RESUMEN
The purpose of this study was to identify the relationship between scapula morphology and rotator cuff tears (RCT). Hundred seventeen shoulders with and 87 shoulders without RCTs were included in this retrospective study. The critical shoulder angle (CSA) and lateral acromion angle in the coronal view, and the acromial coverage angle (ACA) and coracoid and scapular spine angle (CSSA) in the sagittal view were evaluated using 3-dimensional computed tomography. The glenoid anterior tilt, anterior acromial projection angle (AAPA), coracoid process angle, scapular spine angle (SSA), and inferior angle angle (IAA) with respect to the scapular plane were measured in the sagittal view. In univariate logistic regression analysis, CSA, ACA, AAPA, SSA, and IAA were significantly greater in shoulders with RCTs, whereas CSSA was greater in shoulders without RCTs. In multivariate logistic regression analysis, CSA and IAA were greater in shoulders with RCT and were significantly associated with this condition (P=.00073, P=.0032). This study has shown us that RCTs were associated with a greater curvature of the scapular body and greater CSA and IAA.
Asunto(s)
Imagenología Tridimensional , Lesiones del Manguito de los Rotadores , Escápula , Tomografía Computarizada por Rayos X , Humanos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Escápula/diagnóstico por imagen , Escápula/anatomía & histología , Femenino , Estudios Retrospectivos , Masculino , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Imagenología Tridimensional/métodos , Anciano , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/anatomía & histología , Adulto , Acromion/diagnóstico por imagen , Acromion/anatomía & histología , Manguito de los Rotadores/diagnóstico por imagenRESUMEN
Accurate arm circumference (AC) measurement is required for accurate blood pressure (BP) readings. Standards stipulate measuring arm circumference at the midpoint between the acromion process (AP) and the olecranon process. However, which part of the AP to use is not stipulated. Furthermore, BP is measured sitting but arm circumference is measured standing. We sought to understand how landmarking during AC measurement and body position affect cuff size selection. Two variations in measurement procedure were studied. First, AC was measured at the top of the acromion (TOA) and compared to the spine of the acromion (SOA). Second, standing versus seated measurements using each landmark were compared. AC was measured to the nearest 0.1 cm at the mid-point of the upper arm by two independent observers, blinded from each other's measurements. In 51 participants, the mean (±SD) mid-AC measurement using the anchoring landmarks TOA and SOA in the standing position were 32.4 cm (±6.18) and 32.1 cm (±6.07), respectively (mean difference of 0.3 cm). In the seated position, mean arm circumference was 32.2 (±6.10) using TOA and 31.1 (±6.03) using SOA (mean difference 1.1 cm). Kappa agreement for cuff selection in the standing position between TOA and SOA was 0.94 (p < 0.001). The landmark on the acromion process can change the cuff selection in a small percentage of cases. The overall impact of this landmark selection is small. However, standardizing landmark selection and body position for AC measurement could further reduce variability in cuff size selection during BP measurement and validation studies.
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Brazo , Determinación de la Presión Sanguínea , Humanos , Brazo/anatomía & histología , Masculino , Femenino , Determinación de la Presión Sanguínea/métodos , Determinación de la Presión Sanguínea/instrumentación , Determinación de la Presión Sanguínea/normas , Reproducibilidad de los Resultados , Persona de Mediana Edad , Adulto , Variaciones Dependientes del Observador , Presión Sanguínea/fisiología , Puntos Anatómicos de Referencia , Anciano , Postura/fisiología , Antropometría/métodos , Acromion/anatomía & histologíaRESUMEN
INTRODUCTION: This study evaluates the role of anatomic scapular morphology in acromion and scapular spine fracture (SSAF) risk after reverse shoulder arthroplasty (RSA). METHODS: Twelve scapular measurements were captured based on pilot study data, including scapular width measurements at the acromion (Z1), middle of the scapular spine (Z2), and medial to the first major angulation (Z3). Measurements were applied to 3D-CT scans from patients who sustained SSAF after RSA (SSAF group) and compared with those who did not (control group). Measurements were done by four investigators, and the intraclass correlation coefficient was calculated. Regression analysis determined trends in fracture incidence. RESULTS: One hundred forty-nine patients from two separate surgeons (J.L., A.M.) were matched by age and surgical indication of whom 51 sustained SSAF after reverse shoulder arthroplasty. Average ages for the SSAF and control cohorts were 78.6 and 72.1 years, respectively. Among the SSAF group, 15 were Levy type I, 26 Levy type II, and 10 Levy type 3 fractures. The intraclass correlation coefficient of Z1, Z2, and Z3 measurements was excellent (0.92, 0.92, and 0.94, respectively). Zone 1 and 3 measurements for the control group were 18.6 ± 3.7 mm and 3.2 ± 1.0 mm, respectively, compared with 22.5 ± 5.9 mm and 2.0 ± 0.70 mm in the SSAF group, respectively. The fracture group trended toward larger Z1 and smaller Z3 measurements. The average scapular spine proportion (SSP), Z1/Z3, was significantly greater in the control 6.20 ± 1.80 versus (12.60 ± 6.30; P < 0.05). Regression analysis showed a scapular spine proportion of ≤5 was associated with a fracture risk <5%, whereas an SSP of 9.2 correlated with a 50% fracture risk. DISCUSSION: Patients with a thicker acromions (Z1) and thinner medial scapular spines (Z3) have increased fracture risk. Understanding anatomic scapular morphology may allow for better identification of high-risk patients preoperatively.
