Sex determination from scapula by volume rendering technique in Turkish population / Determinación del sexo a partir de la escápula mediante la técnica de representación de volumen en la población turca

SUMMARY: The aim of this study is to measure the significant parameters on scapula at computed tomography images and to determine the effects of these parameters for sex determination. The second aim is to find the most effective single and combined parameters to use for sex determination using scapula in Turkish population. In this study, morphometric measurements of scapula on the computed tomography images of 60 male and 60 females were evaluated and their impacts on sex determination were examined via stepwise logistic regression analysis. 10 parameters and 6 indexes calculated via using these parameters were measured. Scapular breadth of the right scapulae (86.7%), maximum scapular length of the left scapulae (85%), scapular breadth of all scapulae (80%) were found to be the most effective single parameters. Combination of the scapular breadth and maximum scapular length were 85%, 90%, 86.7% effective in sex determination on the right scapulae, on the left scapulae and on all of the scapulae, respectively. We believe that the results of this study will contribute to sex determination studies using the scapula in Turkish population for anatomist, anthropologist and forensic scientists.

El objetivo de este estudio fue medir los parámetros significativos en la escápula en imágenes de tomografía computarizada y determinar los efectos de estos parámetros para la determinación del sexo. El segundo objetivo fue encontrar los parámetros individuales y combinados más efectivos para determinar el sexo utilizando la escápula en la población turca. Se evaluaron las medidas morfométricas de la escápula en las imágenes de tomografía computarizada de 60 hombres y 60 mujeres y se examinó su impacto en la determinación del sexo mediante un análisis de regresión logística paso a paso. Se midieron 10 parámetros y 6 índices calculados mediante el uso de estos parámetros. El ancho escapular de la escápula derecha (86,7 %), la longitud escapular máxima de la escápula izquierda (85 %), el ancho escapular de todas las escápulas (80 %) resultaron ser los parámetros individuales más efectivos. La combinación del ancho escapular y la longitud máxima escapular fueron 85%, 90%, 86,7% efectivas en la determinación del sexo en la escápula derecha, en la escápula izquierda y en todas las escápulas, respectivamente. Creemos que los resultados de este estudio contribuirán a los estudios de determinación de sexo utilizando la escápula en la población turca para anatomistas, antropólogos y científicos forenses.

A study of the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations / 中国修复重建外科杂志

OBJECTIVE@#To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations.@*METHODS@#Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index.@*RESULTS@#Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R 2=0.084.@*CONCLUSION@#Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.

Sex determination from glenoid cavity by computed tomography in Turkish population / Determinación del sexo de la cavidad glenoidea mediante tomografía computarizada en la población turca

SUMMARY: The aim of this study is to contribute to sex determination studies from the scapula in the Turkish population and compare with previous studies. This study was performed with 200 scapulae (100 males and 100 females). The age range of the patients was between 18-93 years old. Computed tomography scans were used and length of glenoid cavity (LGC), breadth of glenoid cavity (BGC), depth of glenoid cavity (DGC), perimeter (PM) and volume (VL) were measured. Randomly selected 20 scapulae were measured three times for examine the intra-rater reliability from those measurements. Gender logistic regression analysis was conducted to find the significant variables at sex determination from the scapula. The most effective parameter in determining sex from scapula was found to be VL (88.5%). The effects of LGC, PM, BGC and DGC at sex determination from scapula were found to be 83%, 82.5%, 79.5%, 66%, respectively. The combination of VL and PM (89.5%) was found to be the most effective combination at sex determination from the scapula. The intraclass correlation values of all measurements were found to be at high reliability. According to the literature, PM and DGC along with the VL in Turkish population, were not used previously for sex determination from the scapula. A combination of the VL and PM was found to be the most effective parameters at sex determination from scapula in the Turkish population. There are few studies on the sex determination from scapula in the Turkish population. This study will guide anthropologists, forensic scientists and anatomists at sex determination studies from scapula and surgeons by morphometrically in clinical situations related to the scapula.

