Estudio comparativo de la distancia coracohumeral en pacientes con patología degenerativa del subescapular y una población voluntaria asintomática / Comparative analysis of the coracohumeral distance between patients with degenerative subscapularis tendon pathology and a normal age-matched population

INTRODUCCIÓN: El pinzamiento subcoracoideo secundario a una distancia coracohumeral (DCH) disminuida, ha sido descrito como una posible etiología de las lesiones degenerativas del tendón del Subescapular (SSC), sin embargo, esa teoría aún es controversial. OBJETIVO: Evaluar si existe una diferencia significativa entre la DCH promedio de pacientes con patología degenerativa del SSC y un grupo control. MATERIALES Y MÉTODOS: Se diseñó un estudio de casos-controles y se estableció un tamaño muestral mínimo de 36 casos por grupo. De nuestra base de datos, y dentro de un periodo de 6 meses, se rescataron 46 Resonancias Magnéticas (RM) de hombro con patología degenerativa avanzada y/o roturas del SSC (grupo SSC). El grupo control fue conformado por 36 RM realizadas a voluntarios asintomáticos sin patología del mango rotador. Se incluyeron en ambos grupos solo pacientes entre 40 y 60 años. Se utilizó prueba de t para determinar las diferencias entre 2 grupos con un nivel de confianza del 95%. RESULTADOS: La edad promedio del grupo SSC fue 50,1 6,1 años y del grupo control 51,7 6,8 años, no existiendo diferencia estadísticamente significativa entre ambos (p » 0.43). La DCH promedio en el grupo SSC fue 8,58 mm [IC: 7,95­9,21 mm], y en el grupo control fue 11,04 mm [IC: 10,05­12,04 mm]. Al comparar la DCH, se encontró una diferencia estadísticamente significativa entre grupos (p » 0,00048). CONCLUSIÓN: Nuestros resultados respaldan la existencia de una asociación estadísticamente significativa entre una DCH disminuida y la presencia de patología degenerativa del SSC. NIVEL DE EVIDENCIA: III (Estudio de casos y controles).

BACKGROUND: The incidence of subscapularis tears is increasing as diagnostic imaging and arthroscopic technology improves. Decreased coracohumeral distance (CHD) with associated Subcoracoid Impingement is thought to be one, potential etiology for these lesions. OBJECTIVE: The purpose of this study was to identify the association between reduced CHD and degenerative pathology of the subscapularis tendon. METHODS: A comparative case-control study was performed. The sample size required to determine significance was calculated to be 36 cases. In total, 46 patients with severe degenerative SSC tendinopathy or subscapularis tears on magnetic resonance imaging (MR) were collected consecutively from our database (SSC group). The control group consisted of 36 asymptomatic volunteers undergoing shoulder MR. Only patients between 40 and 60 years of age were included. An independent t-test was used to determine the statistical significance between the two groups (with a 95% level of confidence). RESULTS: No statistically relevant difference was found between the average age of the two groups (50.1 6.1 and 51.7 6.8; p » 0.43). In the control group, the mean CHD was found to be 11.04 mm [CI:10.05­12.04 mm] and was 8.58 mm [CI: 7.95­9.21 mm] in the subscapularis group. The statistical analysis, comparing the CHD showed a significant difference between groups (p » 0.00048). CONCLUSION: This study supports the conclusion that degenerative subscapularis pathology is associated with narrowed coracohumeral distance, when compared with an asymptomatic age-matched group. LEVEL OF EVIDENCE: III (case-control study).

Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle

BACKGROUND: We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle. METHODS: Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al. RESULTS: The mean neck shaft angles were 133.6degrees (range, 100degrees to 116degrees) at immediate postoperative, 129.8degrees (range, 99degrees to 150degrees) at 3 months postoperative and 128.4degrees (range, 97degrees to 145degrees) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8degrees as compared to 1.3degrees in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant. CONCLUSIONS: The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.

Supratrochlear foramen; study of humerus in north Indians

The knowledge of the presence of STF in a humerus may be important for preoperative planning for treatment of supracondylar fractures. Focused on the STF which is an important variation in the distal end of the humerus. The material consisted of 100 humeri of known sex taken from the Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. 36 pairs of male humeri and 14 pairs of female humeri were taken. The supracondylar foramen is seen in 26% of total humeri. It was present more in the females as compared to males and more frequently on the left side than on the right side. The translucent septum is found more frequently in the males than in females and more frequently on the right side than the left side. The anatomical knowledge of STF may be beneficial for anthropologists, orthopaedic surgeons, and radiologists in day-to-day clinical practice

A Primary Extragonadal Teratoma of the Proximal Humerus

A extragonadal malignant teratoma of the extremity is a rare pheonemenon. We describe a extremely rare case of malignant teratoma of the left proximal humerus in a 14-yr-old female. Radiologic evaluations, including magnetic resonance imaging, suggested a malignant bone tumor, but a pathological examination revealed an immature bony teratoma. Bone scintigraphy and positron emission tomography computed tomography scan showed increased uptake of proximal humerus but no other abnormal lesion.