Asunto(s)
Artroplastía de Reemplazo de Hombro , Escápula , Humanos , Escápula/anatomía & histología , Escápula/diagnóstico por imagen , Anciano , Artroplastía de Reemplazo de Hombro/efectos adversos , Masculino , Femenino , Tomografía Computarizada por Rayos X , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Anciano de 80 o más Años , Persona de Mediana Edad , Acromion/anatomía & histología , Acromion/diagnóstico por imagen , Proyectos Piloto , Imagenología TridimensionalRESUMEN
PURPOSE: Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark-specific nerve position data. The purpose of this study is to address this gap by investigating such relationships. METHOD: This cadaveric study examines axillary, radial and suprascapular nerves' relation with acromion, coracoid and greater tuberosity of the humerus (GT). It also correlates this data with humeral lengths and explores nerve dynamics in relation to arm positions. RESULTS: The mean distance from the axillary nerve to (i) GT was 4.38 cm (range 3.32-5.44, SD 0.53), (ii) acromion was 6.42 cm (range 5.03-7.8, SD 0.694) and (iii) coracoid process was 4.3 cm (range 2.76-5.84, SD 0.769). Abduction brought the nerve closer by 0.36 cm, 0.35 cm and 0.53 cm, respectively. The mean distance from radial nerve to (i) GT was 5.46 cm (range 3.78-7.14, SD 0.839), (ii) acromion was 7.82 cm (range 5.4-10.24, SD 1.21) and (iii) tip of the coracoid process was 6.09 cm (range 4.07-8.11 cm, SD 1.01). The mean distance from the suprascapular nerve to the acromion was 4.2 cm (range 3.1-5.4, SD 0.575). The mean humeral length was noted to be 27.83 cm (range 25.3-30.7, SD 1.13). There was no significant correlation between these distances and humeral lengths. CONCLUSION: It is essential to exercise caution to avoid axillary nerve damage during the abduction manoeuvre, as its distance from the greater tuberosity and tip of the coracoid process has shown a significant reduction. The safe margins, in relation to the length of the humerus and consequently the patient's stature, exhibit no significant variation. In situations where the greater tuberosity (GT) and the border of the acromion are inaccessible due to reasons such as trauma, the tip of the coracoid process can serve as a dependable bone landmark for establishing a secure surgical margin.
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Plexo Braquial , Cadáver , Húmero , Humanos , Plexo Braquial/anatomía & histología , Plexo Braquial/cirugía , Húmero/cirugía , Húmero/inervación , Masculino , Anciano , Femenino , Hombro/inervación , Hombro/cirugía , Acromion/cirugía , Acromion/anatomía & histología , Persona de Mediana Edad , Movimiento/fisiología , Articulación del Hombro/cirugía , Articulación del Hombro/inervación , Articulación del Hombro/fisiología , Anciano de 80 o más Años , Antropometría/métodosRESUMEN
BACKGROUND: Subacromial spurs are considered the one of the pathology underlying shoulder impingement syndrome. Furthermore, few studies have focused on the morphology of the subacromial spurs in normal Chinese people. This study aimed to study the spur distribution and to illustrate the morphology of spurs, which may help guide the extent of acromioplasty. METHODS: A total of 93 normal individuals were enrolled, and both shoulders of all enrolled individuals were analyzed. The subjects were divided and classified into three different groups by ages: group I = 18-40 years, group II = 41-60 years, and group III ≥ 61 years. The osteophyte distribution, osteophyte area, subacromial surface area and osteophyte area/subacromial surface area ratio were measured and illustrated using Mimics and 3-matic software. The shape of the acromion was classified according to the Bigliani and Morrison classification system. The acromial angle was also classified. Then, the relationship between osteophytes, acromial classification and acromial angle was analyzed. RESULTS: Type II (curved shape) was the most common type of acromion, and the hooked shape was a rare form. A significant increase in the left subacromial surface area in males was observed in group III compared with group I (P < 0.001) and group II (P = 0.004). The total spur/subacromial area ratio was significantly higher in group II than I. An obvious increase in the right subacromial area was observed in group III compared with group I (P = 0.004). Furthermore, there was a significant increase in the right spur area (P = 0.021) and total spur/subacromial area ratio (P = 0.006) in females in group II compared with group I. Fewer spurs were observed on the left than on the right side (p = 0.0482). One spur was most common among type II acromions (29/36) (80.56%) on the left side and the right side (34/52, 65.38%). CONCLUSIONS: Spurs osteophytes are mainly distributed with an irregular shape and mostly run through the medial and lateral sides of the subacromial surface in normal subjects. The characteristics of subacromial spurs are so diverse that a surgeon must conduct subacromial decompression completely based on the morphology of individual spurs.
