Activity of periscapular muscles and its correlation with external oblique during push-up: Does scapular dyskinesis change the electromyographic response?

PubMed

de Araújo, Rodrigo Cappatode; Pirauá, André Luiz Torres; Beltrão, Natália Barros; Pitangui, Ana Carolina Rodarti

2018-03-01

Scapular dyskinesis is the term used to describe changes in the positioning or movement of the scapula. Such dysfunction is associated with changes in the activation of the scapular muscles. However, the influence of the axial muscles on the scapular muscles activity of subjects with scapular dyskinesis is unknown. This study aimed to compare the electromyography (EMG) activity of periscapular muscles and its correlation with the external oblique muscle during the execution of push-up performed in different surfaces, in volunteers with and without scapular dyskinesis. Thirty-six men, divided in two groups (control and dyskinesis), performed push-up on stable and unstable surface. The EMG activity of serratus anterior (SA_5th and SA_7th fibers), upper (UT) and lower (LT) trapezius, external oblique (EO) was recorded during execution of each task condition. Statistical analyzes were performed using two way ANOVA repeated measures and Pearson correlation. It was observed effect of interaction between factors, being evidenced increased activity of UT, SA_7th and OE for the control group and decreased activity of SA_5th, SA_7th and EO for dyskinesis group during execution of push-up on unstable surface. In both groups positive correlations (r > 0.47) were observed between EMG activity of SA and EO. In the exercises tested, there seems to be an anatomical and functional relationship between the SA and EO muscles. The use of the unstable surface promotes increased neuromuscular demand, but the neuromuscular strategies appear to differ between groups.

Scapular-Muscle Performance: Two Training Programs in Adolescent Swimmers

PubMed Central

Van de Velde, Annemie; De Mey, Kristof; Maenhout, Annelies; Calders, Patrick; Cools, Ann M.

2011-01-01

Abstract Context: Swimming requires well-balanced scapular-muscle performance. An additional strength-training program for the shoulders is pursued by swimmers, but whether these muscle-training programs need to be generic or specific for endurance or strength is unknown. Objective: To evaluate isokinetic scapular-muscle performance in a population of adolescent swimmers and to compare the results of training programs designed for strength or muscle endurance. Design: Controlled laboratory study. Setting: University human research laboratory. Patients or Other Participants: Eighteen adolescent swimmers. Intervention(s): Each participant pursued a 12-week scapular-training program designed to improve either muscle strength or muscle endurance. Main Outcome Measure(s): Bilateral peak force, fatigue index, and protraction/retraction strength ratios before and after the scapular-training program. Results: Scapular protraction/retraction ratios were slightly higher than 1 (dominant side  =  1.08, nondominant side  =  1.25, P  =  .006). Side-to-side differences in retraction strength were apparent both before and after the training program (P  =  .03 and P  = .05, respectively). After the training program, maximal protraction (P < .05) and retraction (P < .01) strength improved on the nondominant side. Peak force and fatigue index were not different between the training groups. The fatigue indexes for protraction on both sides (P < .05) and retraction on the nondominant side (P  =  .009) were higher after the training program. Conclusions: We describe the scapular-muscle characteristics of a group of adolescent swimmers. Both muscle-strength and muscle-endurance programs improved absolute muscle strength. Neither of the strength programs had a positive effect on scapular-muscle endurance. Our results may be valuable for coaches and physiotherapists when they are designing exercise programs for swimmers. PMID:21391801

Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures.

PubMed

Jones, Clifford B; Cornelius, Jonathan P; Sietsema, Debra L; Ringler, James R; Endres, Terrence J

2009-09-01

To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach. Retrospective review of scapular or glenoid fractures. Level 1 teaching trauma center. All treated scapular or glenoid fractures over 7 years (1999-2005) were determined. Of a total of 227 scapular or glenoid fractures, 37 were treated with open reduction internal fixation and formed the basis of study. All patients were followed for a minimum of 1 year until healing or discharge from care. All operatively treated scapular fractures were performed in the lateral position on a radiolucent table. A modified Judet approach was used in all patients. The posterior deltoid was incised off the scapular spine cephalad reaching the lateral scapular border. The interval between the teres minor and infraspinatus was paramount for fracture reduction and implant insertion. The 2.7-mm minifragment plates were applied along the lateral border of the scapula. Radiographic assessment of fracture healing and clinical assessment of shoulder function. The majority of patients were males (31 males, 6 females) who sustained blunt trauma. All scapular fractures maintained fixation and reduction. No wound or muscle dehiscence problems were noted. Average range of motion was 158 degrees (range 90-180 degrees). There were no fixation failures or instances of implant loosening. The modified Judet approach allows for excellent scapular and glenoid fracture visualization and reduction while preserving rotator cuff function. Minifragment fixation along the lateral scapular border provides excellent plate position, screw length, and fracture stability.

The Effect of Shoulder Muscle Fatigue on Acromiohumeral Distance and Scapular Dyskinesis in Women With Generalized Joint Hypermobility.

PubMed

Alibazi, Razie J; Moghadam, Afsun Nodehi; Cools, Ann M; Bakhshi, Enayatollah; Ahari, Alireza Aziz

2017-12-01

Muscle fatigue is considered to be one cause of shoulder pain, and subjects with generalized joint hypermobility (GJH) are affected more by shoulder pain. The purpose of this study was to examine the effects of muscle fatigue on acromiohumeral distance (AHD) and scapular dyskinesis in women with GJH. Thirty-six asymptomatic participants were assigned to either a GJH (n = 20) or control group (n = 16) using the Beighton scale. Before and after elevation fatigue trials, AHD was measured with ultrasonography at rest and when the arm was in 90° active elevation. A scapular dyskinesis test was used to visually observe alterations in scapular movement. Our results showed that in both groups, the fatigue reduced AHD in the 90° elevation position and increased the presence of scapular dyskinesis; however, no differences were found between the two groups. Although GJH has been identified as a factor for developing musculoskeletal disorders, generalized joint hypermobility did not result in changes to scapular dyskinesis or AHD, even after an elevation fatigue task. More studies are needed to evaluate the effects of muscle fatigue in subjects with GJH and a history of shoulder instability.

Fitting unanchored puzzle pieces in the skeleton: appropriate 3D scapular positions for the quadrupedal support in tetrapods.

PubMed

Fujiwara, Shin-Ichi

2018-05-01

Deducing the scapular positions of extinct tetrapod skeletons remains difficult, because the scapulae and rib cage are connected with each other not directly by skeletal joint, but by thoracic muscles. In extant non-testudine quadrupedal tetrapods, the top positions of the scapulae/suprascapulae occur at the anterior portion of the rib cage, above the vertebral column and near the median plane. The adequacy of this position was tested using three-dimensional mechanical models of Felis, Rattus and Chamaeleo that assumed stances on a forelimb on a single side and the hindlimbs. The net moment about the acetabulum generated by the gravity force and the contractive forces of the anti-gravity thoracic muscles, and the resistance of the rib to vertical compression between the downward gravity and upward lifting force from the anti-gravity thoracic muscle depend on the scapular position. The scapular position common among quadrupeds corresponds to the place at which the roll and yaw moments of the uplifted portion of the body are negligible, where the pitch moment is large enough to lift the body, and above the ribs having high strength against vertical compression. These relationships between scapular position and rib cage morphology should allow reliable reconstruction of limb postures of extinct taxa. © 2018 Anatomical Society.

A method of measuring three-dimensional scapular attitudes using the optotrak probing system.

PubMed

Hébert, L J; Moffet, H; McFadyen, B J; St-Vincent, G

2000-01-01

To develop a method to obtain accurate three-dimensional scapular attitudes and to assess their concurrent validity and reliability. In this methodological study, the three-dimensional scapular attitudes were calculated in degrees, using a rotation matrix (cyclic Cardanic sequence), from spatial coordinates obtained with the probing of three non colinear landmarks first on an anatomical model and second on a healthy subject. Although abnormal movement of the scapula is related to shoulder impingement syndrome, it is not clearly understood whether or not scapular motion impairment is a predisposing factor. Characterization of three-dimensional scapular attitudes in planes and at joint angles for which sub-acromial impingement is more likely to occur is not known. The Optotrak probing system was used. An anatomical model of the scapula was built and allowed us to impose scapular attitudes of known direction and magnitude. A local coordinate reference system was defined with three non colinear anatomical landmarks to assess accuracy and concurrent validity of the probing method with fixed markers. Axial rotation angles were calculated from a rotation matrix using a cyclic Cardanic sequence of rotations. The same three non colinear body landmarks were digitized on one healthy subject and the three dimensional scapular attitudes obtained were compared between sessions in order to assess the reliability. The measure of three dimensional scapular attitudes calculated from data using the Optotrak probing system was accurate with means of the differences between imposed and calculated rotation angles ranging from 1.5 degrees to 4.2 degrees. Greatest variations were observed around the third axis of the Cardanic sequence associated with posterior-anterior transverse rotations. The mean difference between the Optotrak probing system method and fixed markers was 1.73 degrees showing a good concurrent validity. Differences between the two methods were generally very low for one and two direction displacements and the largest discrepancies were observed for imposed displacements combining movement about the three axes. The between sessions variation of three dimensional scapular attitudes was less than 10% for most of the arm positions adopted by a healthy subject suggesting a good reliability. The Optotrak probing system used with a standardized protocol lead to accurate, valid and reliable measures of scapular attitudes. Although abnormal range of motion of the scapula is often related to shoulder pathologies, reliable outcome measures to quantify three-dimensional scapular motion on subjects are not available. It is important to establish a standardized protocol to characterize three-dimensional scapular motion on subjects using a method for which the accuracy and validity are known. The method used in the present study has provided such a protocol and will now allow to verify to what extent, scapular motion impairment is linked to the development of specific shoulder pathologies.

