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Molecular Imaging and Radionuclide... Oct 2022BioNTech (Pfizer) and CoronaVac (Sinovac) vaccines are two of the most administered coronavirus disease-2019 (COVID-19) vaccines worldwide. Vaccination against severe...
OBJECTIVES
BioNTech (Pfizer) and CoronaVac (Sinovac) vaccines are two of the most administered coronavirus disease-2019 (COVID-19) vaccines worldwide. Vaccination against severe acute respiratory syndrome-coronavirus-2 has caused a diagnostic challenge in oncological F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) studies. The aim of our study was to evaluate the F-FDG PET/CT findings of the two most commonly administered vaccines worldwide.
METHODS
Patients over 18 years old who underwent F-FDG PET/CT for oncological purposes in our institution between January 13, 2021 and January 31, 2022, who received a single or second dose of the BioNTech or CoronaVac vaccines in the last two months, were included in the study. Descriptive analyses were presented as mean, standard deviation, frequency and ratio. Additionally, chi-square test was used to analyze categorical variables.
RESULTS
Ipsilateral deltoid muscle hypermetabolism was observed in 6.9% (n=15) and 14.3% (n=22) patients who received CoronaVac and BioNTech vaccines, respectively. Ipsilateral axillary lymph node hypermetabolism was observed in 11% (n=24) and 41.6% (n=64) patients who received CoronaVac and BioNTech vaccines, respectively. Synchronous deltoid muscle and axillary lymph node hypermetabolism was observed in 4.14% (n=9) and 12.33% (n=19) patients who received CoronaVac and BioNTech vaccines, respectively. Significant differences were detected between CoronaVac and BioNTech vaccines in terms of ipsilateral deltoid muscle hypermetabolism, ipsilateral axillary lymph node hypermetabolism and synchronous deltoid muscle and axillary lymph node hypermetabolism (p<0.05).
CONCLUSION
COVID-19 vaccination may result in ipsilateral axillary lymph node hypermetabolism, ipsilateral deltoid muscle hypermetabolism, or synchronous deltoid muscle and axillary lymph node hypermetabolism with different frequencies depending on the type of vaccination. Although synchronous deltoid muscle and axillary lymph node hypermetabolism can reduce misinterpretation of F-FDG PET/CT, to avoid misinterpretation, it is important to question the vaccination history during ongoing COVID-19 vaccination process.
PubMed: 36268854
DOI: 10.4274/mirt.galenos.2022.86570 -
Frontiers in Physiology 2023Scapular dyskinesis is commonly associated with subacromial pain syndrome (SAPS). Addressing scapular dyskinesis is widely accepted as an important component of...
Scapular dyskinesis is commonly associated with subacromial pain syndrome (SAPS). Addressing scapular dyskinesis is widely accepted as an important component of shoulder rehabilitation. Our previous randomized controlled trial showed that Yi Jin Bang (YJB) exercises could effectively manage SAPS, but scapular motions and muscle activity during YJB exercises remain unknown. This study examined scapular kinematics synchronously with scapular muscle activation during YJB exercises. Thirty healthy participants with no shoulder complaints were enrolled in this study. Three-dimensional (3D) scapular kinematics and electromyography (EMG) activation of the upper trapezius, middle trapezius, lower trapezius, serratus anterior, anterior deltoid, middle deltoid, and posterior deltoid were synchronously measured during nine YJB movements. During all YJB movements, the scapula was upwardly rotated and anteriorly tilted, with more upward rotation and a similar or less anterior tilt than the mean resting scapular angle. Column rotation, arm crossover, shoulder support circle, and armpit support high lift generated more internal rotation than the mean resting scapular angle, with the angles of internal rotation significantly greater than the other five movements ( < 0.001). Regarding EMG activity, all YJB movements elicited low activity (1.42%-19.19% maximal voluntary isometric contraction [MVIC]) from the upper trapezius and posterior deltoid and low to moderate activity (0.52%-29.50% MVIC) from the middle trapezius, lower trapezius, serratus anterior, anterior deltoid, and middle deltoid. YJB exercises could be useful in the middle to later phases of shoulder rehabilitation. For patients with insufficient external rotation, some YJB movements should be prescribed with caution.
PubMed: 37362425
DOI: 10.3389/fphys.2023.1169092 -
JSES International Mar 2021The etiologies of glenohumeral osteoarthritis (GHOA) and eccentric glenoid wear within GHOA are unknown, but muscular imbalance may play a role. The purpose of the...
