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EFORT Open Reviews Aug 2017Shoulder stability depends on the position of the arm as well as activities of the muscles around the shoulder. The capsulo-ligamentous structures are the main... (Review)
Review
Shoulder stability depends on the position of the arm as well as activities of the muscles around the shoulder. The capsulo-ligamentous structures are the main stabilisers with the arm at the end-range of movement, whereas negative intra-articular pressure and concavity-compression effect are the main stabilisers with the arm in the mid-range of movement.There are two types of glenoid bone loss: fragment type and erosion type. A bone loss of the humeral head, known as a Hill-Sachs lesion (HSL), is a compression fracture of the humeral head caused by the anterior rim of the glenoid when the humeral head is dislocated anteriorly in front of the glenoid. Four out of five patients with anterior instability have both Hill-Sachs and glenoid bone lesions, which is called a 'bipolar lesion'.With the arm moving along the posterior end-range of movement, or with the arm in various degrees of abduction, maximum external rotation and maximum horizontal extension, the glenoid moves along the posterior articular margin of the humeral head. This contact zone of the glenoid with the humeral head is called the 'glenoid track'.A HSL, which stays on the glenoid track (on-track lesion), cannot engage with the glenoid and cannot cause dislocation. On the other hand, a HSL, which is out of the glenoid track (off-track lesion), has a risk of engagement and dislocation. Clinical validation studies show that the 'on-track/off-track' concept is able to predict reliably the risk of a HSL being engaged with the glenoid. For off-track lesions, either remplissage or Latarjet procedure is indicated, depending upon the glenoid defect size and the risk of recurrence. Cite this article: 2017;2:343-351.
PubMed: 28932486
DOI: 10.1302/2058-5241.2.170007 -
Journal of Shoulder and Elbow... 2019The Walch B2 glenoid is characterized by a biconcave glenoid deformity, acquired glenoid retroversion, and posterior subluxation of the humeral head. Surgical... (Review)
Review
The Walch B2 glenoid is characterized by a biconcave glenoid deformity, acquired glenoid retroversion, and posterior subluxation of the humeral head. Surgical reconstruction of the B2 glenoid is often challenging due to the complexity of the deformity. Bone graft augmentation using humeral head autograft is a valuable adjunct to anatomic total shoulder arthroplasty in the B2 glenoid, particularly in the young, highly active patient with severe glenoid retroversion (>25°-30°). Although this technique affords the ability to correct glenoid version and simultaneously enhances glenoid bone stock, it is technically challenging. The potential for graft-related complications also exists, which may further impact glenoid implant longevity and functional outcome. This review article aims to describe the B2 glenoid morphology, discuss the challenges in managing the B2 deformity, and provide further insight specifically regarding autografting at the time of anatomic total shoulder arthroplasty for reconstruction of the B2 glenoid.
PubMed: 34497955
DOI: 10.1177/2471549219865786 -
Radiology Case Reports Dec 2016Glenoid hypoplasia, also known as glenoid dysplasia and dysplasia of the scapular neck, is a failure of ossification of the posteroinferior two-thirds of the glenoid....
Glenoid hypoplasia, also known as glenoid dysplasia and dysplasia of the scapular neck, is a failure of ossification of the posteroinferior two-thirds of the glenoid. Once thought to be a rare condition, more recent studies have shown that the incidence of glenoid hypoplasia ranges from 18% to 35%. This case report and literature review highlights the typical clinical presentation, the radiologic findings, and the management options for patients with glenoid hypoplasia.
PubMed: 27920867
DOI: 10.1016/j.radcr.2016.08.005 -
Journal of Shoulder and Elbow Surgery Jul 2019Avoiding superior inclination of the glenoid component in reverse shoulder arthroplasty (RSA) is crucial. We hypothesized that superior inclination was underestimated in...
BACKGROUND
Avoiding superior inclination of the glenoid component in reverse shoulder arthroplasty (RSA) is crucial. We hypothesized that superior inclination was underestimated in RSA. Our purpose was to describe and assess a new measurement of inclination for the inferior portion of the glenoid (where the baseplate rests).
METHODS
The study included 47 shoulders with rotator cuff tear arthropathy (mean age, 76 years). The reverse shoulder arthroplasty angle (RSA angle), defined as the angle between the inferior part of the glenoid fossa and the perpendicular to the floor of the supraspinatus, was compared with the global glenoid inclination (β angle or total shoulder arthroplasty [TSA] angle). Measurements were made on plain anteroposterior radiographs and reformatted 2-dimensional (2D) computed tomography (CT) scans by 3 independent observers and compared with 3-dimensional (3D) software (Glenosys) measurements.
RESULTS
The mean RSA angle was 25° ± 8° on plain radiographs, 20° ± 6° on reformatted 2D CT scans, and 21° ± 5° via 3D reconstruction software. The mean TSA angle was on average 10° ± 5° lower than the mean RSA angle (P < .001); this difference was observed regardless of the method of measurement (radiographs, 2D CT, or 3D CT) and type of glenoid erosion according to Favard. In Favard type E1 glenoids with central concentric erosion, the difference between the 2 angles was 12° ± 4° (P < .001).