A new method for motion capture of the scapula using an optoelectronic tracking device: a feasibility study.

PubMed

Šenk, Miroslav; Chèze, Laurence

2010-06-01

Optoelectronic tracking systems are rarely used in 3D studies examining shoulder movements including the scapula. Among the reasons is the important slippage of skin markers with respect to scapula. Methods using electromagnetic tracking devices are validated and frequently applied. Thus, the aim of this study was to develop a new method for in vivo optoelectronic scapular capture dealing with the accepted accuracy issues of validated methods. Eleven arm positions in three anatomical planes were examined using five subjects in static mode. The method was based on local optimisation, and recalculation procedures were made using a set of five scapular surface markers. The scapular rotations derived from the recalculation-based method yielded RMS errors comparable with the frequently used electromagnetic scapular methods (RMS up to 12.6° for 150° arm elevation). The results indicate that the present method can be used under careful considerations for 3D kinematical studies examining different shoulder movements.

Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome.

PubMed

Ha, Sung-min; Kwon, Oh-yun; Yi, Chung-hwi; Cynn, Heon-seock; Weon, Jong-hyuck; Kim, Tae-ho

2016-02-01

The purpose of this study was to investigate the effects of a 6-week scapular upward rotation exercise (SURE) on scapular and clavicular alignment and scapular upward rotators strength in subjects with scapular downward rotation syndrome (SDRS). Seventeen volunteer subjects with SDRS were recruited from university populations. The alignment of the scapula and clavicle was measured using radiographic analysis and compared in subjects before and after a 6-week self-SURE program. A hand-held dynamometer was used to measure the strength of the scapular upward rotators. The subjects were instructed how to perform the self-SURE program at home. The 6-week self-SURE program was divided into two sections (the first section with non-resistive SURE during weeks 1-3, and the second section with resistive SURE using thera-band during weeks 4-6). The significance of the difference between pre- and post-program was assessed using a paired t-test, with the level of statistical significance set at p<0.05. Significant differences between pre- and post-program were found for scapular and clavicular alignment (p<0.05). Additionally, the comparison between pre- and post-program measurements of the strength of the scapular upward rotators showed significant differences (p<0.05). The results of this study showed that a 6-week self-SURE program is effective for improving scapular and clavicular alignment and increasing the strength of scapular upward rotator muscles in subjects with SDRS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial.

PubMed

Surenkok, Ozgur; Aytar, Aydan; Baltaci, Gul

2009-11-01

The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function. Pretest-posttest for 3 groups (SM, sham, and control). A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic. 39 subjects (22 women, 17 men; mean age 54.30 +/- 14.16 y, age range 20-77 y). A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program. Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function. After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05). SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

Biomechanical evaluation of different designs of glenospheres in the SMR reverse total shoulder prosthesis: range of motion and risk of scapular notching.

PubMed

Chou, Justin; Malak, Sharif F; Anderson, Iain A; Astley, Tim; Poon, Peter C

2009-01-01

Reverse total shoulder arthroplasty is a treatment option for cuff tear arthropathy. Scapular notching remains a concern. This biomechanical study compared the range-of-motion in different designs of glenospheres and hence the relative risk of scapular notching. A precision coordinate device was used to investigate four different designs of glenospheres (SMR prosthesis); 36 mm concentric (Standard), 36 mm eccentric, 44 mm concentric, and 44 mm eccentric glenospheres. The centre of rotation in each design was first established. The position of the humeral prosthesis was recorded in the plane of the scapula to compare the degree of adduction and the total range-of-motion. Eccentric glenospheres were found to improve range-of-motion by allowing a higher degree of adduction. Larger diameter glenospheres were found to improve range-of-motion by increasing adduction and abduction. Compared to the 36 mm concentric (standard) glenosphere, the 36 mm eccentric glenosphere improved adduction by 14.5 degrees, the 44 mm concentric glenosphere improved adduction by 11.6 degrees, the 44 mm eccentric glenosphere improved adduction by 17.7 degrees. Eccentric glenospheres with a center-of-rotation placed more inferiorly were shown to improve adduction. This design may reduce the clinical incidence of scapular notching.

Study of the trapezius muscle region pressure pain threshold and latency time in young people with and without depressed scapula.

PubMed

Lee, Kuan-Ting; Chuang, Chiung-Cheng; Lai, Chien-Hung; Ye, Jing-Jhao; Wu, Chien-Lung

2015-02-01

The scapula is stabilized in or moved to a certain position to coordinate shoulder function and achieve shoulder and arm movement during the athletic and daily activities. An alteration in the scapular position both at rest and during arm movements is commonly associated with shoulder injury or dysfunction. The purpose of this study was to assess the influence of the depressed scapular position using pressure pain threshold (PPT) and delayed muscle activation of the upper and middle trapezius muscles. The study included 20 subjects who were divided into normal shoulder (n = 12) and depressed shoulder (n = 8) group. PPT was measured in a relaxed position. Muscle activity was recorded using surface electromyography and by calculating each shrug's muscle latency time (MLT). The results revealed that the healthy young subjects with depressed scapular position had significantly lower PPT levels than those with normal scapular position both in the upper and middle trapezius muscle (P < 0.05). MLT of the upper trapezius was significantly delayed in both sides during the shoulder shrugs (P < 0.05). Copyright © 2014 Elsevier Ltd. All rights reserved.

Scapular Notching on Kinematic Simulated Range of Motion After Reverse Shoulder Arthroplasty Is Not the Result of Impingement in Adduction

PubMed Central

Lädermann, Alexandre; Gueorguiev, Boyko; Charbonnier, Caecilia; Stimec, Bojan V.; Fasel, Jean H.D.; Zderic, Ivan; Hagen, Jennifer; Walch, Gilles

2015-01-01

Abstract Impingement after reverse shoulder arthroplasty (RSA) is believed to occur from repetitive contact in adduction between the humeral component and the inferior scapular pillar. The primary purpose of this biomechanical study was to confirm the presence of different types of impingement and to examine which daily-life movements are responsible for them. A secondary aim was to provide recommendations on the type of components that would best minimize notching and loss of range of motion (ROM). The study included 12 fresh frozen shoulder specimens; each had a computed tomography (CT) image of the entire scapula and humerus in order to acquire topological information of the bones before RSA implantation. Cyclic tests were run postimplantation with 3 shoulders in each modalities. To quantify bone loss due to impingement, 3-dimensional anatomical models of the scapula were reconstructed from the CT scans and compared to their intact states. We found 8 bony impingements in 7 specimens: 2 at the lateral acromion, 1 at the inferior acromion, 4 scapular notching, and 1 with the glenoid resulting to wear at the 3:00 to 6:00 clock-face position. Impingements occurred in all kinds of tested motions, except for the internal/external rotation at 90° of abduction. The 3 specimens tested in abduction/adduction presented bone loss on the acromion side only. Scapular notching was noted in flexion/extension and in internal/external rotation at 0° of abduction. The humeral polyethylene liner was worn in 2 specimens—1 at the 6:00 to 8:00 clock-face position during internal/external rotation at 0° of abduction and 1 at the 4:00 clock-face position during flexion/extension. The present study revealed that 2 types of impingement interactions coexist and correspond to a frank abutment or lead to a scapular notching (friction-type impingement). Scapular notching seems to be caused by more movements or combination of movements than previously considered, and in particular by movements of flexion/extension and internal/external rotation with the arm at the side. Polyethylene cups with a notch between 3 and 9 o’clock and lower neck-shaft angle (145° or 135°) may play an important role in postoperative ROM limiting scapular notching. PMID:26402829

Relationship between scapular muscle and core endurance in healthy subjects.

PubMed

Hazar Kanik, Zeynep; Pala, Omer Osman; Gunaydin, Gurkan; Sozlu, Ugur; Alkan, Zeynep Beyza; Basar, Selda; Citaker, Seyit

2017-01-01

Scapular muscle endurance and core endurance reportedly influence shoulder injury risk. The exact relationship between scapular muscle endurance and core endurance, and how they impact one another in the healthy subjects remain unclear. To investigate the relationship between scapular muscle endurance and core endurance in healthy subjects. Fifty healthy volunteers (23 males, 27 females; mean age 20.42 ± 1.04 years) were participated in this study. Endurance of the serratus anterior and trapezius muscles was assessed using the scapular muscle endurance test. Sorensen test (endurance of trunk extensor muscles), trunk flexor endurance test, and side bridge test (endurance of lateral core muscles) were conducted to assess the core endurance. Pearson's product moment correlations examined relationships between scapular muscle endurance and each of the core endurance tests scores. Scapular muscle endurance test scores showed a positive correlation with the side bridge test scores (r = 0.414; p = 0.003). No significant correlation was found between scapular muscle endurance test scores and the other core endurance tests scores (p > 0.05). There appears to be a link between the scapular muscle endurance and lateral core muscles in healthy subjects; however, more research is needed to provide a definitive answer on the nature of this relationship. Further studies involving patients with shoulder pathology are warranted.