Asunto(s)
Acromion , Pueblos del Este de Asia , Osteofito , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Acromion/diagnóstico por imagen , Acromion/anatomía & histología , Artroplastia , Osteofito/diagnóstico por imagen , Osteofito/patología , Síndrome de Abducción Dolorosa del Hombro/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
BACKGROUND: The etiology of rotator cuff tears (RCTs) have been investigated for years and many underlying causes have been identified. Shoulder joint morphology is one of the extrinsic causes of RCTs. AIM: Morphometric measurements on MRI sections determined which parameters are an important indicator of RCT in patients with shoulder pain. The aim of this study was to determine the risk factors in the etiology of RCTs by evaluating the shoulder joint morphology with the help of previously defined radiological parameters. METHOD: Between January 2019-December 2020, 408 patients (40-70 years old) who underwent shoulder MRI and met the criteria were included in the study. There were 202 patients in the RCT group and 206 patients in the control group. Acromion type, acromial index (AI), critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral acromial angle (LAA), acromial angulation (AA), acromion-greater tuberosity impingement index (ATI), and glenoid version angle (GVA) were measured from the MRI images of the patients. RESULTS: AI (0.64 vs. 0.60, p = 0.003) CSA (35.3° vs. 32.4°, p = 0.004), ATI (0.91 vs. 0.83, P < 0.001), and AA (13.6° vs. 11.9°, p = 0.011) values were higher in the RCT group than in the control group and the difference was significant. AHD (8.1 mm vs. 9.9 mm, P < 0.001), LAA (77.2° vs. 80.9°, p = 0.004) and GVA (-3.9° vs. -2.5°, P < 0.001) values were lower in the RCT group than in the control group, and again the difference was significant. According to the receiver operating characteristic curve analysis, the cutoff values were 0.623 for AI and 0.860 for ATI. CONCLUSION: Acromion type, AI, CSA, AHD, LAA, AA, ATI, and GVA are suitable radiological parameters to evaluate shoulder joint morphology. High AI, CSA, AA, ATI, GVA and low AHD and LAA are risk factors for RCT.
Asunto(s)
Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Adulto , Persona de Mediana Edad , Anciano , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/anatomía & histología , Manguito de los Rotadores/diagnóstico por imagen , Escápula/anatomía & histología , Acromion/diagnóstico por imagen , Acromion/anatomía & histologíaRESUMEN
INTRODUCTION: the acromion is a small portion of the scapula that extends towards the anterior region from the spine of the scapula. Traditionally, the acromion is classified by the shape of its inferior surface in a sagittal plane. Acromial morphology has been found to be related to rotator cuff injury. OBJECTIVE: to determine the association between the type of acromion with a higher incidence of rotator cuff rupture. Study population: patients who come to the Traumatology and Orthopedics Service of a third level hospital at Monterrey, Mexico, due to a painful shoulder and who have undergone a simple magnetic resonance of the shoulder. MATERIAL AND METHODS: a cross-sectional, retrospective and descriptive study was carried out, in which 273 magnetic resonance studies were reviewed in patients who met the inclusion criteria. The type of acromion was reported according to the morphological classification in type I to IV and the state of the rotator cuff: without rupture, partial rupture or complete rupture, making a comparison between right and left shoulder. RESULTS: in this study we found a value of p = 0.473 which concludes that there is no relation between the type of acromion and the injury of the rotator cuff. CONCLUSION: in the present study, unlike what has been published in the literature, it was found that type II acromion was the one that was associated in most cases with a rotator cuff tear.
INTRODUCCIÓN: el acromion es una pequeña porción de la escápula que se extiende hacia la región anterior desde la espina de la escápula. Tradicionalmente se clasifica al acromion por la forma de su superficie inferior en un plano sagital. Se ha encontrado que la morfología acromial está relacionada con la lesión del manguito rotador. OBJETIVO: determinar la asociación entre el tipo de acromion con una mayor incidencia de ruptura de manguito rotador. Población de estudio: pacientes que acudan al Servicio de Traumatología y Ortopedia de un hospital privado de tercer nivel en la ciudad de Monterrey por hombro doloroso y a los cuales se les haya realizado una resonancia magnética simple de hombro. MATERIAL Y MÉTODOS: se realizó un estudio de tipo transversal, retrospectivo y descriptivo, en el cual se revisaron 273 estudios de resonancia magnética en pacientes que cumplieran los criterios de inclusión. Se reportó el tipo de acromion según la clasificación morfológica en tipo I a IV y el estado del manguito rotador: sin ruptura, ruptura parcial o ruptura completa, haciendo una comparación entre hombro derecho e izquierdo. RESULTADOS: se obtuvo un valor de p = 0.473 por lo que se concluye que no existe una asociación entre el tipo de acromion y el estado del manguito rotador. CONCLUSIÓN: en el presente estudio, a diferencia de lo publicado en la literatura, se obtuvo que el acromion tipo II fue al que se asoció la mayoría de los casos con ruptura del manguito rotador.
