Modified Latarjet splitting subscapularis muscle under arthroscopy: an anatomical study based on axillary nerve, glenoid, and subscapularis muscle / 中国修复重建外科杂志

OBJECTIVE@#To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting.@*METHODS@#A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively.@*RESULTS@#In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane.@*CONCLUSION@#In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.

Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects.@*METHODS@#Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation.@*RESULTS@#All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation ( P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation ( P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months.@*CONCLUSION@#Arthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.

Double pulley dual row technique with shoulder arthroscopy for the treatment of Ideberg typeⅠglenoid fracture / 中国骨伤

OBJECTIVE@#To evaluate clinical effects of Double-pulley dual row technique with shoulder arthroscopy in treating scapular glenoid fracture(Ideberg typeⅠ).@*METHODS@#From July 2017 to March 2019, 8 patiens with scapular glenoid fracture (Ideberg typeⅠ) were treated with Double-pulley dual-row technique with shoulder arthroscopy, including 7 males and 1 female;5 cased of injuries in the left shoulder, 3 cased of injuries in the right shoulder;ranging in age from 22 to 56 years old; and the time from injury to operation ranged from 3 to 10 days. X-ray and CT of shoulder joint were taken before and after operation to evaluate the fracture severity and fracture healing. American Shoulder and Elbow Surgeous (ASES) and Constant- Murley scores were used to evaluate shoulder joint function.@*RESULTS@#All patients were followed up, and the duration ranged from 12 to 24 months, and the fracture healing time ranged from 3 to 5 months. No operative site infection was found in all patients. CT scan of shoulder joint showed satisfactory reduction and no displacement. The shoulder joint function recovered well. ASES score at the latest follow up after operation ranged from 85 to 97 points, which were higher than those before operation; Constant-Murley score ranged from 83 to 96 points, which were higher than those before operation.@*CONCLUSION@#Double-pulley dual-row technique with shoulder arthroscopy is effective to fix scapular glenoid fracture of Ideberg typeⅠwith minimal tissue trauma and significant improvement of shoulder joint function.

Anatomy of the Scapula Applied to the Posterior Surgical Approach: Safety Parameters during Access to the Lateral Angle / Anatomia da escápula aplicada à abordagem cirúrgica posterior: Parâmetros de segurança durante acesso ao ângulo lateral

Abstract Objective The objective of this paper was to identify safety parameters in the posterior surgical approach of the scapula through a cross-sectional cadaver study. Methods Thirteen cadaver shoulders with no history of surgery or prior musculoskeletal dysfunction, with mean age, weight, and height of 70.1 years, 61.5 kg, and 1.64 m, respectively, were dissected. The anatomic landmark of the studied pathway (infraglenoid tubercle) and its distance to the axillary and suprascapular nerves were measured. Results The mean distance between the infraglenoid tubercle (IT) and the axillary nerve (AN) was 23.8 mm, and the mean distance from the IT to the suprascapular nerve (SN) was 33.2 mm. Conclusion The posterior approach may be considered safe through the interval between the infraspinatus and teres minor. However, caution should be taken during muscle spacing because of the short distance between the fracture site and the location of the SN and AN. These precautions help to avoid major postoperative complications.

Resumo Objetivo O presente trabalho teve como objetivo identificar parâmetros de segurança para a realização da via de acesso cirúrgico posterior da escápula por meio de um estudo transversal em cadáveres. Métodos Foram dissecados 13 ombros de cadáveres sem história de cirurgia ou disfunção musculoesquelética prévia e em bom estado de conservação, com médias de idade, peso e altura de 70,1 anos, 61,5 kg, 1,64m, respectivamente. Identificou-se marco anatômico da via estudada (tubérculo infraglenoidal) e sua distância para os nervos axilar e supraescapular foi medida. Resultados A distância média encontrada entre o tubérculo infraglenoidal (TI) e o nervo axilar (NA) foi de 23,8 mm e distância média do TI ao nervo supraescapular (NSE) foi de 33,2 mm. Conclusão A via posterior pelo intervalo entre os músculos infraespinal e redondo menor é considerada segura; porém, é preciso atenção e cautela durante o afastamento muscular, devido à curta distância média entre o sítio de fratura e a localização do NSE e do NA. Tais precauções podem evitar maiores complicações pós-operatórias.