Acromiohumeral Distance and 3-Dimensional Scapular Position Change After Overhead Muscle Fatigue

PubMed Central

Maenhout, Annelies; Dhooge, Famke; Van Herzeele, Maarten; Palmans, Tanneke; Cools, Ann

2015-01-01

Context: Muscle fatigue due to repetitive and prolonged overhead sports activity is considered an important factor contributing to impingement-related rotator cuff pathologic conditions in overhead athletes. The evidence on scapular and glenohumeral kinematic changes after fatigue is contradicting and prohibits conclusions about how shoulder muscle fatigue affects acromiohumeral distance. Objective: To investigate the effect of a fatigue protocol resembling overhead sports activity on acromiohumeral distance and 3-dimensional scapular position in overhead athletes. Design: Cross-sectional study. Setting: Institutional laboratory. Patients or Other Participants: A total of 29 healthy recreational overhead athletes (14 men, 15 women; age = 22.23 ± 2.82 years, height = 178.3 ± 7.8 cm, mass = 71.6 ± 9.5 kg). Intervention(s) The athletes were tested before and after a shoulder muscle-fatiguing protocol. Main Outcome Measure(s) Acromiohumeral distance was measured using ultrasound, and scapular position was determined with an electromagnetic motion-tracking system. Both measurements were performed at 3 elevation positions (0°, 45°, and 60° of abduction). We used a 3-factor mixed model for data analysis. Results: After fatigue, the acromiohumeral distance increased when the upper extremity was actively positioned at 45° (Δ = 0.78 ± 0.24 mm, P = .002) or 60° (Δ = 0.58 ± 0.23 mm, P = .02) of abduction. Scapular position changed after fatigue to a more externally rotated position at 45° (Δ = 4.97° ± 1.13°, P < .001) and 60° (Δ = 4.61° ± 1.90°, P = .001) of abduction, a more upwardly rotated position at 45° (Δ = 6.10° ± 1.30°, P < .001) and 60° (Δ = 7.20° ± 1.65°, P < .001) of abduction, and a more posteriorly tilted position at 0°, 45°, and 60° of abduction (Δ = 1.98° ± 0.41°, P < .001). Conclusions: After a fatiguing protocol, we found changes in acromiohumeral distance and scapular position that corresponded with an impingement-sparing situation. PMID:25594913

Biomechanical Analysis of the Closed Kinetic Chain Upper-Extremity Stability Test.

PubMed

Tucci, Helga T; Felicio, Lilian R; McQuade, Kevin J; Bevilaqua-Grossi, Debora; Camarini, Paula Maria Ferreira; Oliveira, Anamaria S

2017-01-01

The closed kinetic chain upper-extremity stability (CKCUES) test is a functional test for the upper extremity performed in the push-up position, where individuals support their body weight on 1 hand placed on the ground and swing the opposite hand until touching the hand on the ground, then switch hands and repeat the process as fast as possible for 15 s. To study scapular kinematic and kinetic measures during the CKCUES test for 3 different distances between hands. Experimental. Laboratory. 30 healthy individuals (15 male, 15 female). Participants performed 3 repetitions of the test at 3 distance conditions: original (36 in), interacromial, and 150% interacromial distance between hands. Participants completed a questionnaire on pain intensity and perceived exertion before and after the procedures. Scapular internal/external rotation, upward/downward rotation, and posterior/anterior tilting kinematics and kinetic data on maximum force and time to maximum force were measured bilaterally in all participants. Percentage of body weight on upper extremities was calculated. Data analyses were based on the total numbers of hand touches performed for each distance condition, and scapular kinematics and kinetic values were averaged over the 3 trials. Scapular kinematics, maximum force, and time to maximum force were compared for the 3 distance conditions within each gender. Significance level was set at α = .05. Scapular internal rotation, posterior tilting, and upward rotation were significantly greater in the dominant side for both genders. Scapular upward rotation was significantly greater in original distance than interacromial distance in swing phase. Time to maximum force in women was significantly greater in the dominant side. CKCUES test kinematic and kinetic measures were not different among 3 conditions based on distance between hands. However, the test might not be suitable for initial or mild-level rehabilitation due to its challenging requirements.

Dual origin and segmental organisation of the avian scapula.

PubMed

Huang, R; Zhi, Q; Patel, K; Wilting, J; Christ, B

2000-09-01

Bones of the postcranial skeleton of higher vertebrates originate from either somitic mesoderm or somatopleural layer of the lateral plate mesoderm. Controversy surrounds the origin of the scapula, a major component of the shoulder girdle, with both somitic and lateral plate origins being proposed. Abnormal scapular development has been described in the naturally occurring undulated series of mouse mutants, which has implicated Pax1 in the formation of this bone. Here we addressed the development of the scapula, firstly, by analysing the relationship between Pax1 expression and chondrogenesis and, secondly, by determining the developmental origin of the scapula using chick quail chimeric analysis. We show the following. (1) The scapula develops in a rostral-to-caudal direction and overt chondrification is preceded by an accumulation of Pax1-expressing cells. (2) The scapular head and neck are of lateral plate mesodermal origin. (3) In contrast, the scapular blade is composed of somitic cells. (4) Unlike the Pax1-positive cells of the vertebral column, which are of sclerotomal origin, the Pax1-positive cells of the scapular blade originate from the dermomyotome. (5) Finally, we show that cells of the scapular blade are organised into spatially restricted domains along its rostrocaudal axis in the same order as the somites from which they originated. Our results imply that the scapular blade is an ossifying muscular insertion rather than an original skeletal element, and that the scapular head and neck are homologous to the 'true coracoid' of higher vertebrates.

Scapular kinematics and shoulder elevation in a traditional push-up.

PubMed

Suprak, David N; Bohannon, Jennifer; Morales, Gabriel; Stroschein, Joseph; San Juan, Jun G

2013-01-01

Proper scapulothoracic motion is critical for the health and function of the shoulder and represents a principal focus in the rehabilitation setting. Variants of the traditional push-up are used frequently to help restore proper scapular kinematics. To date, substantial research has focused on muscle activation levels of rotator cuff and scapular-stabilizing musculature, whereas a dearth of literature exists regarding scapular kinematics during push-up variants. To examine the effect of shoulder position on scapular kinematics across the range of motion (ROM) of a traditional push-up. Cross-sectional study. University laboratory. Sixteen healthy participants without a history of upper extremity or spine injury requiring rehabilitation or surgery. Participants performed a traditional push-up while kinematic measurements were acquired from multiple upper extremity segments. The 3 shoulder position conditions were (1) self-selected position, (2) shoulder adducted upon ascent (at side), and (3) shoulder elevated to approximately 90°. Scapular posterior tilt, upward rotation, and external rotation were examined across elbow-extension ROM and compared across conditions. Posterior tilt was greater in the self-selected and at-side conditions than in the elevated condition and increased linearly with elbow extension. External rotation was greater in the self-selected and at-side conditions compared with that in the elevated condition. In the at-side condition, upward rotation began lower than in the other conditions at the start of the concentric phase but increased above the others soon after the elbow started to extend. Performing a traditional push-up with the shoulders elevated may place the scapula in a position of impingement. Clinicians should be cognizant of shoulder elevation when prescribing and monitoring exercise progression. The results of this study will provide further direction for clinicians in prescribing rehabilitation exercises for the upper extremity, especially closed chain exercises for shoulder conditions.

Rotator cuff muscle function and its relation to scapular morphology in apes.

PubMed

Larson, Susan G; Stern, Jack T

2013-10-01

It is widely held that many differences among primate species in scapular morphology can be functionally related to differing demands on the shoulder associated with particular locomotor habits. This perspective is largely based on broad scale studies, while more narrow comparisons of scapular form often fail to follow predictions based on inferred differences in shoulder function. For example, the ratio of supraspinous fossa/infraspinous fossa size in apes is commonly viewed as an indicator of the importance of overhead use of the forelimb, yet paradoxically, the African apes, the most terrestrial of the great apes, have higher scapular fossa ratios than the more suspensory orangutan. The recent discovery of several nearly complete early hominin scapular specimens, and their apparent morphological affinities to scapulae of orangutans and gorillas rather than chimpanzees, has led to renewed interest in the comparative analysis of human and extant ape scapular form. To facilitate the functional interpretation of differences in ape scapulae, particularly in regard to relative scapular fossa size, we used electromyography (EMG) to document the activity patterns in all four rotator cuff muscles in orangutans and gibbons, comparing the results with previously published data for chimpanzees. The EMG results indicate that the distinctive contributions of each cuff muscle to locomotion are the same in the three ape species, failing to support inferences of differences in rotator cuff function based on relative scapular fossa size comparisons. It is also shown that relative scapular fossa size is not in fact a good predictor of either the relative masses or cross-sectional areas of the rotator cuff muscles in apes, and relative fossa size gives a false impression of the importance of individual cuff muscles to locomotor differences among apes. A possible explanation for the disparity between fossa and muscle size relates to the underappreciated role of the scapular spine in structural reinforcement of the blade. Copyright © 2013 Elsevier Ltd. All rights reserved.

STRENGTH PROFILES IN HEALTHY INDIVIDUALS WITH AND WITHOUT SCAPULAR DYSKINESIS

PubMed Central

Scibek, Jason S.; Carcia, Christopher R.