Asunto(s)
Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Manguito de los Rotadores/diagnóstico por imagen , Acromion/anatomía & histología , Acromion/patología , Estudios Retrospectivos , Estudios Transversales , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Rotura/patología , Espectroscopía de Resonancia MagnéticaRESUMEN
Background: The aim of this study was to assess whether the anteroposterior coverage of the acromion reflecting acromial morphology affects the rotator cuff tear (RCT) and tear size, in addition to the lateral coverage. Methods: Medical records of 356 patients with RCTs, concentric osteoarthritis, and calcific tendinitis identified using three-dimensional computed tomography between January 2016 and December 2017 were retrospectively analyzed. The patients were divided into group A (those with RCTs) and group B (those with concentric osteoarthritis or calcific tendinitis). Subsequently, group A was subdivided into three categories according to the size of RCTs: small-to-medium, large, and massive. The lateral coverage was measured through the lateral acromial angle (LAA) and critical shoulder angle (CSA), whereas the anteroposterior coverage was measured via the acromial tilt (AT), acromiohumeral interval (AHI) in the sagittal view, and anteroposterior coverage index (APCI) as a new radiologic parameter. Results: Between groups A and B, CSA (34.5° ± 3.4° and 30.8° ± 3.4°, respectively), APCI (0.83 ± 0.10 and 0.75 ± 0.08, respectively), and AHI (6.3 ± 2.0 mm and 7.8 ± 1.8 mm, respectively) were significantly different (all p < 0.001), whereas LAA and AT did not show a significant difference between the groups (p = 0.089 and p = 0.665, respectively). The independent predictive radiologic parameters of the RCT were the CSA, APCI, and AHI (p < 0.001, p < 0.001, and p = 0.043, respectively); among these, the APCI showed the highest regression coefficient (odds ratio = 2.82). The parameters associated with the size of RCTs were CSA (p = 0.022) and AHI, of which AHI, in particular, had the most significant effect on both small-to-medium and large tears (all p < 0.001). Conclusions: Large CSA, high APCI, and low AHI were predictors of RCTs, with the APCI showing the strongest correlation. In addition to the large CSA, low AHI also correlated with the size of RCTs and affected the entire size groups. We suggest that both the lateral coverage and anteroposterior coverage of the acromion should be considered essential factors for predicting the presence of RCTs and tear size.
Asunto(s)
Osteoartritis , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Tendinopatía , Humanos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Acromion/diagnóstico por imagen , Acromion/anatomía & histología , Articulación del Hombro/anatomía & histología , RoturaRESUMEN
Despite its time-honored tradition, the classic Neer acromioplasty has come under increased scrutiny in the recent literature, particularly when performed in the absence of rotator cuff repair. The American Medical Association Current Procedural Terminology Committee has transitioned the acromioplasty procedure, and definition of the related Current Procedural Terminology code 29827, to a procedure that is "added-on" to shoulder arthroscopy. Several authors have sought to investigate the true value of arthroscopic subacromial decompression for extrinsic sources of impingement. Common indications for acromioplasty include bursal-sided tears, prominent type III hooked acromial morphology, calcified coracoacromial ligament, and severe rotator cuff tendinopathy. However, the classic arthroscopic acromioplasty may not meaningfully address lateral outlet impingement and acromial overcoverage, as measured by an elevated critical shoulder angle or acromial index, thereby leading to persistent abduction impingement and mechanical abrasion. In these cases, lateral acromial resection of up 5 to 10 mm may be preferentially considered to decrease the pathologic critical shoulder angle (>35°) and reduce the risk of primary or secondary rotator cuff tendon failure.
