ABSTRACT
SUMMARY: Glenoid fossa bone loss has been associated with recurrence and failure after glenoid labrum repair for shoulder instability. Quantification of glenoid fossa bone loss is critical for the successful treatment of glenohumeral instability. The aim of this paper was to estimate a linear regression model based on glenoid height in CT scan adjusted for age and sex to calculate glenoid fossa width in a healthy Chilean sample. CT scans of 101 shoulders were reviewed. The mean age was 51.96 years (SD 19.16; range, 15-88 years) with 53 females and 48 male patients. Studies with signs of bone loss, instability, fracture, or arthritis were excluded. After 3D-CT reconstruction, the height and width of each glenoid fossa was measured using the Owens methodology. All landmarks for the 2 measurements were placed on the most lateral surface of the glenoid fossa margin. Measurements for all shoulders were recorded by 3 observers and repeated on a subset (n = 20) of shoulders, under blinded conditions, by the same observer, at least 2 weeks after the initial measurements. Descriptive statistics, intraclass correlation and regression coefficients were calculated with Stata BE 17® software. A p- value of 0.05 was considered significant. A linear regression model was estimated resulting in the formula "Width = 10.97 + 0.02 * Age + 0.41 * Height - 1.95 * Sex (1=Female, 0=Male)". This model presented all coefficients with p <0.05 and an adjusted R2 of 0.73. Furthermore, it fulfilled the assumption of linearity, normal distribution of errors, independence of errors, and homoscedasticity. Regarding the intraobserver correlation, ICC was 0.76 for height and 0.91 for width; the interobserver ICC was 0.93 for height and 0.86 for width. A 3D-CT specific formula was developed to predict glenoid fossa width based on height with sufficient accuracy to be clinically valuable.
RESUMEN: La pérdida de hueso de la fosa glenoidea se ha asociado con recurrencia y falla después de la reparación del labrum glenoideo por inestabilidad del hombro. La cuantificación de la pérdida ósea glenoidea es fundamental para el tratamiento exitoso de la inestabilidad glenohumeral. El objetivo de este trabajo fue estimar un modelo de regresión lineal basado en la altura glenoidea en una tomografía computarizada ajustada por edad y sexo para calcular el ancho de la fosa glenoidea en una muestra chilena sana. Se revisaron las tomografías computarizadas de 101 hombros. La edad media fue de 51,96 años (DE 19,16; rango, 15- 88 años) con 53 mujeres y 48 hombres. Se excluyeron los estudios con signos de pérdida ósea, inestabilidad, fractura o artritis. Después de la reconstrucción 3D-CT, se midió la altura y el ancho de cada fosa glenoidea utilizando la metodología de Owens. Todos los puntos de referencia para las 2 mediciones se colocaron en la superficie más lateral del margen glenoideo. Las mediciones de todos los hombros fueron registradas por 3 observadores y repetidas en un subconjunto (n = 20) de hombros, en condiciones ciegas, por el mismo observador, al menos 2 semanas después de las mediciones iniciales. La estadística descriptiva, la correlación intraclase y los coeficientes de regresión se calcularon con el software Stata BE 17®. Se consideró significativo un valor de p de 0,05. Se estimó un modelo de regresión lineal que resultó en la fórmula "Ancho = 10,97 + 0,02 * Edad + 0,41 * Altura - 1,95 * Sexo (1 = Mujer, 0 = Hombre)". Este modelo presentó todos los coeficientes con p <0.05 y un R2 ajustado de 0.73. Además, cumplió con los supuestos de linealidad, distribución normal de errores, independencia de errores y homocedasticidad. En cuanto a la correlación intraobservador, el CCI fue de 0,76 para la altura y 0,91 para la anchura; el ICC interobservador fue de 0,93 para la altura y 0,86 para la anchura. Se desarrolló una fórmula específica de 3D-CT para predecir el ancho glenoideo en función de la altura con suficiente precisión para ser clínicamente valiosa.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Tomography, X-Ray Computed , Glenoid Cavity/diagnostic imaging , Shoulder Joint/anatomy & histology , Linear Models , Chile , Glenoid Cavity/anatomy & histologyABSTRACT
@#In the stomatognathic system, a stable jaw position is influenced by occlusion, the temporomandibular joint and neuromuscular stability. The condylar position in the glenoid fossa is closely related to the jaw position, while no consensus has been reached on the optimum jaw position and its corresponding condylar position in oral therapy. This paper summarizes the controversial opinions regarding the selection of jaw position and the corresponding condylar position in prosthetics and orthodontics, including antero-superior, antero-inferior, and therapeutic positions. Their indications, theoretical bases and clinical applications are also included. The literature review results suggest that, the antero-superior position, in other words, centric relation, should be chosen when the patient has a stable jaw position without TMD. In cases where finding an ideal antero-superior position is difficult due to hyperplasia or deformation or disarrangement of the articular disc, the antero-inferior position is recommended to alleviate symptoms and facilitate reconstruction of the TMJ to obtain good stability. Moreover, for high-angle patients with Class Ⅱ malocclusion or for patients with mild skeletal malocclusion, camouflaged orthodontic treatment combined with antero-inferior jaw repositioning through the potential of condyle remodeling can be an alternative to orthognathic surgery and can simplify the treatment plan. While the therapeutic position is specifically proposed for coping with complicated situations related to cranio-mandibular dysfunction, such as maximal intercuspal position abnormalities or deflection, muscle and TMJ dysfunction, unstable jaw position, in which changes in the original occlusion or abnormal TMJ guidance are induced, and a new intercuspal position can be established and stabilized on the basis of occlusal support and modified guidance. The therapeutic position put aside the debate regarding condylar position, however, the specific position of the condyle has not been reported in this case. This review suggests that different jaw positions and condylar positions have different scopes of application, and their clinical selection should be based on based on whether the patient′s joints have organic changes and the stability of the jaw positions should be comprehensively considered. However, the long-term effects of oral therapy based on different jaw positions need to be further verified by controlled clinical trials in the future.