2017-01-01

Background Muscular weakness of the shoulder complex is commonly found in patients presenting with scapular dyskinesis; however, little is known regarding muscular performance in healthy individuals with scapular dyskinesis. Purpose To compare isometric strength measures of the shoulder complex between healthy individuals with and without scapular dyskinesis. It was hypothesized that healthy individuals with scapular dyskinesis would demonstrate decreased isometric strength of the scapular stabilizers and rotator cuff when compared to healthy individuals without scapular dyskinesis. Study Design Cross-sectional study. Methods Forty healthy, college-aged participants were recruited. Sixty-eight percent of subjects (27 of 40) presented with scapular dyskinesis. Thus, a matched-pairs analysis was conducted with 26 subjects (age: 22.00 ± 2.06 y; height: 168.77 ± 8.07 cm; mass: 70.98 ± 13.14 kg; BMI: 24.75 ± 3.04 kg/m2; 6 males; 20 females). The presence of scapular dyskinesis was determined visually using the scapular dyskinesis test with a dichotomous outcome (yes/no). Strength of the scapular stabilizers and rotator cuff was assessed via manual muscle testing using a handheld dynamometer. Force measures obtained with the handheld dynamometer were used to quantify strength. For each muscle tested, the mean peak force of three trials were normalized to body weight and used for data analysis. Additionally, strength ratios were calculated and analyzed. Differences in strength and strength ratios between those with and without scapular dyskinesis were compared using separate two-way mixed ANOVAs with repeated measures. Results No significant differences for either strength (F1.83,43.92 = 1.10, p = .34) or strength ratios (F1.83,44.02 = 1.93, p = .16) were observed between those with and without scapular dyskinesis. A significant main effect (F1.83,43.92 = 239.32, p < .01) for muscles tested was observed, and post-hoc analysis revealed significant trends resulting in a generalized order: the upper trapezius generated the greatest amount of force, followed by serratus anterior and middle trapezius, lower trapezius, supraspinatus, medial rotators, and lateral rotators. Conclusion The results of this study indicate that differences in shoulder muscle strength do not exist between healthy subjects with and without scapular dyskinesis. Additionally, scapular dyskinesis appears to be prevalent in healthy populations. Level of Evidence Level 3 PMID:28593084

Muscle thickness measurements of the lower trapezius with rehabilitative ultrasound imaging are confounded by scapular dyskinesis.

PubMed

Seitz, Amee L; Baxter, Caralyn J; Benya, Kristen

2015-08-01

Alterations in scapular muscle activity have been theorized to contribute to abnormal scapular motion and shoulder pain, but pose challenges to quantify in the clinic. Rehabilitative Ultrasound Imaging (RUSI) has proved useful identifying dysfunction of lumbar regional stabilizing muscle activity, specifically contractile behavior. Although, recent examinations of scapular stabilizing trapezius muscle function using RUSI did not detect alterations individuals with shoulder pain or differences in muscle thickness between varying external loads in asymptomatic individuals, a potential confounder to prior results, scapular dyskinesis has not been controlled. It is unknown if dyskinesis alters scapular muscle thickness during activation measured with RUSI. Thus, the purpose of this study was to compare change in scapular muscle thickness between individuals with and without scapular dyskinesis. Thirty-nine asymptomatic adults with (n = 19) and without (n = 20) scapular dyskinesis, defined with a reliable and validated method, participated. Two separate ultrasound images of the serratus anterior (SA) and lower trapezius (LT) were captured under two randomized conditions, rest and isometric contraction against gravity, and saved for blinded measurement. Change in thickness with contraction was calculated and expressed as a percentage. The dyskinesis group demonstrated a greater increase (p = 0.005) in LT thickness with the isometric contraction than the group without (mean difference = 31.6%; 95%CI = 10.3, 53.0). No differences in SA or resting thickness of either muscle were found between groups. The presence of scapular dyskinesis alters thickness changes of the lower trapezius during activation. Furthermore, potential underlying reasons beyond muscle contractile behavior must be considered. Copyright © 2015 Elsevier Ltd. All rights reserved.

Electromyographic Activity of Scapular Muscle Control in Free-Motion Exercise

PubMed Central

Nakamura, Yukiko; Tsuruike, Masaaki; Ellenbecker, Todd S.

2016-01-01

Context:  The appropriate resistance intensity to prescribe for shoulder rehabilitative exercise is not completely known. Excessive activation of the deltoid and upper trapezius muscles could be counterproductive for scapulohumeral rhythm during humeral elevation. Objective:  To identify the effects of different exercise intensities on the scapular muscles during a free-motion “robbery” exercise performed in different degrees of shoulder abduction in seated and standing positions. Design:  Descriptive laboratory study. Setting:  Kinesiology Adapted Physical Education Laboratory. Patients or Other Participants:  A total of 15 healthy male college students (age = 20.5 ± 2.2 years, height = 174.5 ± 5.3 cm, mass = 63.8 ± 6.0 kg). Intervention(s):  Participants performed 5 repetitions of a randomized exercise sequence of the robbery exercise in 2 body positions (seated, standing), 2 shoulder-abducted positions (W [20°], 90/90 [90°]) at 3 intensities (0%, 3%, and 7% body weight). Main Outcome Measure(s):  Electromyographic (EMG) activity of the upper trapezius, lower trapezius, serratus anterior, anterior deltoid, and infraspinatus muscles of the upper extremity was collected. All EMG activities were normalized by the maximal voluntary isometric contraction of each corresponding muscle (%). Results:  The serratus anterior, anterior deltoid, and infraspinatus EMG activities were greater at 7% body weight in the seated position compared with the standing position (P < .05). The EMG activities in all 5 muscles were greater in the 90/90 position than in the W position (P < .05). Conclusions:  Scapular muscle activity modulated relative to changes in body posture and resistance intensity. These findings will enable clinicians to prescribe the appropriate level of exercise intensity and positioning during shoulder rehabilitation. PMID:26986055

Scapular kinematic and shoulder muscle activity alterations after serratus anterior muscle fatigue.

PubMed

Umehara, Jun; Kusano, Ken; Nakamura, Masatoshi; Morishita, Katsuyuki; Nishishita, Satoru; Tanaka, Hiroki; Shimizu, Itsuroh; Ichihashi, Noriaki

2018-02-23

Although the serratus anterior muscle has an important role in scapular movement, no study to date has investigated the effect of serratus anterior fatigue on scapular kinematics and shoulder muscle activity. The purpose of this study was to clarify the effect of serratus anterior fatigue on scapular movement and shoulder muscle activity. The study participants were 16 healthy men. Electrical muscle stimulation was used to fatigue the serratus anterior muscle. Shoulder muscle strength and endurance, scapular movement, and muscle activity were measured before and after the fatigue task. The muscle activity of the serratus anterior, upper and lower trapezius, anterior and middle deltoid, and infraspinatus muscles was recorded, and the median power frequency of these muscles was calculated to examine the degree of muscle fatigue. The muscle endurance and median power frequency of the serratus anterior muscle decreased after the fatigue tasks, whereas the muscle activities of the serratus anterior, upper trapezius, and infraspinatus muscles increased. External rotation of the scapula at the shoulder elevated position increased after the fatigue task. Selective serratus anterior fatigue due to electric muscle stimulation decreased the serratus anterior endurance at the flexed shoulder position. Furthermore, the muscle activities of the serratus anterior, upper trapezius, and infraspinatus increased and the scapular external rotation was greater after serratus anterior fatigue. These results suggest that the rotator cuff and scapular muscle compensated to avoid the increase in internal rotation of the scapula caused by the dysfunction of the serratus anterior muscle. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effects of short malunion of the clavicle on in vivo scapular kinematics.

PubMed

Kim, DooSup; Lee, DongWoo; Jang, YoungHwan; Yeom, JunSeop; Banks, Scott A

2017-09-01

Short malunion of the clavicle after fracture can change scapular kinematics and alter clinical outcome. However, the effects of malunion on kinematics and outcomes remains poorly understood because there have been no in vivo studies measuring changes during active motion with malunion. This study aimed to measure and to compare in vivo 3-dimensional (3D) scapular kinematics between normal shoulders and shoulders with short malunion using 3D-2-dimensional model image registration techniques. Fifteen patients with clavicle fracture who had been treated conservatively were enrolled in this study. In these patients, the angle of scapular upward rotation, posterior tilting, and external rotation were compared between shoulders with short malunion and contralateral, normal shoulders. A 3D-2-dimensional model image registration technique was used to determine the 3D orientation of the scapula. Scapular upward rotation increased following increase of the arm elevation angle and also showed a significant difference by arm elevation in both groups (P = .04). Posterior tilting of the scapula gradually increased as the arm abduction angle increased, and this varied significantly between groups (P = .01). Shoulders with short malunion also showed a more internally rotated position than the contralateral, normal shoulders between 100° and the maximum abduction angle (P = .04). Our results suggest that clavicle shortening of >10% greatly affects scapular kinematics in vivo. Further studies will be needed to determine the clinical implications of short malunion of the clavicle. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Distal radius fractures result in alterations in scapular kinematics: a three-dimensional motion analysis.

PubMed

Ayhan, Cigdem; Turgut, Elif; Baltaci, Gul

2015-03-01

Scapular motion is closely integrated with arm motion. Injury to a distal segment requires compensatory changes in the proximal segments leading to alterations in scapular motion. Since the effects of distal injuries on scapular kinematics remain unknown, in the present study we investigated the influences on scapular motion in patients with distal injuries. Sixteen subjects with a history of distal radius fracture and 20 asymptomatic healthy subjects (controls) participated in the study. Three-dimensional scapular and humeral kinematic data were collected on all 3 planes of shoulder elevation: frontal, sagittal, and scapular. All testing was performed in a single session; therefore, the sensors remained attached to the participants for all testing. The position and orientation data of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation and 120°, 90°, 60°, and 30° lowering were used for statistical comparisons. Independent samples t-test was used to compare the scapular internal/external rotation, upward/downward rotation, and anterior/posterior tilt between the affected side of subjects with a distal radius fracture and the dominant side of asymptomatic subjects at the same stage of humerothoracic elevation. Scapular internal rotation was significantly increased at 30° elevation (P=0.01), 90° elevation (P=0.03), and 30° lowering (P=0.03), and upward rotation was increased at 30° and 60° elevation (P<0.001) on the affected side during frontal plane elevation. Scapular upward rotation and anterior tilt were significantly increased during 30° lowering on both the scapular (P=0.002 and 0.02, respectively) and sagittal planes (P=0.01 and 0.02. respectively). Patients with distal radius fractures exhibit altered scapular kinematics, which may further contribute to the development of secondary musculoskeletal pathologies. Copyright © 2014 Elsevier Ltd. All rights reserved.