Asunto(s)
Artroscopía , Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/cirugía , Acromion/cirugía , Acromion/anatomía & histología , Manguito de los Rotadores/cirugía , Artroplastia/métodosRESUMEN
INTRODUCTION: Shoulder impingement syndrome is evaluated radiologically with two-dimensional measurement parameters. None of these measurement parameters accurately reflect the three-dimensional geometry. The purpose of this study was to evaluate the volumetric status of the subacromial space in patients with shoulder impingement syndrome and to investigate its relationship with two-dimensional parameters. HYPOTHESIS: The primary hypothesis of this study is that subacromial volume is reduced in patients with impingement syndrome. The second hypothesis is that the sagittal plane morphology of the acromion reflects the subacromial volume better than the coronal plane morphology. PATIENTS AND METHODS: This retrospective study consisted of a total of 52 participants: 26 patients with impingement syndrome and 26 controls. Volumetric measurements were performed with using magnetic resonance imaging. The relationship between humerus and acromion was evaluated by acromiohumeral distance. The sagittal plane morphology of the acromion was evaluated with an objective acromial angle, while the coronal plane morphology was evaluated with a lateral acromial angle. The radiological parameters between groups were compared. RESULTS: The mean subacromial volume was significantly smaller in the impingement group compared to the control group (p=0.01). The subacromial volume had a negative correlation with the objective acromial angle (R=-0.46; p=0.01) The mean tendon volume was significantly higher in the impingement group (p<0.001). The mean acromiohumeral distance in the impingement group (6.8mm±1.0mm), was calculated to be significantly lower than the control group (10.1mm±1.5mm) (p<0.001). There was a positive moderate correlation between subacromial volume and acromiohumeral distance (R=0.61; p=0.01). DISCUSSION: This is the first study to demonstrate a reduction in subacromial volume in patients with impingement syndrome. The sagittal plane morphology of the acromion, rather than the coronal plane, appears to be more closely related to the subacromial volume. LEVEL OF EVIDENCE: III; case-control study.
Asunto(s)
Lesiones del Manguito de los Rotadores , Síndrome de Abducción Dolorosa del Hombro , Acromion/anatomía & histología , Acromion/diagnóstico por imagen , Estudios de Casos y Controles , Humanos , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/patología , Síndrome de Abducción Dolorosa del Hombro/diagnóstico por imagenRESUMEN
BACKGROUND: The acromial arterial rete (AAR) is the junction between the skin blood supply of the cervical side and that of the upper arm, and it is the only site crossed by the trans-regional blood supply of the cervico-humeral flap (CHF). The aim of this study was to explore the structures of AAR to optimizing flap design. METHODS: A body arteriography and spiral CT scan were performed on 33 whole adult corpses. The 3D reconstruction was used to perform continuous digital layered anatomy of the shoulder and upper chest; the acromion and acromioclavicular joint were used as the center to observe the source, route and distribution characteristics of a perforating branch and their anastomosis. RESULTS: The perforating branches were separated from an acromial branch of the transverse cervical artery (97%), posterior humeral circumflex artery (95%), a deltoid branch of the thoracoacromial artery (95%), and the acromial branch of the thoracoacromial artery (93%). The diameter of the acromial branch of the transverse cervical artery at its initial location was 1.18 ± 0.37 mm; the trunk length was 12.53 ± 3.83 cm, and it was anastomosed with other blood vessels in three forms. CONCLUSION: Deep fascia should be included in the flap design. Three kinds of pedicled transfer flaps can be designed with the acromial branch of transverse carotid artery as the vascular pedicle. Free flaps can be designed with the acromial branch of thoracoacromial artery as the vascular pedicle.
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Acromion/anatomía & histología , Acromion/irrigación sanguínea , Imagenología Tridimensional/métodos , Colgajo Perforante/irrigación sanguínea , Tomografía Computarizada Espiral/métodos , Adulto , Brazo/anatomía & histología , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.
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Acromion/cirugía , Artroplastia/métodos , Lesiones del Manguito de los Rotadores/cirugía , Articulación del Hombro/cirugía , Acromion/anatomía & histología , Acromion/diagnóstico por imagen , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/etiología , Articulación del Hombro/anatomía & histología , Articulación del Hombro/diagnóstico por imagen , Resultado del TratamientoRESUMEN
To find out which structure is crucial for the formation of shoulder impingement syndrome with the purpose of directing surgical procedures of subacromial decompression and discussing whether it is necessary to manage acromioclavicular joint during operation and how to do it properly. METHODS: This was a retrospective study. Clinical data and preoperative computed tomography (CT) images were collected from patients who were diagnosed with rotator cuff tears between January 2017 and August 2019 (sample size: 46) and those who were diagnosed without rotator cuff tears between March 2018 and August 2019 (sample size: 44) in our institution, respectively. Three-dimensional models of shoulders were established by multiplanar reconstruction of CT scans and measurements were performed on these models. The parameters such as the acromial length and width, the axial tilt, and the distance from acromial margin to glenoid plane were measured in an adjusted axial plane, and the critical shoulder angle and the spatial volume under acromioclavicular joint were measured in an adjusted coronal plane. The demographic characteristics, the acromial morphology and the spatial volume under acromioclavicular joint were compared to find significant differences between the two groups. The association between the axial tilt and the distance from acromial margin to glenoid plane was evaluated by an ordinary least squares linear regression. RESULTS: The patients with rotator cuff tears consisted of 16 males and 30 females, among which 30 right shoulders and 16 left shoulders were included. The patients without rotator cuff tears consisted of 28 males and 16 females, among which 15 right shoulders and 29 left shoulders were involved. Significant differences between the groups were found in the acromial width (3.332 cm vs 3.111 cm), the axial tilt (33.765° vs 23.829°), the critical shoulder angle (32.630° vs 30.363°), the distance from anterior 3 cm of lateral acromial margin (range, 2.476 cm-3.302 cm vs 1.993 cm-3.089 cm), and anterior 0.9 cm of medial acromial margin (range, 0.967 cm-2.369 cm vs 0.668 cm-1.993 cm) to glenoid plane, and the spatial volume under acromioclavicular joint (1.089 cm vs 1.446 cm) in the two groups. No significant differences were found in the age (60.0 years vs 58.3 years) or the acromial length (4.187 cm vs 4.184 cm). Significant association was revealed by linear regression analysis between the axial tilt and the distance from anterior two-thirds of lateral acromial margin to glenoid plane, and similar association was also found in the anterior half of medial margin. CONCLUSION: Anterior two-thirds of lateral acromial margin, anterior half of medial acromial margin, and inferior aspect of acromioclavicular joint are crucial structures and need to be fully decompressed when treating patients with rotator cuff tears.
