Predictors of shoulder degeneration in the Kwazulu-Natal population of South Africa / Indicadores de la degeneración del hombro en la poblacion Kwazulu/Natal de Sudáfrica

SUMMARY: The critical shoulder angle and acromion index are conventional radiological tools employed as predictors of shoulder degeneration. As they represent the static components of glenohumeral stability, the scapulo-humeral geometry and underlying subacromial tissue appear as the resultant cause-effect factors. Consequently, the purpose of this study was to investigate the critical shoulder angle and acromion index as interrelated parameters within the South African population. The measurement of both biomechanical parameters was conducted on two-hundred and sixty (n = 260) true AP radiographs. This was a cross-sectional study that also incorporated the demographic representation of the population group which was analysed accordingly. The mean values recorded for both the critical shoulder angle (36.31±5.84º) and acromion index (0.74±0.13) suggested rotator cuff arthropathy. The results confirmed the theories of Nyffeler et al. (2006) and Moor et al. (2012) who alluded to glenoid inclination and the acromial coverage over the humeral head. A significant proportionality correlation, verified by a P value of 0.000, was established between the acromion index and critical shoulder angle which may assist to differentiate between normal asymptomatic shoulders and those with cuff disease. Furthermore, these predictors of shoulder degeneration may present as a preventative tool against tear progression.

RESUMEN: El ángulo crítico del hombro y el índice acromial son herramientas radiológicas convencionales empleadas como indicadores de la degeneración del hombro. Debido a que representan los componentes estáticos de la estabilidad glenohumeral, la geometría escápulo-humeral y el tejido subacromial subyacente aparecen como los factores causa-efecto resultantes. En consecuencia, el propósito de este estudio fue investigar el ángulo crítico del hombro y el índice acromial como parámetros interrelacionados dentro de la población sudafricana. La medición de ambos parámetros biomecánicos se realizó en 260 radiografías antero-posteriores (AP). Se realizó un estudio transversal que también incorporó la representación demográfica del grupo de la población que fue analizada. Los valores medios registrados tanto para el ángulo crítico del hombro (36,31 ± 5,84º) como para el índice del acromión (0,74 ± 0,13) sugirieron una artropatía del manguito rotador. Los resultados confirmaron las teorías de Nyffeler et al. (2006) y Moor et al. (2012) que aludían a la inclinación glenoide y a la cobertura acromial sobre la cabeza humeral. Se estableció una correlación de proporcionalidad significativa, verificada por un valor de P de 0,000, entre el índice acromial y el ángulo crítico del hombro, lo que puede ayudar a diferenciar entre los hombros asintomáticos normales y aquellos con enfermedad del manguito rotador. Además, estos predictores de degeneración del hombro pueden ser útiles como una herramienta preventiva contra la progresión del desgarro.

The Prevalence of Os Acromiale in Korean Patients Visiting Shoulder Clinic

BACKGROUND: The prevalence of os acromiale has been documented to be between 1% and 15% and is known to be clinically associated with subacromial impingement or rotator cuff tear. However, the prevalence of os acromiale in Korea has not yet been determined. The purpose of this study is to evaluate the prevalence of os acromiale in Korean patients who visited shoulder clinics and to investigate the correlations with rotator cuff tear. METHODS: We retrospectively reviewed the X-rays of patients visiting a shoulder clinic at a tertiary hospital in Korea from January 2011 to January 2012 to determine the frequency of os acromiale. X-ray findings were confirmed with magnetic resonance imaging (MRI) for patients who had these images available. MRI was also used to assess the status of the rotator cuff. The correlation between the presence of os acromiale either with gender, hand dominance or rotator cuff tear was analyzed statistically. RESULTS: A total of 2,946 shoulders from 1,568 patients were analyzed with X-rays. Thirteen cases out of 1,568 patients had an os acromiale; and there were five and eight cases of pre-acromiale and meso-acromiale, respectively. Thus, the prevalence of os acromiale in this study population was found to be 0.7 (7 cases per 1,000 patients). Bilaterality was found in two cases. Os acromiale was not more frequent according to gender (five males versus eight females, p = 0.525) and hand dominance was not associated with frequency of os acromiale (seven dominant arms versus six non-dominant arms, p = 0.631). A sub-analysis of shoulders with available MRIs (1,074 shoulders) revealed that there were two rotator cuff tears (40%) out of five cases of os acromiale, whereas 607 rotator cuff tears were observed (57%) among 1069 cases without os acromiale. This difference was not statistically significant (p = 0.656). CONCLUSIONS: The identified prevalence of os acromiale in Korean patients who visited shoulder clinics is 0.7%, which is much lower as compared with the prevalence of general population from other ethnic groups. No correlation was observed between rotator cuff tears and os acromiale in this study population.

Os acromiale bilateral en un jugador de beísbol: reporte de un caso / Os acromiale a bilateral baseball player: a case report

El Os Acromialis es una patología poco frecuente en el hombro y se ha de producir por falta de consolidación del acromion, se presenta como una causa de dolor del hombro de adolescentes. Se reporta el caso de un paciente de 34 años, jugador de béisbol, al que le realizamos la estabilización del acromion derecho con tornillo de 4.0 de 50mm y alambre de kirschner, más injerto óseo de la meseta tibial, el izquierdo estaba bien estable. La evolución del paciente fue satisfactoria.

Tumores malignos do acrômio: relato de 3 casos / Malignant tumors of the acromion: report of 3 cases

Os autores relatam três casos de lesoes tumorais malignas localizadas no acrômio, iniciando-se o quadro com dor no ombro. Em todos os casos houve demora no diagnóstico definitivo, tendo sido tratados como bursite e/ou tendinite do ombro. As biópsias por via aberta identificaram um plasmocitoma, um linfoma e uma metástase de adenocarcinoma pulmonar, esta última submetida a acromionectomia total. Os três pacientes evoluíram para óbito em até no máximo oito meses após o diagnóstico.

Avaliaçäo do tratamento conservador do pinçamento subacromial e das lesöes do manguito rotador / Evaluation of conservative treatment of impingement syndrome and rotator cuff lesions

Foi realizado trabalho de avaliaçäo do tratamento conservador em 189 ombros de 171 pacientes portadores de pinçamento subacromial e ruptura do manguito rotador, divididos em grupos I e II, respectivamente. Procurou-se caracterizar o grupo de estudo quanto aos dados de anamnese, exame fisico e tempo de tratamento, correlacionando-os com o resultado final. Encontraram-se 80,1 por cento e 75 por cento de resultados satisfatorios no grupo I ao fim de um e dois anos, respectivamente. No grupo II, 42,9 por cento e 21,5 por cento. O fator limitante na avaliaçäo dos resultados foi o abandono do tratamento.

Avaliaçäo de pacientes operados devido à síndrome do pinçamento, com ou sem lesäo do manguito rotador / Evaluation of operated patients due to impingement syndrome, with or without rotator cuff lesions

O trabalho se refere a 68 pacientes operados de síndrome do pinçamento (31 pacientes) e lesäo de manguito associada (37). Utilizamos o score da UCLA para avaliaçäo oós-operatória. Apresentamos como resultado da síndrome do pinçamento estádio II, 75,75 por cento satisfatório e, para o estádio III, 55,25 por cento. A qualidade do ventre muscular, o tempo de lesäo e o tratamento fisioterápico säo fatores importantes para um bom resultados

Giant cell tumour of the acromion

A case of osteoclastoma of the acromion process, is surgical management and a review of the literature are presented