Electromyographic activity of selected scapular stabilizers during glenohumeral internal and external rotation contractions.

PubMed

Schachter, Aaron K; McHugh, Malachy P; Tyler, Timothy F; Kreminic, Ian J; Orishimo, Karl F; Johnson, Christopher; Ben-Avi, Simon; Nicholas, Stephen J

2010-09-01

An important synergistic relationship exists between the scapular stabilizers and the glenohumeral rotators. Information on the relative contribution of the scapular stabilizers to glenohumeral rotation would be useful for exercise prescription for overhead athletes and for patients with shoulder pathology. We hypothesized that the scapular stabilizers would be highly active during both maximal and submaximal internal and external rotation. Eight healthy male volunteers (16 shoulders) performed internal and external glenohumeral rotation testing at maximal and submaximal intensities. They also performed a scapular retraction rowing exercise at maximal and submaximal levels. Electromyographic (EMG) signals were recorded from the infraspinatus, pectoralis major, serratus anterior, and middle trapezius. Values were compared among muscle groups, among individual muscles at different intensity levels, and among individual muscles at different points in the arc of motion. For submaximal glenohumeral internal rotation, activity in the scapular stabilizers was not different (P = .1-.83) from activity in the internal rotator throughout the range of motion. For the initial two-thirds of maximal internal rotation, middle trapezius activity and pectoralis major activity were higher (P < .05) than serratus anterior activity. For submaximal external rotation, activity in the scapular stabilizers during the middle phase of the motion was higher (P < .05) than activity in the external rotators. For maximal external rotation these differences were present throughout the motion with middle trapezius activity exceeding 100% maximal voluntary contraction. The scapular stabilizers functioned at a similar or higher intensity than the glenohumeral rotators during internal and external rotation. This highlights the importance of training the scapular stabilizers in upper extremity athletes and in patients with shoulder pathology. (c) 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

The effect of trunk rotation during shoulder exercises on the activity of the scapular muscle and scapular kinematics.

PubMed

Yamauchi, Taishi; Hasegawa, Satoshi; Matsumura, Aoi; Nakamura, Masatoshi; Ibuki, Satoko; Ichihashi, Noriaki

2015-06-01

In patients with shoulder disease, kinetic chain exercises including hip or trunk movement are recommended. However, the actual muscle activation and scapular kinematics of these exercises are not known. The purpose of this study was to examine the effect of trunk rotation on shoulder exercises that are devised to improve scapular function. Thirteen healthy young men participated in this study. Scaption, external rotation in the first and second positions, and prone scapular retraction at 45°, 90°, and 145° of shoulder abduction were performed with and without trunk rotation. Electromyography was used to assess the scapular muscle activity of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA), and electromagnetic motion capture was used to assess scapular motion. The muscle activity ratio, which is the activity of the UT to the MT, LT, and SA, was calculated. These data were compared between 2 conditions (with and without trunk rotation) for each exercise. Adding trunk rotation to scaption, the first external rotation, and the second external rotation significantly increased scapular external rotation and posterior tilt, and all 3 exercises increased LT activation. In addition, trunk rotation with scapular retraction at 90° and 145° of shoulder abduction significantly decreased the UT/LT ratio. Our findings suggest that shoulder exercises with trunk rotation in this study may be effective in patients who have difficulty in enhancing LT activity and suppressing excessive activation of the UT or in cases in which a decreased scapular external rotation or posterior tilt is observed. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Standing on the shoulders of apes: Analyzing the form and function of the hominoid scapula using geometric morphometrics and finite element analysis.

PubMed

Püschel, Thomas A; Sellers, William I

2016-02-01

The aim was to analyze the relationship between scapular form and function in hominoids by using geometric morphometrics (GM) and finite element analysis (FEA). FEA was used to analyze the biomechanical performance of different hominoid scapulae by simulating static postural scenarios. GM was used to quantify scapular shape differences and the relationship between form and function was analyzed by applying both multivariate-multiple regressions and phylogenetic generalized least-squares regressions (PGLS). Although it has been suggested that primate scapular morphology is mainly a product of function rather than phylogeny, our results showed that shape has a significant phylogenetic signal. There was a significant relationship between scapular shape and its biomechanical performance; hence at least part of the scapular shape variation is due to non-phylogenetic factors, probably related to functional demands. This study has shown that a combined approach using GM and FEA was able to cast some light regarding the functional and phylogenetic contributions in hominoid scapular morphology, thus contributing to a better insight of the association between scapular form and function. © 2015 Wiley Periodicals, Inc.

Effect of a 6-week strengthening program on shoulder and scapular-stabilizer strength and scapular kinematics in division I collegiate swimmers.

PubMed

Hibberd, Elizabeth E; Oyama, Saki; Spang, Jeffrey T; Prentice, William; Myers, Joseph B

2012-08-01

Shoulder injuries are common in swimmers because of the demands of the sport. Muscle imbalances frequently exist due to the biomechanics of the sport, which predispose swimmers to injury. To date, an effective shoulder-injury-prevention program for competitive swimmers has not been established. To assess the effectiveness of a 6-wk strengthening and stretching intervention program on improving glenohumeral and scapular muscle strength and scapular kinematics in collegiate swimmers. Randomized control trial. University biomechanics research laboratory. Forty-four Division I collegiate swimmers. The intervention program was completed 3 times per week for 6 wk. The program included strengthening exercises completed using resistance tubing-scapular retraction (Ts), scapular retraction with upward rotation (Ys), scapular retraction with downward rotation (Ws), shoulder flexion, low rows, throwing acceleration and deceleration, scapular punches, shoulder internal rotation at 90° abduction, and external rotation at 90° abduction-and 2 stretching exercises: corner stretch and sleeper stretch. Scapular kinematics and glenohumeral and scapular muscle strength assessed preintervention and postintervention. There were no significant between-groups differences in strength variables at pre/post tests, although shoulder-extension and internal-rotation strength significantly increased in all subjects regardless of group assignment. Scapular kinematic data revealed increased scapular internal rotation, protraction, and elevation in all subjects at posttesting but no significant effect of group on the individual kinematic variables. The current strengthening and stretching program was not effective in altering strength and scapular kinematic variables but may serve as a framework for future programs. Adding more stretching exercises, eliminating exercises that overlap with weight-room training and swim training, and timing of implementation may yield a more beneficial program for collegiate swimmers.

Comparing non-invasive scapular tracking methods across elevation angles, planes of elevation and humeral axial rotations.

PubMed

Grewal, T-J; Cudlip, A C; Dickerson, C R

2017-12-01

Altered scapular motions premeditate shoulder impingement and other musculoskeletal disorders. Divergent experimental conditions in previous research precludes rigorous comparisons of non-invasive scapular tracking techniques. This study evaluated scapular orientation measurement methods across an expanded range of humeral postures. Scapular medial/lateral rotation, anterior/posterior tilt and protraction/retraction was measured using an acromion marker cluster (AMC), a scapular locator, and a reference stylus. Motion was captured using reflective markers on the upper body, as well as on the AMC, locator and stylus. A combination of 5 arm elevation angles, 3 arm elevation planes and 3 arm axial rotations was examined. Measurement method interacted with elevation angle and plane of elevation for all three scapular orientation directions (p < 0.01). Method of measurement interacted with axial rotation in anterior/posterior tilt and protraction/retraction (p < 0.01). The AMC had strong agreement with the reference stylus than the locator for the majority of humeral elevations, planes and axial rotations. The AMC underestimated lateral rotation, with the largest difference of ∼2° at 0° elevation. Both the locator and AMC overestimated posterior tilt at high arm elevation by up to 7.4°. Misestimations from using the locator could be enough to potentially obscure meaningful differences in scapular rotations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Optimal baseplate rotational alignment for locking-screw fixation in reverse total shoulder arthroplasty: a three-dimensional computer-aided design study.

PubMed

Stephens, Byron F; Hebert, Casey T; Azar, Frederick M; Mihalko, William M; Throckmorton, Thomas W

2015-09-01

Baseplate loosening in reverse total shoulder arthroplasty (RTSA) remains a concern. Placing peripheral screws into the 3 pillars of the densest scapular bone is believed to optimize baseplate fixation. Using a 3-dimensional computer-aided design (3D CAD) program, we investigated the optimal rotational baseplate alignment to maximize peripheral locking-screw purchase. Seventy-three arthritic scapulae were reconstructed from computed tomography images and imported into a 3D CAD software program along with representations of an RTSA baseplate that uses 4 fixed-angle peripheral locking screws. The baseplate position was standardized, and the baseplate was rotated to maximize individual and combined peripheral locking-screw purchase in each of the 3 scapular pillars. The mean ± standard error of the mean positions for optimal individual peripheral locking-screw placement (referenced in internal rotation) were 6° ± 2° for the coracoid pillar, 198° ± 2° for the inferior pillar, and 295° ± 3° for the scapular spine pillar. Of note, 78% (57 of 73) of the screws attempting to obtain purchase in the scapular spine pillar could not be placed without an in-out-in configuration. In contrast, 100% of coracoid and 99% of inferior pillar screws achieved full purchase. The position of combined maximal fixation was 11° ± 1°. These results suggest that approximately 11° of internal rotation is the ideal baseplate position for maximal peripheral locking-screw fixation in RTSA. In addition, these results highlight the difficulty in obtaining optimal purchase in the scapular spine. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The relationship between latissimus dorsi stiffness and altered scapular kinematics among asymptomatic collegiate swimmers.