Asunto(s)
Articulación Acromioclavicular/anatomía & histología , Articulación Acromioclavicular/diagnóstico por imagen , Acromion/anatomía & histología , Acromion/diagnóstico por imagen , Imagenología Tridimensional , Síndrome de Abducción Dolorosa del Hombro/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Articulación Acromioclavicular/cirugía , Acromion/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Síndrome de Abducción Dolorosa del Hombro/cirugíaRESUMEN
BACKGROUND: Shoulder injections for conditions such as adhesive capsulitis are commonly performed and can be administered through image-based or landmark-based injection approaches. Ultrasound-guided injections are widely used and accurate because ultrasound allows real-time visualization of the needle and injected contrast. Landmark-based injections would be advantageous, if they were accurate, because they would save the time and expense associated with ultrasound. However, few prospective studies have compared well-described landmark-based shoulder injection techniques without ultrasound. QUESTION/PURPOSE: Using anatomic landmarks, and without using ultrasound, is the accuracy of glenohumeral injection for adhesive capsulitis greater via the posterior approach or via a new anterior approach? METHODS: Between 2018 and 2020, we treated 108 patients potentially eligible for adhesive capsulitis treatment. These patients had clinical symptoms of aggravating shoulder pain with a duration of less than 4 months and passively impaired, painful glenohumeral ROM. Due to the exclusion of patients with other shoulder conditions (full-thickness rotator cuff ruptures and posttraumatic stiffness), 95 patients received an injection in this sequential, prospective, comparative study. Between 2018 and 2019, 41 patients (17 males and 24 females; mean age 52 ± 5 years; mean BMI 24 ± 3 kg/m2) were injected through the posterior approach, with the acromion as the anatomical landmark, during the first part of the study period. After that, between 2019 and 2020, 54 patients (20 males and 34 females; mean age 54 ± 4 years; mean BMI 23 ± 3 kg/m2) received an injection through a new anterior approach, with the acromioclavicular joint as the anatomic landmark, during the second part of the study period. Injections via both approaches were administered by two experienced shoulder specialists (both with more than 10 years of experience). Both specialists had experience with the posterior approach before this study, and neither had previous training with the new anterior approach. Injections contained a corticosteroid, local anaesthetic, and contrast medium. Radiographs were taken within 20 minutes after the injection, and a radiologist blinded to the technique determined accuracy. Accurate injections were defined as having contrast fluid limited to the glenohumeral joint, while inaccurate injections displayed leakage of contrast fluid into the soft tissue or subacromial space. All of the enrolled patients were analyzed. RESULTS: In the group with the posterior approach, the accuracy was 78% (32 of 41) in contrast to 94% (51 of 54, odds ratio 0.21 [95% CI 0.05 to 0.83]; p = 0.03) in patients with the new anterior approach. CONCLUSION: The new anterior approach without the use of ultrasound was more accurate than the posterior approach. In fact, it was nearly as accurate as previously published ultrasound-guided approaches. We recommend using the new anterior approach for intraarticular glenohumeral injections instead of ultrasound-guided injections because it will save time and costs associated with ultrasound. Still, the clinical effects (anxiety, pain, functional outcome, and adverse events) of the new anterior approach should be compared with ultrasound-guided injections in a randomized study. LEVEL OF EVIDENCE: Level II, therapeutic study.