RESUMEN: El objetivo de este estudio fue contribuir a la determinación del sexo a partir de la escápula en la población turca y comparar con estudios previos. Esta investigación se realizó con 200 escápulas (100 hombres y 100 mujeres). El rango de edad de los pacientes estaba entre de 18 años y 93 años. Escaner de tomografía computada se usó para medir en la cavidad glenoidea los siguientes parámetros: longitud (LCG), ancho (ACG), profundidad (PCG), perímetro (PG) y volumen (VCG). Se midieron 20 escápulas seleccionadas tres veces al azar para examinar la confiabilidad intraevaluador de estas mediciones. Se realizó un análisis de regresión logística de género para encontrar las variables significativas en la determinación del sexo a partir de la escápula. El parámetro más eficaz para determinar el sexo a partir de la escápula resultó ser VCG (88,5%). Los efectos de LCG, PG, ACG y PCG en la determinación del sexo a partir de la escápula fueron del 83 %, 82,5 %, 79,5 % y 66 %, respectivamente. La combinación de VCG y PG (89,5%) resultó ser la combinación más efectiva en la determinación del sexo a partir de la escápula. Se encontró que los valores de correlación intraclase de todas las mediciones tenían una alta confiabilidad. De acuerdo con la literatura, PG y PCG junto con el VCG en la población turca, no se han utilizado previamente para la determinación del sexo a partir de la escápula. Se determinó que una combinación de VCG y PG son los parámetros más efectivos en la determinación del sexo a partir de la escápula. Existe escasa información sobre la determinación del sexo a partir de la escápula en la población turca. Este estudio guiará a los antropólogos, forenses y anatomistas en los estudios de determinación del sexo de la escápula y sera útil para los cirujanos en situaciones clínicas relacionadas con la escápula.

Accuracy of sonographic identification of suprascapular nerve at supraclavicular fossa: a cadaveric study / Precisión de la identificación ecográfica del nervio supraescapular en la fosa supraclavicular: un estudio cadavérico

SUMMARY: Sonographic identification of suprascapular nerve (SSN) is essential for diagnosis of suprascapular neuropathy and ultrasound-guided suprascapular nerve block. This study aims to demonstrate the accuracy of identification of SSN at supraclavicular region by ultrasonography in fresh cadavers. Ninety-three posterior cervical triangles were examined. With ultrasonography, SSN emerging from the upper trunk of brachial plexus was identified and followed until it passed underneath the inferior belly of omohyoid muscle. Sonographic visualization of SSN in supraclavicular fossa was recorded. Then, cadaveric dissection was performed to determine the presence or absence of SSN. An agreement between sonographic identification and direct visualization was specified and categorized the following three patterns: "correctly identified" (pattern I), "incorrectly identified" (pattern II), and "unidentified" (pattern III). The identification of SSN using sonography was correct in almost 90 %. The diameter of SSN with pattern I was the largest compared to those of other two patterns. In pattern I, SSN ran laterally from the upper trunk of brachial plexus and passed underneath the inferior belly of omohyoid muscle. Therefore, SSN was easily identified under ultrasonography. In pattern II, nerve identified by ultrasonography was literally the dorsal scapular nerve. In pattern III, SSN was unable to be identified because of its anatomical variation. The accuracy of ultrasonographic identification of SSN at supraclavicular fossa is high and the key sonoanatomical landmarks are the lateral margin of brachial plexus and the inferior belly of omohyoid muscle. The anatomical variants of SSN are reasons of incorrect or unable identification of SSN under ultrasonography.

RESUMEN: La identificación ecográfica del nervio supraescapular (NSE) es esencial para el diagnóstico de neuropatía supraescapular y bloqueo del nervio supraescapular mediante la ecografía. Este estudio tiene como objetivo demostrar la precisión de la identificación de NSE en la región supraclavicular por ecografía en cadáveres frescos. Se examinaron noventa y tres triángulos cervicales posteriores. Se identificó el NSE emergente de la parte superior del tronco del plexo braquial con la ecografía, y se siguió hasta su trayecto por debajo del vientre inferior del músculo omohioideo. Se registró la visualización ecográfica del NSE en la fosa supraclavicular. Luego, se realizó disección cadavérica para determinar la presencia o ausencia de NSE. Se especificó un acuerdo entre la identificación ecográfica y la visualización directa y se categorizaron los siguientes tres patrones: "identificado correctamente" (patrón I), "identificado incorrectamente" (patrón II) y "no identificado" (patrón III). La identificación de NSE mediante ecografía fue correcta en casi el 90 %. El diámetro del NSE con el patrón I fue el más grande en comparación con los de los otros dos patrones. En el patrón I, NSE corría lateralmente desde la parte superior del tronco del plexo braquial y pasaba por debajo del vientre inferior del músculo omohioideo. Por lo tanto, el NSE se identificó fácilmente mediante ecografía. En el patrón II, el nervio identificado por ecografía era literalmente el nervio escapular dorsal; en el patrón III, el NSE no pudo ser identificado debido a su variación anatómica. La precisión de la identificación ecográfica del NSE en la fosa supraclavicular es alta y los puntos de referencia sonoanatómicos clave son el borde lateral del plexo braquial y el vientre inferior del músculo omohioideo. Las variantes anatómicas de NSE son razones de identificación incorrecta o incapaz de NSE bajo ecografía.