PubMed

Laudner, Kevin G; Williams, Jeffrey G

2013-02-01

To determine the strength of the relationship between latissimus dorsi stiffness and altered scapular kinematics among swimmers. Cross sectional. Laboratory. Nineteen NCAA Division III swimmers (7 male, 12 female) (age = 18.8 ± 0.9 years, height = 174.7 ± 8.9 cm, mass = 71.6 ± 11.9 kg) volunteered to participate. Subjects had no recent history of upper extremity pathology or any previous surgery. We measured latissimus dorsi stiffness of the dominant arm while in a lengthened position with a myotonometer. We used an electromagnetic tracking device with specialized software to measure scapular kinematics at humeral elevation angles of 30°, 60°, 90°, and 110° within the scapular plane. Latissimus dorsi stiffness and scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt. Latissimus dorsi stiffness showed moderate-to-good relationships with increased scapular upward rotation (r > -0.63, P < 0.002) and posterior tilt (r > -0.62, P < 0.004) at all four angles of humeral elevation. Increased latissimus dorsi stiffness also showed moderate-to-good relationships with decreased scapular internal rotation at humeral elevation angles of 60° (r = 0.47, P = 0.03) and 90° (r = 0.54, P = 0.01). Our results suggest there are several moderate-to-good relationships between increased latissimus dorsi stiffness in swimmers and altered scapular upward rotation, internal rotation, and posterior tilt at various angles of humeral elevation. If latissimus dorsi stiffness is not addressed subsequent scapular alterations, which have been associated with shoulder dysfunction, may occur. Published by Elsevier Ltd.

3D scapular orientation on healthy and pathologic subjects using stereoradiographs during arm elevation.

PubMed

Ohl, Xavier; Hagemeister, Nicola; Zhang, Cheng; Billuart, Fabien; Gagey, Olivier; Bureau, Nathalie J; Skalli, Wafa

2015-11-01

Alterations of the scapular kinematics in different pathologic conditions have been widely studied. However, results have shown considerable discrepancies concerning the direction and the amplitude of scapular movement. The lack of consistency in the literature probably has several explanations. The purpose of this study was to analyze scapular orientation with the arm at rest and with 90° lateral elevation in healthy and pathologic subjects by use of stereoradiographs. All participants (n = 65) underwent a clinical examination and magnetic resonance imaging of the shoulder to assess rotator cuff status. Participants were separated into 3 groups: healthy, rotator cuff tear (RCT), and RCT and subacromial impingement syndrome (RCT+ SIS). A 3-dimensional model of the scapula was fitted to each low-dose stereoradiograph acquired with the arm at rest and 90° arm elevation. Orientation of the scapula with the arm at rest was not significantly different between groups. During lateral elevation, scapular orientation was not significantly different between the healthy group and the RCT group. However, upward rotation was significantly reduced in the RCT + SIS group. Alterations of scapular kinematics in symptomatic subjects are multifactorial. We observed a link between clinically assessed subacromial impingement and scapular orientation during lateral elevation of the arm. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial

PubMed Central

Balcı, Nilay Comuk; Yuruk, Zeliha Ozlem; Zeybek, Aslican; Gulsen, Mustafa; Tekindal, Mustafa Agah

2016-01-01

[Purpose] The aim of our study was to compare the initial effects of scapular proprioceptive neuromuscular facilitation techniques and classic exercise interventions with physiotherapy modalities on pain, scapular dyskinesis, range of motion, and function in adhesive capsulitis. [Subjects and Methods] Fifty-three subjects were allocated to 3 groups: scapular proprioceptive neuromuscular facilitation exercies and physiotherapy modalities, classic exercise and physiotherapy modalities, and only physiotherapy modalities. The intervention was applied in a single session. The Visual Analog Scale, Lateral Scapular Slide Test, range of motion and Simple Shoulder Test were evaluated before and just after the one-hour intervention in the same session (all in one session). [Results] All of the groups showed significant differences in shoulder flexion and abduction range of motion and Simple Shoulder Test scores. There were statistically significant differences in Visual Analog Scale scores in the proprioceptive neuromuscular facilitation and control groups, and no treatment method had significant effect on the Lateral Scapular Slide Test results. There were no statistically significant differences between the groups before and after the intervention. [Conclusion] Proprioceptive neuromuscular facilitation, classic exercise, and physiotherapy modalities had immediate effects on adhesive capsulitis in our study. However, there was no additional benefit of exercises in one session over physiotherapy modalities. Also, an effective treatment regimen for shoulder rehabilitation of adhesive capsulitis patients should include scapular exercises. PMID:27190456

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion.

PubMed

Lee, Kwang Won; Kim, Yong In; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

2016-09-01

There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

PubMed Central

Lee, Kwang Won; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

2016-01-01

Background There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Methods Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. Results There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). Conclusions The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. PMID:27583116

Evaluation of the optimal plate position for the fixation of supraglenoid tubercle fractures in warmbloods.

PubMed

Frei, Sina; Geyer, Hans; Hoey, Seamus; Fuerst, Anton E; Bischofberger, Andrea S

2017-03-20

To determine scapular cortex thickness, distal scapular bone density and describe the exact suprascapular nerve course to evaluate the best plate position for the fixation of supraglenoid tubercle fractures in horses. Twelve equine cadaveric shoulders were examined with computed tomography. Computed tomography morphometry and density measurements (Hounsfield units [HU]) of the scapula were recorded. Statistical comparisons were made between the cranial and caudal aspects of the scapula. Dissection of each shoulder was performed and the suprascapular nerve course was described morphometrically and morphologically. The suprascapular nerve was found on the periosteum and embedded in connective tissue at the cranial aspect of the scapula. It ramified proximally and distally into the supraspinatus muscle, coursed caudolaterally at a median of 2 cm (1-2 cm) distal to the scapular spine and ramified proximally and distally into the infraspinatus muscle. The scapular cortex measurements (HU) cranially were significantly larger than caudally at most levels of the scapula. The bone density of the distal scapula cranially (651.3 ± 104.2) was significantly lower than caudally (745.7 ± 179.1). For surgical access to the supraglenoid tubercle, knowledge of the anatomy is important. It is easiest to avoid the suprascapular nerve at the most cranial aspect of the scapula, where it has not yet ramified. For a stable fixation, knowledge of the characteristics of the equine scapula, such as scapular cortex thickness, is important.

Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated?: A case-control study with surface and fine-wire EMG.

PubMed

Castelein, Birgit; Cools, Ann; Parlevliet, Thierry; Cagnie, Barbara

2016-12-01

The function of the scapula is important in normal neck function and might be disturbed in patients with neck pain. The surrounding muscular system is important for the function of the scapula. To date, it is not clear if patients with idiopathic neck pain show altered activity of these scapulothoracic muscles. Therefore, the objective of this study was to investigate differences in deeper and superficial lying scapulothoracic muscle activity between patients with idiopathic neck pain and healthy controls during arm elevation, and to identify the influence of scapular dyskinesis on muscle activity. Scapular dyskinesis was rated with the yes/no method. The deeper lying (Levator Scapulae, Pectoralis Minor (Pm) and Rhomboid major) and superficial lying (Trapezius and Serratus Anterior) scapulothoracic muscles' activity was investigated with fine-wire and surface EMG, respectively, in 19 female subjects with idiopathic neck pain (age 28.3±10.1years, average duration of neck pain 45.6±36.3months) and 19 female healthy control subjects (age 29.3±11.7years) while performing scaption and towel wall slide. Possible interactions or differences between subject groups, scapular dyskinesis groups or phases of the task were studied with a linear mixed model. Higher Pm activity during the towel wallslide (p=0.024, mean difference 8.8±3.3% MVIC) was shown in patients with idiopathic neck pain in comparison with healthy controls. For the MT, a significant group∗dyskinesis interaction effect was found during scaption which revealed that patients with neck pain and scapular dyskinesis showed lower Middle Trapezius (MT) activity in comparison with healthy controls with scapular dyskinesis (p=0.029, mean difference 5.1±2.2% MVIC). In the presence of idiopathic neck pain, higher Pm activity during the towel wallslide was found. Patients with neck pain and scapular dyskinesis showed lower MT activity in comparison with healthy controls with scapular dyskinesis during scaption. Scapular dyskinesis did not have a significant influence on scapulothoracic muscle activity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Scapular dyskinesia: evolution towards a systems-based approach

PubMed Central

Smith, Michael J

2015-01-01

Historically, scapular dyskinesia has been used to describe an isolated clinical entity whereby an abnormality in positioning, movement or function of the scapula is present. Based upon this, treatment approaches have focused on addressing local isolated muscle activity. Recently, however, there has been a progressive move towards viewing the scapula as being part of a wider system of movement that is regulated and controlled by multiple factors, including the wider kinetic chain and individual patient-centred requirements. We therefore propose a paradigm shift whereby scapular dyskinesia is seen not in isolation but is considered within the broader context of patient-centred care and an entire neuromuscular system. PMID:27583003

Orientation and position of head posture, scapula and thoracic spine in mouth-breathing children.