Asunto(s)
Puntos Anatómicos de Referencia , Bursitis/tratamiento farmacológico , Inyecciones Intraarticulares/métodos , Articulación del Hombro/anatomía & histología , Articulación Acromioclavicular/anatomía & histología , Acromion/anatomía & histología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: We investigated the branching pattern and topographic anatomy of the nerves to the teres minor (Tm) and the long head of the triceps brachii (LHT) in relation to reference lines extending between surface landmarks, to identify the innervation patterns of, and the optimal needle placement points within, the Tm and the LHT. METHODS: The anatomical courses of the nerves to the Tm and the LHT were investigated in 37 upper limbs of fresh-frozen cadavers. Distances from the acromion to nerve penetration points, and crossing points of reference lines with the Tm and LHT were measured in 27 cadaveric upper limbs. RESULTS: The Tm was innervated by the axillary nerve in all specimens in three patterns, and the LHT was innervated exclusively by the radial nerve. Our dissection and measurements indicate that the midpoint of the reference line from the acromion to the inferior angle of the scapula is the optimal needle insertion point for the Tm. The target point for the LHT appears to be the one-third point of the reference line from the acromion to the medial epicondyle, or the two-thirds point of the reference line from the acromion to the axillary fold. CONCLUSIONS: We investigated the branching pattern of the nerves to the Tm and the LHT and propose optimal needle placement points for electromyography of the Tm and LHT.
Asunto(s)
Puntos Anatómicos de Referencia , Brazo/inervación , Plexo Braquial/anatomía & histología , Músculo Esquelético/inervación , Nervio Radial/anatomía & histología , Manguito de los Rotadores/inervación , Acromion/anatomía & histología , Anciano , Anciano de 80 o más Años , Axila/anatomía & histología , Cadáver , Electromiografía , Femenino , Humanos , Húmero/anatomía & histología , Masculino , Escápula/anatomía & histologíaRESUMEN
Advanced cases of subacromial impingement syndrome usually present with acromial spurs. However, previous studies have reported variations in the prevalence of acromial spurs in shoulders with or without subacromial impingement syndrome as well as with age, sex, and side. Therefore, this study is aimed at investigating the prevalence of acromial spurs in cadaveric shoulders and reviewing the factors leading to the reported variable frequencies. The study examined 220 cadaveric shoulders (110 male and 110 female), with a median age of 82 years (with a range of 53 to 102 years). In 155 shoulders, the rotator cuff tendons were evaluated for tears; acromial spurs were observed in 95 shoulders (43%). No significant association was observed between the prevalence of acromial spurs and sex or side. However, a significant prevalence of spurs (57%) was observed in the oldest-old group, aged ≥ 85 years. Those with acromial spurs also tended to be older (84 years) than those without spurs (81 years). A significant difference in the prevalence of acromial spurs was observed in shoulders with rotator cuff tears compared to those without them: 80% compared to 20%, respectively. Analysis showed a significant number of acromial spurs in shoulders with full-thickness tears (46%) and partial tears (34%). A significant prevalence of acromial spurs was found in shoulders with rotator cuff tears, as well as in aged shoulders. In relevant literature, the prevalence of acromial spurs varies with the type of study undertaken, age, prevalence of rotator cuff tears, and type of radiograph examined
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Acromion/anatomía & histología , Estudios de Cohortes , Hombro/anatomía & histología , Manguito de los Rotadores/anatomía & histología , Cadáver , Acromion/patología , Estudios Prospectivos , Disección/métodos , Lesiones del Hombro/patología , Dolor de HombroRESUMEN
CONTEXT: Recreational overhead athletes are exposed to high overload, which increases the risk of shoulder injuries. Reduction of the acromiohumeral distance (AHD) is often associated with rotator cuff-related shoulder pain (RCRSP) among the general population. However, the AHD of symptomatic shoulders of recreational athletes has not yet been compared with their asymptomatic shoulders. OBJECTIVE: To compare the AHD of a symptomatic to asymptomatic shoulder at rest (0°) and 60° abduction. To establish the relationship between AHD, pain, and functional limitations of recreational athletes with RCRSP. DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: A total of 45 recreational overhead athletes with RCRSP were examined. MAIN OUTCOME MEASURES: The AHD was measured by ultrasonography at 0° and 60° abduction (angles). Shoulder pain was assessed using a numeric pain scale, whereas functional limitations were assessed using the The Disabilities of the Arm, Shoulder, and Hand questionnaire. Differences in the between-shoulders condition (symptomatic and asymptomatic) were determined using 2-way analysis of variance for repeated measures. A Pearson correlation established the relationship between AHD, pain, and functional limitations. RESULTS: No angles × shoulder condition interactions (P = .776) nor shoulder condition effects (P = .087) were detected, suggesting no significant differences (P > .05) between asymptomatic and symptomatic shoulders in the AHD at 0° or 60°. The AHD at 60° reduced significantly compared with 0° (3.05 [1.36] mm [2.77-3.33], angle effects: P < .001). The AHD at 0° and 60° was not correlated with pain or functional limitations (-.205 ≤ r ≤ .210, .167 ≤ P ≤ .585). CONCLUSIONS: The AHD of recreational athletes is not decreased in symptomatic shoulders compared with asymptomatic shoulders. Reduction of the AHD in symptomatic shoulders is not associated with an increase in pain or functional limitations of recreational athletes with RCRSP.