BACKGROUND
The etiologies of glenohumeral osteoarthritis (GHOA) and eccentric glenoid wear within GHOA are unknown, but muscular imbalance may play a role. The purpose of the present study was to determine the relationship between deltoid muscle area, GHOA, and eccentric glenoid wear. We hypothesized that patients with GHOA would have overall deltoid atrophy as compared with controls and that increasing posterior deltoid areas would associate with glenoid retroversion in the Walch B-type (eccentric) GHOA group.
METHODS
The study was a retrospective review of computed tomography imaging studies. We included a control group of subjects without GHOA and a group of individuals with GHOA before undergoing total shoulder arthroplasty. We assigned Walch types via consensus. Cross-sectional area was measured for the anterior and posterior deltoid musculature demarcated via the scapular line, normalized to the total deltoid area. Absolute and normalized total, anterior, and posterior deltoid areas were compared between controls and the entire GHOA group. Normalized anterior and posterior deltoid areas were compared between Walch A-type and B-type GHOA patients within the GHOA group. Univariate linear regression was used to evaluate for an association between glenoid retroversion and normalized posterior deltoid areas in controls, Walch A-type, and Walch B-type patients. Multivariate linear regression analysis was used to evaluate the effects of normalized posterior deltoid area, age, sex, and height on glenoid retroversion within the Walch B-type subgroup.
RESULTS
We included 99 patients with GHOA and 47 controls. The control and GHOA patients did not differ in absolute deltoid areas (21.8 ± 8.8cm vs. 20.6 ± 7.9cm; = .488). Patients with GHOA had a statistically significant increase in normalized posterior deltoid area (0.50 ± 0.10 vs. 0.46 ± 0.10; = .032) and a reciprocal decrease in normalized anterior deltoid area (0.50 ± 0.10 vs. 0.54 ± 0.10; = .040) compared with controls. Walch A-type and B-type patients did not differ in normalized posterior deltoid areas (0.50 ± 0.11 vs. 0.50 ± 0.10; = .780). Normalized posterior deltoid area positively associated with glenohumeral retroversion in Walch B-type GHOA (R = 0.102; = .020), a relationship maintained in multivariate linear regression, using gender, age, and height as covariates (standardized beta = 0.309, = .027).
CONCLUSION
GHOA is not associated with deltoid atrophy, calling into question the suggestion that periarticular muscular atrophy in GHOA is secondary to disuse. Increasing normalized posterior deltoid area associates with increased glenoid retroversion in patients with Walch B-type glenoid morphology. Muscular imbalance may play a role in the etiology or progression of the glenoid deformity observed in eccentric GHOA.
PubMed: 33681850
DOI: 10.1016/j.jseint.2020.10.012 -
Clinical Orthopaedics and Related... Feb 2015Reverse total shoulder arthroplasty (RTSA) allows the deltoid to substitute for the nonfunctioning rotator cuff. To date, it is unknown whether preoperative deltoid and...
BACKGROUND
Reverse total shoulder arthroplasty (RTSA) allows the deltoid to substitute for the nonfunctioning rotator cuff. To date, it is unknown whether preoperative deltoid and rotator cuff parameters correlate with clinical outcomes.
QUESTIONS/PURPOSES
We asked whether associations exist between 2-year postoperative results (ROM, strength, and outcomes scores) and preoperative (1) deltoid size; (2) fatty infiltration of the deltoid; and/or (3) fatty infiltration of the rotator cuff.
METHODS
A prospective RTSA registry was reviewed for patients with cuff tear arthropathy or massive rotator cuff tears, minimum 2-year followup, and preoperative shoulder MRI. Final analysis included 30 patients (average age, 71±10 years; eight males, 22 females). Only a small proportion of patients who received an RTSA at our center met inclusion and minimum followup requirements (30 of 222; 14%); however, these patients were found to be similar at baseline to the overall group of patients who underwent surgery in terms of age, gender, and preoperative outcomes scores. The cross-sectional area of the anterior, middle, and posterior deltoid was measured on axial proton density-weighted MRI. Fatty infiltration of the deltoid, supraspinatus, infraspinatus, teres minor, and subscapularis were quantitatively assessed on sagittal T1-weighted MR images. Patients were followed for Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) scores, subjective shoulder value, pain, ROM, and strength. Correlations of muscle parameters with all outcomes measures were calculated.