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Introduction: The detail understanding about discrepancy in anatomy of glenoid cavity like different shape, sizeand dimensions are important for orthopaedicians and prosthetic designers. Studies concerning glenoidmorphometry among south Indians are scarce. Present study aims at obtaining anthropometric data of glenoidcavity in south Indian scapulae.Materials and Methods: A total of 72 dry adult unpaired scapulae of unknown age and sex were used in the study.Shape and diameters of glenoid fossa in each scapula were recorded and analysed statistically.Results: The average vertical diameter of glenoid fossa was 37.1mm on right side and 37.3mm on left side. Theaverage transverse I and II diameter was 23.3mm and 17.4mm on right side, 23.3mm and 17.7mm on the left side.The average spino-glenoid depth was 16.9 and 16.3mm on right and left side. The average Coraco-glenoiddistance was 25.1mm on both sides. The average acromio-glenoid distance was 32.2 and 32.6mm on right andleft side. Glenoid index was 63.2% on the right side and 62.4% on the left side.Conclusion: The findings of this study would assist to design proper size of glenoid component to be used in totalshoulder arthroplasty among south Indians
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Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.
Subject(s)
Aged , Humans , Accidental Falls , Elbow , Emergency Service, Hospital , Follow-Up Studies , Magnetic Resonance Imaging , Range of Motion, Articular , Rotator Cuff , Scapula , Shoulder Dislocation , Shoulder Pain , Shoulder , TearsABSTRACT
Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.
Subject(s)
Aged , Humans , Accidental Falls , Elbow , Emergency Service, Hospital , Follow-Up Studies , Magnetic Resonance Imaging , Range of Motion, Articular , Rotator Cuff , Scapula , Shoulder Dislocation , Shoulder Pain , Shoulder , TearsABSTRACT
Context: Whenever there is loss of teeth and occlusion, it triggers a change in the functional and structural relationship of the mandible. Various physiologic factor such as age and changes in occlusion lead to specific remodeling changes in the temporomandibular joint (TMJ). Aims: The aim of this study was to evaluate and compare the influence of dentition on condyle‑fossa position by comparing this variable in dentulous and edentulous subjects using lateral cephalogram. Settings and Design: The study was conducted on 25 dentulous and 25 edentulous subjects, comprising of males and females, visiting Yenepoya University, Mangalore. Subjects and Methods: The age ranges of dentulous subjects were 25–30 years and edentulous subjects of 45–65 years with 1–5 years of edentulousness were chosen. Lateral cephalograms were taken, and various reference lines and planes were used to determine the center of condyle and center of the glenoid fossa. Statistical Analysis Used: The results were analyzed by SPSS version 7.0 (SPSS Inc., Chicago) and statistical analysis used was t‑test. Results: Condyle was placed upward and forward, and glenoid fossa was situated more anteriorly in edentulous subjects compared to dentulous subjects. Conclusions: This study supports the concept that TMJ is an articular triad with two points of contact provided by TMJ and third contact by the dentition. Alteration in any one of these contact points will produce secondary morphological changes in other two points.
