tomography (DVT) C-arm navigated implantation with regard to the general trend toward increasingly minimally invasive procedures.
MATERIALS AND METHODS
The implantation of a TightRope suture button system (SD) via a navigated vertical drill channel through the clavicle and coracoid was investigated in 10 synthetic shoulder models with a mobile isocentric C-arm image intensifier setup in the usual parasagittal position. Thereby, in addition the placement of an additive horizontal suture cerclage via a navigated drill channel through the acromion was assessed.
RESULTS
All vertical drill channels in the Coracoclavicular (CC) direction could be placed in a line centrally through the clavicle and the coracoid base. The horizontal drill channels in the Acromioclavicular (AC) direction ran strictly in the acromion, without affecting the AC joint or lateral clavicle. All SD could be well inserted and anchored. After tensioning and knotting of the system, the application of the horizontal AC cerclage was easily possible. The image quality was good and all relevant structures could be assessed well.
CONCLUSION
Intraoperative 3D DVT imaging of the shoulder joint using a mobile isocentric C-arm in the usual parasagittal position to the patient is possible. Likewise, DVT navigated SD implantation at the AC joint in CC and AC direction on a synthetic shoulder model. By combining both methods, the application in vivo could be possible. Further clinical studies on feasibility and comparison with established methods should be performed.
Topics: Humans; Acromioclavicular Joint; Radiography; Clavicle; Acromion; Upper Extremity; Joint Dislocations
PubMed: 37938379
DOI: 10.1007/s00402-023-05112-5 -
Emergency Medicine International 2022Full-thickness rotator cuff tear and rotator cuff injury are frequently occurring diseases and widely exist in the social population. Surgical repair is the most...
Full-thickness rotator cuff tear and rotator cuff injury are frequently occurring diseases and widely exist in the social population. Surgical repair is the most effective treatment for rotator cuff tears and injuries. With the continuous development of arthroscopy, more and more surgeons choose arthroscopic acromioplasty plus rotator cuff repair for the treatment of rotator cuff injury. However, previously published systematic reviews or meta-analyses still cast doubt on the efficacy of such concomitant procedures for postoperative patient function and pain recovery. In this study, we analyzed the effects of parameters such as shoulder function and acromion morphology on aged patients with full-thickness rotator cuff tear combined with rotator cuff injury treated with arthroscopic acromion plasty and rotator cuff repair. The results showed that arthroscopic acromion plasty and rotator cuff repair helped to promote the joint function recovery of the aged patients with full-thickness rotator cuff tear combined with rotator cuff injury and alleviate the pain of the patients. Compared with simple rotator cuff repair, this technique can increase the postoperative AT and reduce the ACEA and to some extent reduce the risk of postoperative rotator cuff reinjury, which is worthy of promotion.
PubMed: 35966500
DOI: 10.1155/2022/4475087 -
Chinese Journal of Traumatology =... Mar 2024A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the...
A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.
Topics: Male; Humans; Middle Aged; Acromion; Coracoid Process; Scapula; Fractures, Bone; Fracture Fixation, Internal
PubMed: 37210253
DOI: 10.1016/j.cjtee.2023.04.003 -
American Family Physician Feb 1998Rotator cuff impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. Symptoms include pain, weakness and loss of motion.... (Review)
Review
Rotator cuff impingement syndrome and associated rotator cuff tears are commonly encountered shoulder problems. Symptoms include pain, weakness and loss of motion. Causes of impingement include acromioclavicular joint arthritis, calcified coracoacromial ligament, structural abnormalities of the acromion and weakness of the rotator cuff muscles. Conservative treatment (rest, ice packs, nonsteroidal anti-inflammatory drugs and physical therapy) is usually sufficient. Some patients benefit from steroid injection, and a few require surgery.
Topics: Diagnosis, Differential; Humans; Patient Education as Topic; Rotator Cuff Injuries; Shoulder Impingement Syndrome; Teaching Materials
PubMed: 9490991
DOI: No ID Found