PubMed

Neiva, Patrícia Dayrell; Kirkwood, Renata Noce; Godinho, Ricardo

2009-02-01

Mouth-breathing is a common clinical condition among school-age children and some studies have correlated this condition with quality of life and postural alterations. Therefore, the objective of this study was to investigate the orientation and position of the scapula, thoracic spine and head posture among mouth-breathing (MB) children and nasal-breathing (NB) children. Twenty-one male MB children and 21 male NB children between 8 and 12 years of age participated in the study. Data were obtained through a stereophotogrammetry system that uses passive markers over anatomical landmarks to capture the position of the segments. Internal rotation, upward rotation, anterior tilt, scapular elevation and abduction were measured bilaterally as well as thoracic kyphosis, forward head position and shoulder protrusion. The MB children showed increased scapular superior position in relation to the NB group. No statistically significant differences were found between groups regarding the angular and linear measurements of the scapula. To verify reliability, three measurements were taken for each variable in the study. The intraclass correlation coefficient (ICC) showed results above 0.8 for all the variables except for the internal rotation angle (I-Rot), below 0.5, probably due to uncertainty in the palpation of the inferior angle of the scapula. Ninety-five percent of the NB children and 58% among the MB children had been breastfed, this difference was statistically significant. There were statistically significant differences between groups regarding the domains of the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQEI) scale and body mass index, which was higher among the NB children. MB children increased scapular superior position in comparison to NB children due probably to the position of forward head, leading to an alteration in the positioning of the mandible. The absence of significantly difference in posture pattern between groups in the present study could attributed to height-weight development in this age, as the posture of children changes in order to adapt to new body proportions, regardless of health status. The results observed in this study demonstrate the importance of using reliable measurements in the postural assessment of MB and NB children helping physical therapists to focus their strategies during rehabilitation in more specific conditions.

Effect of scapular stabilization during horizontal adduction stretching on passive internal rotation and posterior shoulder tightness in young women volleyball athletes: a randomized controlled trial.

PubMed

Salamh, Paul A; Kolber, Morey J; Hanney, William J

2015-02-01

To evaluate the effect of scapular stabilization during horizontal adduction stretching (cross-body) on posterior shoulder tightness (PST) and passive internal rotation (IR). Randomized controlled trial with single blinding. Athletic club. Asymptomatic volleyball players who are women with glenohumeral internal rotation deficit (N=60). Subjects were randomly assigned to either horizontal adduction stretching with manual scapular stabilization (n=30) or horizontal adduction stretching without stabilization (n=30). Passive stretching was performed for 3- to 30-second holds in both groups. Range of motion measurements of PST and IR were performed on the athlete's dominant shoulder prior to and immediately after the intervention. Baseline mean angular measurements of PST and IR for all athletes involved in the study were 62°±14° and 40°±10°, respectively, with no significant difference between groups (P=.598 and P=.734, respectively). Mean PST measurements were significantly different between groups after the horizontal adduction stretch, with a mean angle of 83°±17° among the scapular stabilization group and 65°±13° among the nonstabilization group (P<.001). Measurements of IR were also significantly different between groups, with a mean angle of 51°±14° among the scapular stabilization group and 43°±9° among the nonstabilization group (P=.006). Horizontal adduction stretches performed with scapular stabilization produced significantly greater improvements in IR and PST than horizontal adduction stretching without scapular stabilization. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: A systematic review.

PubMed

Lange, Toni; Struyf, Filip; Schmitt, Jochen; Lützner, Jörg; Kopkow, Christian

2017-07-01

Systematic review. The aim of this systematic review was to summarize and evaluate intra- and interrater reliability research of physical examination tests used for the assessment of scapular dyskinesis. Scapular dyskinesis, defined as alteration of normal scapular kinematics, is described as a non-specific response to different shoulder pathologies. A systematic literature search was conducted in MEDLINE, EMBASE, AMED and PEDro until March 20th, 2015. Methodological quality was assessed with the Quality Appraisal of Reliability Studies (QAREL) by two independent reviewers. The search strategy revealed 3259 articles, of which 15 met the inclusion criteria. These studies evaluated the reliability of 41 test and test variations used for the assessment of scapular dyskinesis. This review identified a lack of high-quality studies evaluating intra- as well as interrater reliability of tests used for the assessment of scapular dyskinesis. In addition, reliability measures differed between included studies hindering proper cross-study comparisons. The effect of manual correction of the scapula on shoulder symptoms was evaluated in only one study, which is striking, since symptom alteration tests are used in routine care to guide further treatment. Thus, there is a strong need for further research in this area. Diagnosis, level 3a. Copyright © 2016. Published by Elsevier Ltd.

Secondary Maxillary and Orbital Floor Reconstruction With a Free Scapular Flap Using Cutting and Fixation Guides Created by Computer-Aided Design/Computer-Aided Manufacturing.

PubMed

Morita, Daiki; Numajiri, Toshiaki; Tsujiko, Shoko; Nakamura, Hiroko; Yamochi, Ryo; Sowa, Yoshihiro; Yasuda, Makoto; Hirano, Shigeru

2017-11-01

Computer-aided design/computer-aided manufacturing (CAD/CAM) guides are now widely used in maxillofacial reconstruction. However, there are few reports of CAD/CAM guides being used for scapular flaps. The authors performed the secondary maxillary and orbital floor reconstruction using a free latissimus dorsi muscle, cutaneous tissue, and scapular flap designed using CAD/CAM techniques in a 72-year-old man who had undergone partial maxillectomy four years previously. The patient had diplopia, the vertical dystopia of eye position, and a large oral-nasal-cutaneous fistula. After the operation, the authors confirmed that the deviation between the postoperative and preoperative planning three-dimensional images was less than 2 mm. Because scapular guides require 3 cutting surfaces, the shape of the scapular guide is more complex than that of a conventional fibular guide. In orbital floor reconstruction, the use of a CAM technique such as that used to manufacture the authors' fixation guide is as necessary for accurate, safe, and easy reconstruction as is preoperative CAD planning. The production of a fixation guide as well as a cutting guide is particularly useful because it is difficult to determine the angle for reconstructing the orbital floor by freehand techniques. In this case, the orbital floor was reconstructed based on a mirror image of the healthy side to avoid overcompression of the orbital tissue. Although the patient's vertical dystopia of eye position was improved, diplopia was not improved because, for greater safety, the authors did not plan overcorrection of the orbital volume.

Age-Related, Sport-Specific Adaptions of the Shoulder Girdle in Elite Adolescent Tennis Players

PubMed Central

Cools, Ann M.; Palmans, Tanneke; Johansson, Fredrik R.

2014-01-01

Context: Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. Objective: To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (<14, 14–16, and >16 years). Design: Cross-sectional study. Setting: Tennis training sports facilities. Patients or Other Participants: Fifty-nine adolescent Swedish elite tennis players (ages 10–20 years) selected based on their national ranking. Main Outcome Measure(s): We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Results: Players older than 16 years showed less scapular upward rotation on the dominant side at 90° and 180° (P < .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight–normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Conclusions: Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence. PMID:25098662

Age-related, sport-specific adaptions of the shoulder girdle in elite adolescent tennis players.

PubMed

Cools, Ann M; Palmans, Tanneke; Johansson, Fredrik R

2014-01-01

Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (<14, 14-16, and >16 years). Cross-sectional study. Tennis training sports facilities. Fifty-nine adolescent Swedish elite tennis players (ages 10-20 years) selected based on their national ranking. We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Players older than 16 years showed less scapular upward rotation on the dominant side at 90° and 180° (P < .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight-normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence.

A morphometric study on the cross-sections of the scapular spine in dogs.

PubMed

Ocal, M K; Toros, G

2007-01-01

In cases of unstable scapular body fractures, the base of the scapular spine is one of the sites where there is adequate bone for the application of plate fixation in dogs. In this type of fixation, the amount of bone is an important factor with regard to the holding power of the screw from the biomechanical viewpoint. Therefore, the aim of this paper is to present the detailed quantitative features of the sectional area of the scapular spine in dogs. A total of 28 scapulas from 14 dogs were used, and each was divided into 10 equal slices The height of the scapular spine, depths of the supra-spinous and infraspinus fossae were measured from the scanned images with the aid of a computer program. The results showed that the depth of the supraspinous fossa was greater in the ventral half of the spine, while the depth of the infraspinous was greater in the dorsal half. The differences between the depths of the two fossae were noticeable in the ventral half of the scapular spine.

Comparison of shoulder strength in males with and without myofascial trigger points in the upper trapezius.

PubMed

Kim, H A; Hwang, U J; Jung, S H; Ahn, S H; Kim, J H; Kwon, O Y

2017-11-01

This study was conducted in order to compare the strength of scapular elevator and shoulder abductor with and without restricted scapular elevation between male subjects with and without myofascial trigger points in the upper trapezius. In total, 15 male subjects with myofascial trigger points, and 15age- and weight-matched male subjects without myofascial trigger points in the upper trapezius. Each subject was measured in the strength of maximum isometric scapular elevation and shoulder abduction with and without restricted scapular elevation. Maximum isometric contractions were measured using the Smart KEMA strength measurement system. Independent t-tests were used to compare shoulder strength values between the myofascial trigger points and non- myofascial trigger points groups. The results showed that shoulder abductor strength in the group with myofascial trigger points (5.64kgf) was significantly lower than in the group without myofascial trigger points (11.96kgf) when scapular elevation was restricted (p<0.05). However, there was no significant difference in the strength of the scapular elevator or shoulder abductor between groups (p>0.05). These findings suggest that decreased strength in the shoulder abductor with restricted scapular elevation should be considered in evaluating and treating individuals with myofascial trigger points of the upper trapezius. Copyright © 2017 Elsevier Ltd. All rights reserved.

Morphological and radiological study of ossified superior transverse scapular ligament as potential risk factor of suprascapular nerve entrapment.