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Background: Knowledge of normal variations in shape and size of the glenoid fossa are required to improve efficacy and minimize failure rates in shoulder arthroplasty, particularly those involving the glenoid component of shoulder joint. Studies concerning glenoid morphometry among Egyptian population are scarce. The objective of the present study was to determine morphological types and diameters of glenoid fossa in adult Egyptian scapulae . Material and methods: A total of 68 dry adult unpaired scapulae of unknown age and sex were randomly selected. The shape and diameters of glenoid fossa in each specimen were recorded and collected data were statistically analyzed. Results: Glenoid fossa revealed a superior - inferior diameter of 3.31 ± 0.39 and 2.87 ± 0.41 centimeters and an anterior - posterior diameter of 2.44 ± 0.44 and 2.21 ± 0.44 centimeters on the right and left sides respectively. The anterior margin of glenoid fossa presented a notch in 76.47% of studied scapulae, and accordingly the fossa was classified into three morphological types; pear-shaped (45.59%), inverted comma-shaped (30.88%) and oval – shaped (23.53%). Conclusion: The documented findings about glenoid fossa in the present study would help to decide the proper size of glenoid component in shoulder arthroplasty among Egyptians. Moreover, approximately one third of Egyptians are liable to Bankart lesion.
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Glenohumeral instability is a common cause of pain and functional limitation of the shoulder, which involves symptomatic subluxation or dislocation of the humeral head with respect to the glenoid fossa. Glenohumeral instability may be classified according to several parameters: degree, direction, timing, etiology and biomechanics of the dislocation, among others. Imaging methods play an important role in the evaluation of glenohumeral instability, being all of them useful, complementary, and not necessarily mutually exclusive modalities. The following article presents a review of the main types of glenohumeral instability and related imaging findings.
La inestabilidad glenohumeral es una causa frecuente de dolor y limitación funcional del hombro, que implica subluxación o luxación sintomática de la cabeza humeral con respecto de la fosa glenoidea. Puede clasificarse considerando varios aspectos: grado, dirección, cronología, etiología y biomecánica de la luxación, entre otros. La imaginología juega un rol importante en la evaluación de la inestabilidad glenohumeral, siendo todos los métodos de imágenes útiles, complementarios entre sí y no necesariamente excluyentes. En el siguiente artículo presentamos una revisión de los principales tipos de inestabilidad glenohumeral y los hallazgos imaginológicos asociados.
Subject(s)
Humans , Shoulder Joint , Joint Instability , Shoulder Dislocation , Biomechanical Phenomena , Joint Instability/classificationABSTRACT
A study of the glenoid fossa in Thais was carried out in ninety five normal shoulders in cadavers from the Department of Anatomy, Faculty of Medicine Siriraj Hospital. The mean age of the cadavers at the time of death was 69.8 years. In order to provide basic structural information of the glenoid orientation in adult Thais, the work was done by using a custom-made scapula holder which kept the scapula the scapula in position in which the reference line superimposed with the axis of the scapula. The angular measurement performed by using a goniometer placed contact on both rims of the glenoid and center was superimposed with the reference line. Most of the scapulae, 85%, showed in upward inclination with the value of +6.7o+3.4o (mean + SD) and 13% scapulae tilted downward with -3.7o+1.9o. In a horizontal orientation, 81% of the scapulae faced backward (retroversion) with -5.5o+3.0o and 16% facing forward (anteroversion) with +3.8o+1.6o. The similar figures were also found in the scapula male and female cadavers; 8.5% of male scapulae had an upward inclination with +6.3o+3.3o and 13% a downward inclination with -3.7o+1.9o. Glenoid retroversion was found in 78% of male scapulae (-4.9o+2.7o) and 86% in the female scapulae (-6.1o+3.2o). The glenoid anterversion was found in 20% of male scapulae (+4o+1.5o) and 12% in female scapulae (+3.5o+1.9o). Statistacal analysis between genders and side showed no significant difference, nor a correlation to the dominatarm.
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Objective:To comprehend morphology changes of temporomandibular joint in adults with mandible deviation,and the correlation in these changes.Methods:The mesofault radiographs of temporomandibular joint were taken in 21 adult patients with mandible deviation.The data described morphology of temporomandibular joint were analysed.Results:In adult patients with mandible deviation,the condyle process of opposite side was anterior and inferior when compared with deflected side.The height of condyle process,the upper height of condyle process,the gradient of prosobevel of condyle process and the gradient of back bevel of glenoid fossa were augmented when compared to deflected side.The gradient of prosobevel of condyle process showed positive correlation to the prosoblank of joint and the deep of glenoid fossa,and the height of condyle process showed positive correlation to the upper height of condyle process in both sides.The gradient of back bevel of condyle process showed positive correlation to the gradient of back bevel of glenoid fossa in deflected side.The gradient of back bevel of condyle process showed negative correlation to the supper blank of joint and the height of articular tubercle in opposite side.Conclusion:There are some differences in morphology of both temporomandibular joint in adults with mandible deviation,and there is some correlation between these changes.