Progress in skeletal age estimation with measurement method of X-ray film / 法医学杂志

Age estimation by the measurement method is to get the data such as the length, width, thickness, area of the ossification center, transverse diameter of the metaphysis, transverse diameter of osteoepiphysis, width of the epiphyseal line and the ratio between the diaph and the epiphyseal, by measuring the different bones of human in different ages with the radiological technology and to explore the relationship between these data and the life age by statistics. According to the relationships the personal life age may be estimated. In this article the measurement methods above mentioned and its application in age estimation were reviewed.

Stature estimation from upper extremity long bones by digital radiography / 法医学杂志

OBJECTIVE@#To obtain regression formula for estimation of stature in Han population in Sichuan Province from length of the upper extremity long bones by digital radiography.@*METHODS@#The statures of 365 healthy adults and digital radiographs of their right upper extremity long bones were measured. All statistical dispositions were done in SPSS including description and regression analysis.@*RESULTS@#Twenty-seven simple regression and 3 multiple regression formulae with statistic significance in estimation of the stature from the sum of the length of the upper extremity long bones were established. Regression coefficient was higher in ulna than in radius, in male than in female, and was more accurate in multiple regression formulae than in simple regression formulae.@*CONCLUSION@#Digital radiograph measurement of the length of the upper extremity long bones seems to be a simple and practical method to estimate human stature in forensic practice.

Humerus Varus in a Patient with Pseudohypoparathyroidism

A 7-yr-old girl presented with progressive shortening of the right upper arm and limitation of shoulder motion. Pseudohypoparathyroidism associated with Albright's hereditary osteodystrophy was diagnosed by biochemical, hormonal and radiographic studies. Her condition was complicated by severe humerus varus on the right side. Proximal humeral valgization osteotomy and concomitant humeral lengthening resulted in an improvement of the shoulder joint motion and activity in daily life.

The differences between left & right side development of osteophiphysis in estimating male juvenile age / 法医学杂志

OBJECTIVE@#The influence on age estimation by comparing the differences between left and right side development of osteophiphysis.@*METHODS@#27 osteophiphysis development indexes in the X-ray films of 6 major joints and pelvises in 130 male juveniles were observed. The positions and levels of difference between left and right side development of osteophiphysis were compared. The male juvenile age by regression equation according to left side and right side were estimated respectively.@*RESULTS@#In 76 cases, the age estimation results are the same for both sides. In 47 cases, the difference between left and right side is less than 6 months. In 7 cases, the difference is between 6 and 12 months. The error of 94.6% age estimation is within 6 months. The differences between left and right osteophiphysis development are often found in proximal humerus, distal radius, distal ulna and crista iliaca.@*CONCLUSION@#The subtle difference between left and right osteophiphysis development has no influence on age estimation.

Bilateral treponema periostitis

Symmetrical exuberant periostitis is a rare disease caused, by variety of infectious and non-infectious causes. Treponematosis is one of the rare causes of this condition. We report a patient who presented with left arm swelling, secondary to onion peel periostitis of the humerus, which was caused by Treponema species

Humeral head ossification center in congenital heart disease.

The objective of this study was to evaluate the ossification (visualization) of proximal humeral ossification center (PHOC) which may indicate bone growth in infants with acyanotic and cyanotic congenital heart disease (HD) compared to normal infants. The medical records and chest radiographs within 3 months after birth of infants who were diagnosed as congenital HD by echocardiography or cardiac catheterization from 1989 to 1999 were reviewed. The PHOC was recorded from chest radiograph as presence or absence in every one-month interval since birth. In all cases, the corrected age of 0 month was defined as 40 weeks post conception. We used a study of 260 normal Korean infants as the normal population in this study. We found that from 67 cases enrolled in this study; 10 cases were excluded because of lack of complete medical records and sequential chest radiographs. In the remaining 57 cases, the average gestational age of the infants was 38.1 +/- 2.7 weeks and the average birth weight was 2860.5 +/- 597.7 grams. Female to male ratio was 1.28:1. The infants were classified by gestational age as term (75.4%) and pre-term (24.6%). Types of congenital HD were diagnosed from echocardiogram (96.5%) and cardiac catheterization (3.5%) of cases; and were divided as acyanotic HD (64.9%) and cyanotic HD (35.1%). The ossification of PHOC in acyanotic full-term infants at 0, 1, 2, and 3 months was 24.0 per cent, 32.0 per cent, 72.0 per cent and 88.0 per cent; in cyanotic full-term infants it was 27.8 per cent, 33.3 per cent, 77.8 per cent, and 94.4 per cent; and in acyanotic pre-term infants was 8.3 per cent, 8.3 per cent, 25.0 per cent, and 41.7 per cent, respectively. There were 2 cyanotic pre-term infants who did not show ossification of PHOC until 3 months. In full-term infants with both types of HD; the appearance of PHOC was significantly later than normal at 1 month corrected age (p = 0.000002) but not significant at 0, 2, and 3 months (p > 0.05); whereas, in pre-term infants with acyanotic HD, the appearance was later than normal at 1, 2, and 3 months (p = 0.02, p = 0.01, and p = 0.0002, respectively). We concluded that the ossification of PHOC is significantly later than normal in pre-term infants with congenital HD, but not significant in full-term infants with congenital HD.