Asunto(s)
Acromion/diagnóstico por imagen , Cabeza Humeral/diagnóstico por imagen , Manguito de los Rotadores , Dolor de Hombro/etiología , Acromion/anatomía & histología , Adulto , Análisis de Varianza , Enfermedades Asintomáticas , Atletas , Béisbol , Baloncesto , Estudios Transversales , Femenino , Humanos , Cabeza Humeral/anatomía & histología , Masculino , Persona de Mediana Edad , Montañismo , Dimensión del Dolor/métodos , Rendimiento Físico Funcional , Deportes de Raqueta , Rango del Movimiento Articular/fisiología , Reproducibilidad de los Resultados , Descanso , Lesiones del Manguito de los Rotadores , Dolor de Hombro/diagnóstico , Evaluación de Síntomas/métodos , Ultrasonografía , Adulto JovenRESUMEN
BACKGROUND: Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, conventional AHD measurements using two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to evaluate the three-dimensional (3D) actual distance between the acromion and humeral head in the standing position and compare the AHD values with those obtained using conventional measuring methods. METHODS: Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30-49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. The minimum distance between the acromion and humeral head on the 3D surface models was considered as the 3D AHD. We measured the 2D AHD on anteroposterior digitally reconstructed radiographs. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements. RESULTS: The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9-15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3-14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7-14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4-13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001). CONCLUSIONS: This study evaluated the 3D AHD of normal shoulders in the standing position using an upright CT scanner. The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value.
Asunto(s)
Acromion/anatomía & histología , Acromion/diagnóstico por imagen , Cabeza Humeral/anatomía & histología , Cabeza Humeral/diagnóstico por imagen , Imagenología Tridimensional/métodos , Posición de Pie , Adulto , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Posición Supina , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The purpose was to analyze the influence of deltoid lengthening due to different implant designs and anatomic variations of the acromion and scapular spine (SS) in the parasagittal plane on strain patterns after reverse shoulder arthroplasty (RSA). METHODS: Ten cadaveric shoulders with strain rosettes placed on the surface of the acromial body (Levy II) and SS (Levy III) were tested using a shoulder simulator. RSA using humeral onlay (+3, +5, +8, +10, +13 mm) and glenosphere lateralization (0, +6 mm) was performed. Arm lengthening and magnitude of strain on acromion/SS were measured. The length of deltoid was assessed using validated computer modeling. Anatomic variance of the SS angle and position of acromion in relation to the scapular plane was examined. For comparison of strain as a function of deltoid lengthening, 25 mm was used as a threshold value for comparison based on previous literature demonstrating a decrease in Constant score and active anterior elevation in patients with arm lengthening >25 mm. RESULTS: At maximal deltoid lengthening (30.8 mm), average strains were 1112 µÎµ (acromion) and 1165 µÎµ (SS) (P < .01). There was an 82.6% increase in acromial strain at maximum lengthening compared with 25 mm (P = .02) and a strain increase of 79 µÎµ/mm deltoid lengthening above a threshold of 25 mm. The strain results delineated 2 anatomic groups: 5 of 10 specimens (group A) showed higher strain on SS (1445 µÎµ) vs. acromion (862 µÎµ, P = .02). Group A had a more posteriorly oriented acromion, whereas group B was anteriorly oriented (P < .001). CONCLUSION: Deltoid lengthening above 25 mm produced large strains on the acromion/SS. Anatomic variation may indicate that as the acromion is more posteriorly oriented, the SS takes more strain from the deltoid vs. the acromion. Our study's data may help surgeons identify a high-risk population for increased strain patterns after RSA.
Asunto(s)
Acromion/anatomía & histología , Artroplastía de Reemplazo de Hombro , Músculo Deltoides/fisiopatología , Diseño de Prótesis , Articulación del Hombro/fisiopatología , Acromion/fisiopatología , Acromion/cirugía , Adulto , Variación Anatómica , Fenómenos Biomecánicos , Cadáver , Simulación por Computador , Femenino , Humanos , Masculino , Persona de Mediana Edad , Articulación del Hombro/cirugía , Prótesis de Hombro , Estrés MecánicoRESUMEN
The critical shoulder angle has been associated with the development of rotator cuff lesions. Over time, this association has been interpreted as a cause-effect relation without scientific evidence. Beyond the controversies that exist on the reliability and relevance of this radiographic parameter, the critical shoulder angle per se may not be responsible for rotator cuff tears because patient activities throughout several decades could induce not only cuff lesions but also bone remodeling at the acromial level.