Osteocondroma escapular: un caso infrecuente / Scapular osteochondroma: an infrequent case

El osteocondroma de la escápula es un tumor beningno muy raro por su ubicación, que produce dolor y disfunción mecánica de la articulación cuando se establece en la superficie ventral de la escápula, afecta principalmente a los varones en los períodos del crecimiento óseo, entre 10 y 30 años de edad, representan el 14,4 % de todos los tumores de la escápula y el 49 % de los tumores benignos de la escápula. Surgen en las regiones metafisarias de los huesos largos (fémur, húmero, tibia), causando irritación mecánica que conduce a impotencia funcional, bursitis, e incluso fractura de la escápula, pocos casos en huesos planos han sido descritos. El diagnostico se realiza con la valoración física, clínica y exámenes complementarios, debiendo ser confirmado por el histopatológo previa biopsia. La indicación quirúrgica incluye la disfunción mecánica de una articulación o tendón en relación con el tamaño de la lesión, y del cambio sarcomatoso siendo el procedimiento de elección la escisión quirúrgica abierta. A continuación se describe el caso de una joven de 11 años a quien se diagnosticó un osteocondroma subescapular, previabiopsia escisional.

Osteochondroma of the scapulais a rare benign tumor in view of its location, which produces pain and mechanical dysfunction of the joint when it is on the ventral surface of the scapula, mainly affecting men during bone growth periods, betweenthe ages of 10 and 30, accounting for 14.4 % of allscapula tumors and 49 % of benign tumors of thescapula. They arise in the metaphyseal regions ofthe long bones (femur, humerus, tibia), causing mechanical irritation leading to functional impotence,bursitis, and fracture of the scapula. Few cases inflat bones have been described. Diagnosis is made with physical, clinical and complementary examinations, and must be confirmed by prior histopathology biopsy. The surgical indication includes mechanical dysfunction of a joint or tendon in relationto the size of the lesion, sarcomatous change being the procedure of choice in open surgical excision. The case of an 11-year-old girl who was diagnosed with a subscapular osteochondroma after previous excisional biopsy, is described below.

Tratamiento artroscópico de las calcificaciones del subescapular. Reporte de un caso y revisión de la bibliografía / Arthroscopic treatment of subscapularis tendon calcification. Case report and bibliographic revision

Las calcificaciones del manguito rotador afectan mayormente al tendón del supraespinoso. El compromiso del tendón del subescapular es menos frecuente y sólo unos pocos casos han sido reportados. Presentamos un caso de una calcificación del subescapular en un paciente sin respuesta al tratamiento conservador, que fue tratado con la remoción completa de la misma y la posterior reparación del defecto residual con un arpón de doble sutura reforzada. Un año luego de la cirugía el paciente se presentaba sin dolor, con movilidad completa y sin restos de calcio en los estudios postoperatorios. La combinación de la remoción completa de la calcificación y la subsecuente reparación del defecto con arpones en forma artroscópica puede resultar en excelentes resultados funcionales, sin comprometer la integridad del manguito rotador en pacientes con calcificaciones del subescapular. Nivel de Evidencia: V...

The supraspinatus tendon is the most common tendon associated with the calcific tendinosis of the rotator cuff. The subscapularis tendon is rarely affected, and only a few prior cases have been reported. We present a case of a subscapularis tendon calcification in a patient with a failed conservative treatment that was treated arthroscopically with complete removal of the calcific deposit and posterior repair of the defect with suture anchors. One year after surgery the patient had no pain, he had full range of motion and there were not residual calcium deposits in the postoperative studies. The combination of complete calcium removal and posterior repair with suture anchors can led to excellent functional outcomes without compromising the integrity of the rotator cuff in patients with calcifications of the subscapularis tendon. Level Of Evidence: V...

Retalho Duoescapular: uma nova opção na cirurgia reparadora do ombro / Duoscapular flap: a new option in shoulder reconstructive surgery

INTRODUÇÃO: O Dermatofibrossarcoma do Ombro é patologia incomum e seu tratamento demanda extensas ressecções. O sistema escapular é fonte de retalhos bastante utilizados nesta região. MÉTODO: Realizado estudo longitudinal, prospectivo, através da condução de um caso de Dermatofibrossarcoma Protuberans em ombro direito, submetido a ressecção e reconstrução local com Retalho Duoescapular, obtido através da associação dos retalhos escapular e paraescapular. RESULTADOS: Paciente evoluiu sem intercorrências no pós-operatório, não sendo observadas complicações sistêmicas e locais, e limitações funcionais. CONCLUSÃO: O Retalho Duoescapular é nova e relevante opção para reconstrução de feridas extensas, com exposição de estruturas nobres no ombro. Permite fechamento primário da área doadora, sem acrescentar morbidade ao procedimento.