CONCLUSION
The same angle cannot be used to measure glenoid inclination in anatomic and reverse prostheses. The TSA (or β) angle underestimates the superior orientation of the reverse baseplate in RSA. The RSA angle (20° ± 5°) needs to be corrected to achieve neutral inclination of the baseplate (RSA angle = 0°). Surgeons should be aware that E1 glenoids (with central erosion) are at risk for baseplate superior tilt if the RSA angle is not corrected.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Female; Glenoid Cavity; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Shoulder Joint; Tomography, X-Ray Computed
PubMed: 30935825
DOI: 10.1016/j.jse.2018.11.074 -
Journal of Clinical Medicine Mar 2024Posterior glenoid bone loss (pGBL) is frequently associated with posterior shoulder instability. Posterior glenohumeral instability accounts for a small percentage of... (Review)
Review
Posterior glenoid bone loss (pGBL) is frequently associated with posterior shoulder instability. Posterior glenohumeral instability accounts for a small percentage of shoulder pathologies, and critical bone loss in posterior instability has not been well defined in the literature. Younger patient populations who participate in activities that repetitively stress the posterior stabilizing structures of the shoulder are more prone to developing posterior shoulder instability. A variety of surgical options have been described, ranging from isolated capsulolabral repair to glenoid osteotomy. Soft-tissue repair alone may be an inadequate treatment in cases of pGBL and places patients at a high risk of recurrence. Our preferred technique for posterior glenoid reconstruction in cases of pGBL involves the transfer of a free iliac crest bone graft onto the native glenoid. The graft is contoured to fit the osseous defect and secured to provide an extension of the glenoid track. In this study, we review pGBL in the setting of posterior instability and describe our technique in detail. Further long-term studies are needed to refine the indications for glenoid bone graft procedures and quantify what constitutes a critical pGBL.
PubMed: 38610781
DOI: 10.3390/jcm13072016 -
JSES International Sep 2022Estimating glenoid bone loss when assessing the unstable shoulder can be challenging. The aim of this article was to describe a simple derived ratio to estimate glenoid...
BACKGROUND
Estimating glenoid bone loss when assessing the unstable shoulder can be challenging. The aim of this article was to describe a simple derived ratio to estimate glenoid bone loss.
METHODS
When the glenoid is damaged and bone is damaged because of instability, the anterior aspect of the glenoid loses its normal curvature and becomes flattened. In geometry, this represents a chord. There are 3 assumptions for the calculations: (1) the lower glenoid is a circle; (2) there is a relationship between the glenoid height and the diameter of the glenoid circle; and (3) the length of the measured bone loss of the glenoid is a chord. Two measurements are required: glenoid height and length of the glenoid defect. The calculations involved in the ratio are reviewed.
RESULTS
If the ratio of the length of the bone defect to the glenoid height is 0.5 (otherwise, 50% of the height), the estimated bone loss is 12%.
CONCLUSION
Glenoid bone loss can be estimated by measuring the length of the glenoid and the length of the defect.
PubMed: 36081688
DOI: 10.1016/j.jseint.2022.05.001 -
The Open Orthopaedics Journal 2017Osteoarthritis of the shoulder is a common condition in the aging population, and it can have profound effects on patients' quality of life. The anatomic total shoulder... (Review)
Review
Osteoarthritis of the shoulder is a common condition in the aging population, and it can have profound effects on patients' quality of life. The anatomic total shoulder arthroplasty is a well-described treatment modality resulting generally excellent outcomes. The objective of this review is to discuss the technical aspects of primary anatomic total shoulder arthroplasty, and to provide a framework to follow to achieve a successful surgical result. The topics covered include preoperative planning, surgical considerations, and approaches, humeral preparation, glenoid bone loss and the emerging concept of using the reverse total shoulder arthroplasty for the type B2 glenoid.
PubMed: 29152006
DOI: 10.2174/1874325001711011115 -
Cureus Jun 2023Background The inconsistent morphology of the scapula is based on variable dimensions of its glenoid cavity, in addition to its broadened and truncated lateral angle....
Background The inconsistent morphology of the scapula is based on variable dimensions of its glenoid cavity, in addition to its broadened and truncated lateral angle. Its variable shapes are attributed to the spinoglenoid cavity (superior and posterior aspect of the scapula), which appears oval, inverted comma-shaped, and piriform (pear-shaped). Traumatic conditions often lead to glenoid dislocation/fracture. The precise administration of total shoulder arthroplasty with glenoid component adjustment warrants a comprehensive knowledge of scapular morphology. This study aims to assess the glenoid cavity/scapula shapes (anthropometric assessment) among individuals located in Odisha, India. Methods This cross-sectional analysis was undertaken on 74 left-sided and 70 right-sided, dry, and undeteriorated scapulae of human adult specimens obtained from the anatomy department irrespective of their gender and age. Results The glenoid cavity was most commonly inverted comma-shaped (34.02%) and pear-shaped (48.61%) while 17.36% of scapulae had oval-shaped glenoid cavities. The mean scapular breadth and length dimensions were 98.12±7.87mm and 135.76±12.85mm, respectively. Statistically insignificant bilateral variations were observed between the glenoid cavity index (mean value: 68.44±7.98%), glenoid diameter-2 (anteroposterior; mean value: 16.17±2.24mm), glenoid diameter-1 (anteroposterior; mean value: 22.67±1.53mm), and glenoid diameter (superoinferior; mean value: 36.03±2.15mm). Conclusion The size and shape of the glenoid cavity are directly associated with the dislocation of the shoulder joint and may disturb the results of total shoulder arthroplasty and rotator cuff surgeries. The current study analyzed the morphological types and diameters of the glenoid cavity in the scapulae to improve efficiency and lessen the failure proportions in shoulder arthroplasty. The study shows that morphological measurement of scapulae plays a vital role in the effective maintenance of posture and shoulder functions.
PubMed: 37415989
DOI: 10.7759/cureus.39981