Osteocondroma escapular / Scapular osteochondroma

El osteocondroma es una lesión compuesta de hueso medular y cortical recubierta de una capa de cartílago hialino. La localización en la escápula es infrecuente. Se presentan 2 casos clínicos. Puede manifestarse con dolor o con síntomas por compresión de estructuras vecinas. La resección quirúrgica es el tratamiento de elección para el osteocondroma sintomático.

Osteochondromas are tumors composed of medullary and cortical bone with hyaline cartilage caps. Involvement of the scapula is uncommon. We report two cases. Patients may present with pain or symptoms due to compression of the adjacent structures. Surgery is the treatment of choice of symp­tomatic osteochondromas.

Periosteal Osteosarcoma Arising from the Rib and Scapula: Imaging Features in Two Cases

Periosteal osteosarcoma is an extremely rare chondroblastic osteosarcoma in the flat bone. There were authors reporting of two cases of periosteal osteosarcoma in the highly unusual sites. One of them arose from the rib, in a 17-year-old male, which appeared as a hypodense juxtacortical mass with periosteal reaction on CT. The other one arose from the scapula, in a 17-year-old female, which showed the intermediate signal intensity (SI) on T1-weighted image (WI), heterogeneous high SI on T2WI, and rim-enhancement on contrast-enhanced T1WI with cortical destruction on MRI.

Métodos de avaliação dos movimentos escapulares durante a elevação dos membros superiores: uma revisão crítica da literatura / Methods of assessment of scapular movements during upper limb elevations: literature review

Realizar uma revisão crítica da literatura sobre os métodos utilizados para avaliar os movimentos escapulares durante a elevação dos membros superiores (MMSS) e apontar as vantagens, desvantagens e limitações associadas a cada um deles. Método: Foram realizadas buscas nas bases de dados MEDLINE, SCIELO, LILACS e PEDro com combinação de palavras-chave relacionadas ao assunto. Os critérios de inclusão para os estudos foram: estar publicado nos idiomas português/espanhol/inglês/francês até o último dia do ano de 2005 e realizar a avaliação dos movimentos escapulares durante a elevação dos MMSS. Foi considerado como critério de exclusão a avaliação dos movimentos escapulares na posição de decúbito. Resultados: Foram encontrados 181 estudos diferentes e, após a verificação dos critérios estabelecidos, selecionaram-se 29 para análise, os quais foram agrupados em 4 categorias distintas: medidas bidimensionais estáticas, bidimensionais dinâmicas, tridimensionais estáticas e tridimensionais dinâmicas. Apesar da diversidade de métodos empregados na avaliação dos movimentos escapulares, ainda não existe um que tenha aplicabilidade clínica e seja capaz de fornecer medidas relacionadas à real cinemática escapular. Outro problema encontrado foi a ausência de padronização na nomenclatura utilizada para descrever os movimentos, planos e eixos. Além disso, os métodos tridimensionais dinâmicos com aplicabilidade em estudos científicos ainda apresentam importantes limitações, como elevado custo, treinamento de pessoal e erros de medidas que podem ser significativos na determinação de alterações da cinemática escapular. Conclusão: é essencial a padronização da nomenclatura dos movimentos e dos planos e eixos em que eles ocorrem e o desenvolvimento de métodos de análises funcionais completas com aplicabilidade clínica, confiáveis e válidos.