INTRODUCTION: Shoulder cutaneous fibrosarcoma is an unusual pathology that requires extensive resections. The scapula is a source of flaps widely used in this region. METHOD: A longitudinal and prospective study was carried out in a patient with protuberans cutaneous fibrosarcoma on the right shoulder who underwent resection followed by local reconstruction with a Duoscapular Flap (a combination of scapular and parascapular flaps). RESULTS: The patient had no postoperative complications, as systemic and local complications as well as functional limitations were not observed. CONCLUSION: Duoscapular Flap placement is a novel procedure and a relevant choice for the reconstruction of extensive wounds exposing noble structures in the shoulder. It allows the primary closure of the donor area without increasing the morbidity of the procedure.

Efeito da reabilitação funcional da cintura escapular superior no pós-operatório imediato de implante de marcapasso / Physical training effect in pacemaker patient

O implante de marcapasso cardíaco artificial é uma prática médica consagrada, cujas indicações são definidas pelas Diretrizes Brasileiras de Dispositivos Eletrônicos Implantáveis do Departamento de Estimulação Cardíaca Artificial da Sociedade Brasileira de Cirurgia Cardiovascular1,2,13. Os benefícios relatados após o implante vão desde o aumento da sobrevida à melhora da qualidade de vida dos pacientes. Algumas complicações decorrentes do procedimento e da inatividade que os pacientes autoimpõem-se por períodos indeterminados poderiam ser evitadas ou minimizadas com a mobilização precoce da cintura escapular e a realização de atividades cotidianas. Não há diretrizes internacionais indicando o tempo que o paciente deve permanecer sem mobilidade após o implante de marcapasso. O objetivo deste estudo é avaliar o efeito da mobilidade da cintura escapular e das orientações funcionais a portadores de marcapasso. A hipótese é que aqueles submetidos à mobilização precoce terão benefícios com a prescrição de atividades físicas e orientações para as atividades diárias...

Artificial Cardiac Pacemaker Implant is a medical practice established in the literature and its indications are defined by the Brazilian Guidelines for Implantable Electronic Devices of the Brazilian Society of Cardiovascular Surgery - SBCCV, through its Department of Artificial Cardiac Pacing - DECA. The benefits reported after pacemaker implantation range from improved survival to quality of life. However, despite evidence of benefits, following some complications resulting from the procedure itself and inactivity in patients with shoulder girdle for indefinite periods of time, which could be avoided or minimized by the early mobilization and instructions for daily activities. However, despite the obvious complications there are no international guidelines indicating how long the patient should remain without mobility after pacemaker implantation. Thus, the purpose of this study is to evaluate the effect of the mobility of the shoulder girdle and functional instructions to patients with a pacemaker. The hypothesis is that pacemaker patients undergoing early mobilization, rather than remaining strictly in bed or immobilized upper limbs, will benefit from the early prescription of physical activities and instructions for daily activities...

Fratura da escápula: resultados do tratamento cirúrgico em 15 pacientes / Scapula fractures: outcomes after surgical treatment in 15 patients

OBJETIVO: Apresentar os resultados do tratamento cirúrgico de 15 pacientes com fratura da escápula. MÉTODOS: Avaliação retrospectiva dos resultados clinicos e radiográficos do tratamento cirurgico de fraturas da escápula, em um periodo de dez anos. A avaliação clínica baseou-se tanto no escore de Schofer et al. quanto no Constant-Murley. Na avaliação radiográfica, pesquisou-se a existência de perda da redução, pseudartrose ou alterações póstraumáticas. A análise estatística foi puramente descritiva, por meio de cálculo percentual dos achados. RESULTADOS: Todas as fraturas consolidaram em um período médio de 90 dias, confor- me documentação radiográfica. Na última consulta ambulatorial, o tempo médio de seguimento foi de 45,6 meses (variando de 14 a 109,2 meses). Nenhum paciente referiu dor constante e incapacitante no ombro operado. O escore médio de Constant- Murley foi de 84 pontos (variando de 76 a 90 pontos). Dos 15 pacientes, 13 (86,7 por cento) retornaram ao nível funcional prévio sem restrição (atividades profissional e recreacionais). Não forma detectados sinais de perda de redução, pseudartrose ou osteo- artrose pós-traumática. Não ocorreram penetração ou impacto articular pela presença do material de osteossíntese. CONCLUSÃO: Em pacientes com fraturas da escápula, que se enquadrem nos critérios para tratamento cirúrgico, os resultados são bons desde que sejam respeitados os tecidos moles periarticulares e realizado o devido planejamento da via de acesso e do protocolo de reabilitação.