RESULTS
Preoperative deltoid size correlated positively with postoperative Constant-Murley score (67.27±13.07) (ρ=0.432, p=0.017), ASES (82.64±14.25) (ρ=0.377; p=0.40), subjective shoulder value (82.67±17.89) (ρ=0.427; p=0.019), and strength (3.72 pounds±2.99 pounds) (ρ=0.454; p=0.015). Quantitative deltoid fatty infiltration (7.91%±4.32%) correlated with decreased postoperative ASES scores (ρ=-0.401; p=0.047). Quantitative fatty infiltration of the infraspinatus (30.47%±15.01%) correlated with decreased postoperative external rotation (34.13°±16.80°) (ρ=-0.494; p=0.037).
CONCLUSIONS
Larger preoperative deltoid size correlates with improved validated outcomes scores, whereas fatty infiltration of the deltoid and infraspinatus may have deleterious effects on validated outcomes scores and ROM after RTSA. The current study is a preliminary exploration of this topic; future studies should include prospective enrollment and standardized MRI with a multivariate statistical approach. Quantitative information attained from preoperative imaging not only holds diagnostic value, but, should future studies confirm our findings, also might provide prognostic value. This information may prove beneficial in preoperative patient counseling and might aid preoperative and postoperative decision-making by identifying subpopulations of patients who may benefit by therapy aimed at improving muscle properties.
LEVEL OF EVIDENCE
Level III, prognostic study.
Topics: Adipose Tissue; Aged; Aged, 80 and over; Arthroplasty, Replacement; Deltoid Muscle; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Preoperative Period; Range of Motion, Articular; Retrospective Studies; Rotator Cuff; Shoulder Joint; Treatment Outcome
PubMed: 25388633
DOI: 10.1007/s11999-014-4047-2 -
Effects of conditioned pain modulation on Capsaicin-induced spreading muscle hyperalgesia in humans.Scandinavian Journal of Pain Oct 2023Muscle pain can be associated with hyperalgesia that may spread outside the area of primary injury due to both peripheral and central sensitization. However, the...
OBJECTIVES
Muscle pain can be associated with hyperalgesia that may spread outside the area of primary injury due to both peripheral and central sensitization. However, the influence of endogenous pain inhibition is yet unknown. This study investigated how endogenous pain inhibition might influence spreading hyperalgesia in experimental muscle pain.
METHODS
Conditioned pain modulation (CPM) was assessed in 30 male volunteers by cold pressor test at the non-dominant hand as conditioning and pressure pain thresholds (PPT) at the dominant 2nd toe as test stimuli. Subjects were classified as having inhibitory or facilitating CPM based on published reference values. Subsequently, muscle pain and hyperalgesia were induced by capsaicin injection into the non-dominant supraspinatus muscle. Before and 5, 10, 15, 20, 30, 40, 50 and 60 min later, PPTs were recorded at the supraspinatus, infraspinatus and deltoid muscle, ring finger and toe.
RESULTS
Compared to baseline, PPTs decreased at the supraspinatus, infraspinatus and deltoid muscle (p≤0.03), and increased at the finger and toe (p<0.001). In facilitating CPM (n=10), hyperalgesia occurred at 5, 10, 15, 20 and 40 min (p≤0.026). In inhibitory CPM (n=20), hyperalgesia only occurred after 10 and 15 min (p≤0.03). At the infraspinatus muscle, groups differed after 5 and 40 min (p≤0.008).
CONCLUSIONS
The results suggest that facilitating CPM is associated with more spreading hyperalgesia than inhibitory CPM. This implies that poor endogenous pain modulation may predispose to muscle pain and spreading hyperalgesia after injury, and suggest that strategies to enhance endogenous pain modulation may provide clinical benefits.