To carry out a literature review on methods to assess scapular movements during upper limb elevation and point out their advantages, disadvantages, and limitations. Methods: The search was performed assessing MEDLINE, SCIELO, LILACS e PEDro databases with key words related to the subject. To be included, the studies would have to be published in Portuguese/English/Spanish/French until the last day of 2005 and have assessed scapular movement during upper limb elevation. The exclusion criterion included assessments in the decubitus position. Results: one hundred eighty-one different studies were found and after the verification of the established criteria, 29 were selected for the analysis, which were divided into four groups: bidimensional static, bidimensional dynamic, three-dimensional static and three-dimensional dynamic assessment methods. Despite the variety of assessment techniques, a method that shows clinical applicability and is able to carry out measurements related to the functional movements of the scapula is yet to be developed. Another problem found was the lack of standardization of the terminology regarding movements, planes and axes. Furthermore, the three-dimensional methods applicable to scientific studies showed important limitations, such as high cost, need for specialized human resources, and measurement errors, which could be significant when determining changes in scapular kinematics. Conclusion: It is essential to standardize the terminology used to describe scapular movements, planes and axes and to develop complete functional assessment methods with clinical applicability, reliability and validity.

Anatomical basics and variations of the scapula in Turkish adults

To analyze the anatomical basis of the scapula, acromion, os acromiale, coracoid process, coraco-acromial arch, and glenoid cavity in Turkish adults. We performed the study at the Faculty of Medicine, Akdeniz University, Turkey between January 2004 and December 2005. A total of 90 dry bones of the scapula from human cadavers were randomly selected. The length, width, and anterior thickness of the acromion and the acromial facet of the acromioclavicular joint were measured with an electronic caliber and was examined visually. For the radiological evaluation, the posterior anterior and the lateral shoulder radiographs of 90 consecutive adult patients with normal findings were used. These films were evaluated and grouped according to the acromial arch morphology. The distribution of the acromial morphologic types according to slope was type I [flat] 10%, type II [curved] 73%, type III [hooked] 17%. Type I was seen in 11%, type II 66%, type III 23% of the specimens. The morphological shape of the tip of the acromion was 31% cobra shaped, 13% square shaped, and 56% intermediate type. The scapulas, coracoid process and the coraco acromial arch were measured. In 72% of the specimen, the glenoid notch of the scapulas were absent and oval shaped, whereas in 28% the notch was well expressed and the glenoid cavity was pear shaped. The mean vertical length of the glenoid cavity was 36.3 +/- 3 mm, and the mean transverse length was 24.6 +/- 2.5 mm. Os acromiale is a rare anatomical condition. Its incidence has been documented in radiographic and anatomical studies to be between 1-15%. The presence of os acromiale was 1% in shoulder radiographs [os pre-acromiale], and in dry bones [os meta-acromiale]. We reported the exact morphological measurements of the bone structures of the scapula in Turkish adult population. Our results present an instructive figures of anatomical preparations and radiological cases that can be used to make a more precise radiological and a differential diagnoses

Parosteal osteosarcoma of the scapula

Parosteal osteosarcoma is a low-grade osteosarcoma, which occurs on the surface of the bone. We had experienced a parosteal osteosarcoma involving the flat bone, the scapula of a 21-year-old man. This is an extremely rare location for a parosteal osteosarcoma. Plain radiograph showed broad-based, well-defined radiodense lesion at the scapula. Computed tomogram demonstrated an intact cortex and absence of a medullary involvement. Tumor showed a lobulated, high-density lesion, indicating bone formation. Histologically, parosteal osteosarcoma is a well-differentiated osteosarcoma. The tumor is composed of a hypocellular proliferation of spindle cells, with minimal cytologic atypia. The bone is in the form of a well-formed bony trabeculae. Occasional cartilage is present in the form of a cap.

Parosteal osteosarcoma of the scapula

Parosteal osteosarcoma is a low-grade osteosarcoma, which occurs on the surface of the bone. We had experienced a parosteal osteosarcoma involving the flat bone, the scapula of a 21-year-old man. This is an extremely rare location for a parosteal osteosarcoma. Plain radiograph showed broad-based, well-defined radiodense lesion at the scapula. Computed tomogram demonstrated an intact cortex and absence of a medullary involvement. Tumor showed a lobulated, high-density lesion, indicating bone formation. Histologically, parosteal osteosarcoma is a well-differentiated osteosarcoma. The tumor is composed of a hypocellular proliferation of spindle cells, with minimal cytologic atypia. The bone is in the form of a well-formed bony trabeculae. Occasional cartilage is present in the form of a cap.