OBJECTIVE: To evaluate the clinical and radiographic outcomes on 15 unstable scapula fractures treated by open reduction and internal fixation. METHODS: A retrospective study to evaluate the results of scapula fracture fixation in 15 patients, managed at our Institution during a 10-year period. Shoulder function was recorded in both upper extremities with both the Schofer et al. and the Constant-Murley score. Radiographic analysis was done in terms of loss of reduction, nonunion, and post-traumatic degenerative changes. Statistical analysis was purely descriptive with calculation of percentage. RESULTS: All fractures healed in a mean of 90 days, as documented by simple radiographs. At the last consultation, the mean follow-up was 45.6 months (ranging from 14 to 109,2 months). No patient had constant pain or referred incapacity. The mean Constant- Murley score for the 15 patients was 84 points (ranging from 76 to 90 points). Of the 15 patients, 13 (86.7 percent) had returned to their previous employment and recreational activities with- out restrictions. No signs of loss of reduction, nonunion, or post-traumatic degenerative changes were seen. In addition, no ardware impingement or articular penetration was observed in any case. CONCLUSION: The respect to the soft tissue is the cornerstone of proper treatment of this scapular fractures. In our series good results were obtained when appropriate preoperative planning and post-operative rehabilitation has been performed.

Liberacion endoscopica del nervio supraescapular: aportaciones anatomicas / Endoscopic release of the suprascapular nerve: anatomical considerations

En la práctica artro-endoscópica del aparato locomotor, se desarrollan constantemente nuevas opciones terapéuticas, en ocasiones insospechadas. En general, estas nuevas técnicas requieren de una gran habilidad y de un nuevo conocimiento anatómico, la anatomía artro-endoscópica. El objetivo de esta publicación es proporcionar un recuerdo anatómico útil para la realización de la liberación endoscópiea del nervio supraescapular.

Tratamiento artroscopico de la compresión del nervio supraescapular por ganglión espinoglenoideo / The compression of the supraescapular nerve by spinoglenoid cyst: arthroscopic treatment

Una de las patologías más comunes en nuestras consultas es el síndrome del hombro doloroso. Tiene diversos factores que pueden originario (tendinopatía del manguito rotador, bíceps, inestabilidad, hernia de disco cervical.). Sin embargo, es importante conocer que existen otras causas menos frecuentes. Presentamos, por su rareza, el caso de un paciente masculino de de 34 años con limitación funcional progresiva a la abducción del miembro superior izquierdo; tratado con analgésicos-antiinflamatorios y rehabilitación sin mejoría clínica. Al realizar resonancia magnética nuclear se descubre ganglión supraglenoideo y SLAP. Se solicita electromiograma que describe el atrapamiento del nervio supraescapular. Su tratamiento fue por artroscopía.

Forensic identification of floating shoulder injury / 法医学杂志

OBJECTIVE@#To discuss forensic identification of floating shoulder injury (FSI).@*METHODS@#To analyze fifteen cases of FSI which were accepted from Jan. 1993 to Jan. 2006, including 15 shoulder neck fracture, 13 clavide stem fracture and 2 distal end clavide fracture, the function of shoulder joint was evaluated six months after injure considering the following three aspects: result of forensic examination such as X-ray photograph, CT and MRI, the injurers' symptom, objective sign and joint function, shoulder joint territory, degree of pain and local muscle power.@*RESULTS@#Basing on the curative effect standard of Herscovic, all cases were divided into good. Modest, worst, which included 2, 4, 9 cases respectively; referring the standard of GA35-92, GB18667-2002, all cases were divided into six, seven, eight, nine and ten degree, which included 2,9,2,1,1 cases respectively.@*CONCLUSION@#As a special powerful injure, FSI always companied with concurrent and multiple injure, and characterized by missed, incorrect and delayed diagnosis and infelicitous treatment, which lead to the high frequency and degree of injure. To prevent missed and incorrect forensic identification, we should have a full realization of the particularity of FSI, and evaluate the function of shoulder all-sidely, objectively and synseticaly.