Topics: Humans; Male; Hyperalgesia; Capsaicin; Myalgia; Pain Measurement; Rotator Cuff
PubMed: 37293789
DOI: 10.1515/sjpain-2023-0020 -
Journal of Orthopaedic Research :... Mar 2023Functional outcome after reverse-shoulder-arthroplasty (RSA) in proximal humerus fractures (PHF) depends on deltoid muscle integrity and successful reattachment of the... (Randomized Controlled Trial)
Randomized Controlled Trial
Functional outcome after reverse-shoulder-arthroplasty (RSA) in proximal humerus fractures (PHF) depends on deltoid muscle integrity and successful reattachment of the tuberosities for best possible recovery of rotator-cuff function. In this monocentric, prospective, randomized, controlled trial we investigated whether a reverse-fracture-prosthesis (RFP) with a metaphyseal fenestrated stem achieved superior shoulder and muscle function compared to a common reverse-prosthesis (RP) design for patients with PHF. Our hypothesis was that patients with RFP may achieve a superior healing rate of the greater tuberosity (GT) compared to patients receiving RP, which translates to significantly higher clinical outcome and functional scores as well as differences in deltoid muscle microperfusion. Forty-four patients with PHF were randomized preoperatively to one of the prosthesis types in RSA between 2018 and 2020 (22 with RFP and 22 with RP) and prospectively assessed 6 months after surgery. We assessed osteointegration of the GT with radiographs 1 day and 6 months postoperatively and examined shoulder function and patient satisfaction by using established shoulder scores. A contrast-enhanced ultrasound (CEUS) examination of both shoulders was performed to quantify intramuscular blood flow and evaluate vitality of the deltoid muscle. None of the functional and psychosocial scores or radiographs and ultrasound examinations showed significant differences between the RSA designs. The constant-Murley score (p = 0.384) and active anterior-elevation-abduction, and external rotation were comparable between the RFP and RP group. Similar healing rates of the GT were observed (p = 0.655). CEUS-assessed deltoid microperfusion revealed equivalent muscle vitality for both groups (p = 0.312). Level of evidence: Level II; Randomized Controlled Trial; Treatment Study. Clinical significance: The radiographic evaluation for the investigation of the GT healing rate indicates that the proclaimed benefits of the fracture prosthesis with fenestration design might not be as great as expected.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Prospective Studies; Deltoid Muscle; Treatment Outcome; Shoulder; Shoulder Joint; Shoulder Fractures; Range of Motion, Articular; Retrospective Studies
PubMed: 35662238
DOI: 10.1002/jor.25392 -
Cureus Nov 2023The shoulder joint is a multiaxial joint in the upper body known for its high degree of motion. It is also infamously known for recurrent dislocations compared to other... (Review)
Review
The shoulder joint is a multiaxial joint in the upper body known for its high degree of motion. It is also infamously known for recurrent dislocations compared to other joints. These dislocations are mainly fixed by closed reduction methods like the Hippocrates technique, Stimpson's gravity technique, and the most commonly used modified Kocher's technique. The modified Kocher's technique uses traction followed by external rotation, adduction, and internal rotation. Rotator cuff tears are associated with shoulder joint dislocations. Rotator cuff tears slowly heal and persist for 10-20 years, irrespective of their etiology. When left untreated, fibrosis can set in the joint. After fibrosis, it is repaired with a reverse shoulder arthroplasty. Reverse shoulder arthroplasty allows a greater degree of movement compared to the conventional arthroplasty. In reverse shoulder arthroplasty, the latissimus dorsi tendon is removed from its original insertion and attached to the humerus around the insertion of the deltoid muscle. This change increases the torque and external rotation of the joint and provides better results than the surgeries where the tendon transfer is not done. This article compiles the various etiologies of shoulder dislocation and its treatment, shoulder arthroplasty. It discusses the indications and contraindications of total and reverse total arthroplasty. This article aims to compare conventional shoulder arthroplasty and reverse shoulder arthroplasty. It highlights the advantages of using latissimus dorsi grafts in reverse shoulder arthroplasty in shoulder joint dislocations.
PubMed: 38074062
DOI: 10.7759/cureus.48469 -
Scientific Reports Jan 2022Current US Centers for Disease Control and Prevention intramuscular injection needle length guidelines for injection fo the deltoid muscle are based on weight and...
Current US Centers for Disease Control and Prevention intramuscular injection needle length guidelines for injection fo the deltoid muscle are based on weight and gender. The aims of this study are (1) to evaluate whether other biometric data (age, gender, height, weight and body mass index (BMI)) are better predictors of the thickness of the deltoid subcutaneous fat pad (DSFP) than weight and gender and (2) to evaluate the performance of the CDC weight-based needle length guidelines. This was a retrospective single center cohort study of 386 patients who underwent surveillance PET/CT between 01/01/2020 and 04/01/2021. Patient age, gender, height, weight, BMI and CT measurements of the DSFP were evaluated. DSFP was positively correlated with weight and BMI in men (r = 0.67, P < 0.001; r = 0.74, P < 0.001) and women (r = 0.69, P < 0.001; r = 0.75, P < 0.001) respectively. DSFP was negatively correlated with age in women (r = - 0.19, P = 0.013). Age and BMI were better predictors of DSFP than weight. The best model to predict the DSFP is: [Formula: see text] A 1-inch needle is expected to reach the deltoid in 85.3% of women less than 200 pounds, and 98.6% of men less than 260 pounds. This rate differed between genders (P < 0.001, odds ratio (OR) 0.08, 95% CI (0.02, 0.29)). A 1.5-inch needle is expected to reach the deltoid in 76.7% of women greater than 200 pounds, and 75.0% of men greater than 260 pounds. Current CDC deltoid intramuscular injection needle length guidelines result in women and obese individuals being more likely to receive subcutaneous injections. Age and BMI based guidelines for needle length selection are more accurate.
Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Biometry; Body Height; Body Mass Index; Cohort Studies; Deltoid Muscle; Female; Humans; Injections, Intramuscular; Injections, Subcutaneous; Male; Middle Aged; Models, Statistical; Needles; Obesity; Retrospective Studies; Skin; Subcutaneous Fat; Subcutaneous Tissue
PubMed: 35058499
DOI: 10.1038/s41598-022-05020-5 -
The Open Orthopaedics Journal 2017The proximal humerus is a common location for both primary and metastatic bone tumors. There are numerous reconstruction options after surgical resection. There is no... (Review)
Review
PURPOSE
The proximal humerus is a common location for both primary and metastatic bone tumors. There are numerous reconstruction options after surgical resection. There is no consensus on the ideal method of reconstruction.
METHODS
A systematic review was performed with a focus on the surgical reconstructive options for lesions involving the proximal humerus.
RESULTS
A total of 50 articles and 1227 patients were included for analysis. Reoperation rates were autograft arthrodesis (11%), megaprosthesis (10%), RSA (17%), hemiarthroplasty (26%), and osteoarticular allograft (34%). Mechanical failure rates, including prosthetic loosening, fracture, and dislocation, were highest in allograft-containing constructs (APC, osteoarticular allograft, arthrodesis) followed by arthroplasty (hemiarthroplasty, RSA, megaprosthesis) and lowest for autografts (vascularized fibula, autograft arthrodesis). Infections involving RSA (9%) were higher than hemiarthroplasty (0%) and megaprosthesis (4%). Postoperative function as measured by MSTS score were similar amongst all prosthetic options, ranging from 66% to 74%, and claviculo pro humeri (CPH) was slightly better (83%). Patients were generally limited to active abduction of approximately 45° and no greater than 90°. With resection of the rotator cuff, deltoid muscle or axillary nerve, function and stability were compromised even further. If the rotator cuff was sacrificed but the deltoid and axillary nerve preserved, active forward flexion and abduction were superior with RSA.
DISCUSSION
Various reconstruction techniques for the proximal humerus lead to relatively similar functional results. Surgical choice should be tailored to anatomic defect and functional requirements.
PubMed: 28458733
DOI: 10.2174/1874325001711010203 -
Turkish Journal of Medical Sciences Dec 2022It isimportant to evaluate the vaccine-related metabolic changes on FDG PET/CT to avoid confusing results. We here aimed to assess the frequency and intensity of... (Observational Study)
Observational Study
BACKGROUND
It isimportant to evaluate the vaccine-related metabolic changes on FDG PET/CT to avoid confusing results. We here aimed to assess the frequency and intensity of regional and systemic metabolic PET/CT changes of patients who received the mRNAbased COVID-19 vaccine (BNT162b2-Pfizer/BioNTech) and to analyze possible factors affecting these changes.
METHODS
Among the patients who underwent FDG PET/CT for any indication in our department between July 2021 and December 2021, 129 volunteer patients with a history of COVID-19 vaccination were included in this prospective observational study. Bilateral axillary lymph nodes, ipsilateral deltoid muscle, bone marrow, spleen, thyroid, and liver FDG uptakes were evaluated visually and semiquantitatively for each examination.
RESULTS
The frequencies of positive axillary lymph nodes after vaccination were 40%, 44.4%, 32.6%, and 44.7% in all, 1st dose, 2nd dose, and heterologous vaccination regimens groups, respectively. Maximum standardized uptake values of spleen, liver, and bone marrow were statistically high in patients with positive axillary lymph nodes than with negative ones (p < 0.05). Positive deltoid muscle uptake and diffusely increased thyroid uptake findings were observed in 10 and 8 patients, respectively. The median time interval between vaccination and imaging was 9.5 days for patients with positive axillary lymph nodes and 17 days for patients with negative nodes. In our study group, only 8 patients had a positive documented history of COVID-19 infection.
DISCUSSION
Regional and systemic metabolic changes were occasionally found on FDG PET/CT imaging in patients who received the mRNA-based COVID-19 vaccine. To avoid these timely decreasing changes, we recommend managing the ideal timing of imaging or vaccination and taking a careful history.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; COVID-19 Vaccines; BNT162 Vaccine; COVID-19; Lymph Nodes; Vaccination
PubMed: 36945983
DOI: 10.55730/1300-0144.5519