Functional and oncological outcome of total scapulectomy in the management of shoulder girdle malignant bone and soft tissue tumors

The aim of this study was to evaluate the functional and oncological outcome of total scapulectomy in the management of primary malignant bone and soft tissue tumors in and around the shoulder girdle. Eight patients [5 males, 3 females] with an age range of 7-48 years [average 25.5 years] had undergone total scapulectomy in our centre between 1999 and 2003. Five patients had stage IIB, two stage IB, and one stage III tumors according to Enneking's staging system. The follow- up period ranged from 6 to 48 months. The oncological outcome was assessed and the functional outcome was evaluated using the Musculoskeletal Tumor Society [MSTS] rating scale. Seven patients are still alive, one patient died of disease. Local recurrence was not detected in any of our patients while chest metastases occurred in two [one of them already had it at the time of presentation]. The mean functional score was 22.4. The shoulder function was significantly impaired in all cases especially abduction and flexion while the elbow and hand function were completely preserved. It was concluded that total scapulectomy remains a good limb-sparing technique that preserves a functionally useful extremity

Tratamento cirúrgico de tumores malignos envolvendo ombro e membro superior: estudo de 10 casos / Surgical treatment of malignant tumors from the shoulder and upper limb: a study of 10 cases

Para alguns pacientes com neoplasias em região de ombro e/ ou membro superior, a desarticulação interescapulotorácica (Cirurgia de Berger) ou a desarticulação escápulo-umeral, embora radicais, são o tratamento cirúrgico de escolha. No entanto, em casos selecionados, a escapulectomia ou a cirurgia de Tikhoff-Linberg (ressecção interescapulotorácica supra-umeral) pode ser uma alternativa. Neste trabalho, avaliamos 10 pacientes submetidos às diversas cirurgias em região de ombro e membro superior, de 2000 a 2003, nos hospitais ASCOMCER, Oncológico e Dr. João Felício, de Juiz de Fora (MG), procedendo à discussão sobre a modalidade cirúrgica aplicada a cada caso, a relação entre tipo histológico, localização do tumor e/ ou comprometimento de feixe vásculo-nervoso com a indicação de uma ou outra cirurgia, a recorrência local ou sistêmica relacionada à técnica cirúrgica, a utilização de terapias neoadjuvantes e adjuvantes à cirurgia, o tempo de acompanhamento clínico sem indício de recidiva e óbitos.

Surelevation congenitale de l'omoplate

21 cases of sprengel deformity in 19 patients were treated in paediatric orthopaedic unit of children's hospital of Rabat in 20 years. Only 6 patients [4 girls, 2 boys] were operated on. The ages of the patients at operation ranged from four to fiveting years [mean age: 10 years]. The duration of follow-up ranged from 8 months to 10 years [average: 4 years and 2 months] the woodward procedure was constantly used. Post operatively, the average increase in total abduction was 40° [range 30 to 75°]. Functional and cosmetic results were judged good in 3 patients, moderate in 2 and fair in one case. We emphasize that patients who are less than 4 years old are the ideal candidates for scapular displacement procedure

Osteocondroma de localización infrecuente / A case of osteochondroma with rare localization

Se presenta un paciente de 11 años de edad, sexo masculino y piel blanca, que desde hace un año se queja de molestias en el hombro izquierdo. Se realiza un examen físico, radiográfico y tomográfico y se diagnostica un osteocondroma subescapular. Se somete el paciente a tratamiento quirúrgico y se realiza exéresis y biopsia de la lesión. El examen anatomopatológico confirmó el diagnóstico de osteocondroma. El paciente evolucionó satisfactoriamente

Sprengel's deformity Case report

A case of sprengel's deformity [congenital elevation of scapula] in a 12 year old girl with major cosmetic and functional defect is presented. The child was operated by modified Green's procedure with release and relocation of scapula and resection of omovertebral connection. The cosmetic appearance and shoulder abduction achieved, were satisfactory