PubMed

Polguj, Michał; Sibiński, Marcin; Grzegorzewski, Andrzej; Waszczykowski, Michał; Majos, Agata; Topol, Mirosław

2014-01-01

The suprascapular notch is covered superiorly by the superior transverse scapular ligament. This region is the most common place of suprascapular nerve entrapment formation. The study was performed on 812 specimens: 86 dry scapulae, 104 formalin-fixed cadaveric shoulders, and 622 computer topography scans of scapulae. In the cases with completely ossified superior transverse scapular ligament, the following measurements were performed: proximal and distal width of the bony bridge, middle transverse and vertical diameter of the suprascapular foramen, and area of the suprascapular foramen. An ossified superior transverse scapular ligament was observed more often in men and in the right scapula. The mean age of the subjects with a completely ossified superior transverse scapular ligament was found to be similar than in those without ossification. The ossified band-shaped type of superior transverse scapular ligament was more common than the fan-shaped type and reduced the space below the ligament to a significantly greater degree. The ossified band-shaped type should be taken into consideration as a potential risk factor in the formation of suprascapular nerve entrapment. It could explain the comparable frequency of neuropathy in various populations throughout the world despite the significant differences between them in occurrence of ossified superior transverse scapular ligament.

A SYSTEMATIC REVIEW OF THE EXERCISES THAT PRODUCE OPTIMAL MUSCLE RATIOS OF THE SCAPULAR STABILIZERS IN NORMAL SHOULDERS

PubMed Central

Schory, Abbey; Bidinger, Erik; Wolf, Joshua

2016-01-01

ABSTRACT Purpose The purpose of this systematic review was to determine the exercises that optimize muscle ratios of the periscapular musculature for scapular stability and isolated strengthening. Methods A systematic search was performed in PubMed, CINAHL, SPORTDiscus, Scopus, and Discovery Layer. Studies were included if they examined the muscle activation of the upper trapezius compared to the middle trapezius, lower trapezius, or serratus anterior using EMG during open chain exercises. The participants were required to have healthy, nonpathological shoulders. Information obtained included maximal voluntary isometric contraction (MVIC) values, ratios, standard deviations, exercises, and exercise descriptions. The outcome of interest was determining exercises that create optimal muscle activation ratios between the scapular stabilizers. Results Fifteen observational studies met the inclusion criteria for the systematic review. Exercises with optimal ratios were eccentric exercises in the frontal and sagittal planes, especially flexion between 180 ° and 60 °. External rotation exercises with the elbow flexed to 90 ° also had optimal ratios for activating the middle trapezius in prone and side-lying positions. Exercises with optimal ratios for the lower trapezius were prone flexion, high scapular retraction, and prone external rotation with the shoulder abducted to 90 ° and elbow flexed. Exercises with optimal ratios for the serratus anterior were the diagonal exercises and scapular protraction. Conclusion This review has identified optimal positions and exercises for periscapular stability exercises. Standing exercises tend to activate the upper trapezius at a higher ratio, especially during the 60-120 ° range. The upper trapezius was the least active, while performing exercises in prone, side-lying, and supine positions. More studies need to be conducted to examine these exercises in greater detail and confirm their consistency in producing the optimal ratios determined in this review. Level of evidence 1a PMID:27274418

Scapular muscle performance in individuals with lateral epicondylalgia.

PubMed

Day, Joseph M; Bush, Heather; Nitz, Arthur J; Uhl, Tim L

2015-05-01

Descriptive, laboratory-based, cross-sectional study. To describe scapular musculature strength, endurance, and change in thickness in individuals with unilateral lateral epicondylalgia (LE) compared to the uninvolved limb and the corresponding limb of a matched comparison group. Reported poor long-term outcomes for the nonsurgical management of individuals with LE suggest a less-than-optimal rehabilitation process. Knowledge of scapular muscle function in a working population of individuals with LE may help to further refine conservative management of this condition. Twenty-eight patients with symptomatic LE and 28 controls matched by age and sex were recruited to participate in the study. Strength of the middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) was measured with a handheld dynamometer. A scapular isometric muscle endurance task was performed in prone. Changes in muscle thickness of the SA and LT were measured with ultrasound imaging. Analysis-of-variance models were used to determine within- and between-group differences. The involved side of the group with LE had significantly lower values for MT strength (P = .031), SA strength (P<.001), LT strength (P = .006), endurance (P = .003), and change in SA thickness (P = .028) when compared to the corresponding limb of the control group. The involved side of the group with LE had significantly lower strength of the LT (P = .023) and SA (P = .016) when compared to the uninvolved limb; however, these differences were small and of potentially limited clinical significance. When compared to a matched comparison group, there were impairments of scapular musculature strength and endurance in patients with LE, suggesting that the scapular musculature should be assessed and potentially treated in this population. Cause and effect cannot be established, as the weakness of the scapular musculature could be a result of LE.

Effects of scapular taping on the activity onset of scapular muscles and the scapular kinematics in volleyball players with rotator cuff tendinopathy.

PubMed

Leong, Hio Teng; Ng, Gabriel Yin-Fat; Fu, Siu Ngor

2017-06-01

To examine the effect of scapular taping on the activity onset of scapular muscles and the scapular kinematics during arm elevation in volleyball players with rotator cuff (RC) tendinopathy. Randomized placebo-controlled repeated measures METHODS: Twenty-six male volleyball players with RC tendinopathy (mean age=23.6±3.3years) participated in the study. Electromyography (EMG) activity onset of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) and the three-dimensional scapular kinematics quantified by using an acromial marker cluster method were compared with three scapular taping protocols, namely, no taping, therapeutic taping, and placebo taping. The MT, LT and SA activated significantly earlier in both therapeutic taping (all p<0.005) and placebo taping conditions than no taping conditions (all p<0.002). There was a small increase in the scapular upward rotation when therapeutic taping and no taping conditions were compared (p=0.007). Scapular taping may enhance the neuromotor control of the scapular muscles. Whether it provides adequate support for normal scapular kinematics during arm movement in athletes with RC tendinopathy await for further studies. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

A bi-articular model for scapular-humeral rhythm reconstruction through data from wearable sensors.

PubMed

Lorussi, Federico; Carbonaro, Nicola; De Rossi, Danilo; Tognetti, Alessandro

2016-04-23

Patient-specific performance assessment of arm movements in daily life activities is fundamental for neurological rehabilitation therapy. In most applications, the shoulder movement is simplified through a socket-ball joint, neglecting the movement of the scapular-thoracic complex. This may lead to significant errors. We propose an innovative bi-articular model of the human shoulder for estimating the position of the hand in relation to the sternum. The model takes into account both the scapular-toracic and gleno-humeral movements and their ratio governed by the scapular-humeral rhythm, fusing the information of inertial and textile-based strain sensors. To feed the reconstruction algorithm based on the bi-articular model, an ad-hoc sensing shirt was developed. The shirt was equipped with two inertial measurement units (IMUs) and an integrated textile strain sensor. We built the bi-articular model starting from the data obtained in two planar movements (arm abduction and flexion in the sagittal plane) and analysing the error between the reference data - measured through an optical reference system - and the socket-ball approximation of the shoulder. The 3D model was developed by extending the behaviour of the kinematic chain revealed in the planar trajectories through a parameter identification that takes into account the body structure of the subject. The bi-articular model was evaluated in five subjects in comparison with the optical reference system. The errors were computed in terms of distance between the reference position of the trochlea (end-effector) and the correspondent model estimation. The introduced method remarkably improved the estimation of the position of the trochlea (and consequently the estimation of the hand position during reaching activities) reducing position errors from 11.5 cm to 1.8 cm. Thanks to the developed bi-articular model, we demonstrated a reliable estimation of the upper arm kinematics with a minimal sensing system suitable for daily life monitoring of recovery.

In vivo kinematic analysis of the glenohumeral joint during dynamic full axial rotation and scapular plane full abduction in healthy shoulders.

PubMed

Kozono, Naoya; Okada, Takamitsu; Takeuchi, Naohide; Hamai, Satoshi; Higaki, Hidehiko; Ikebe, Satoru; Shimoto, Takeshi; Miake, Go; Nakanishi, Yoshitaka; Iwamoto, Yukihide

2017-07-01

The purpose of this study was to evaluate the kinematics of healthy shoulders during dynamic full axial rotation and scapular plane full abduction using three-dimensional (3D)-to-two-dimensional (2D) model-to-image registration techniques. Dynamic glenohumeral kinematics during axial rotation and scapular plane abduction were analysed in 10 healthy participants. Continuous radiographic images of axial rotation and scapular plane abduction were taken using a flat panel radiographic detector. The participants received a computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial radiographic images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the humerus and scapula during dynamic full axial rotation and scapular plane full abduction. The humeral head centre translated an average of 2.5 ± 3.1 mm posteriorly, and 1.4 ± 1.0 mm superiorly in the early phase, then an average of 2.0 ± 0.8 mm inferiorly in the late phase during external rotation motion. The glenohumeral external rotation angle had a significant effect on the anterior/posterior (A/P) and superior/inferior (S/I) translation of the humeral head centre (both p < 0.05). 33.6 ± 15.6° of glenohumeral external rotation occurred during scapular plane abduction. The humeral head centre translated an average of 0.6 ± 0.9 mm superiorly in the early phase, then 1.7 ± 2.6 mm inferiorly in the late phase, and translated an average of 0.4 ± 0.5 mm medially in the early phase, then 1.6 ± 1.0 mm laterally in the late phase during scapular plane abduction. The humeral abduction angle had a significant effect on the S/I and lateral/medial (L/M) translation of the humeral head centre (both p < 0.05). This study investigated 3D translations of the humerus relative to the scapula: during scapular plane full abduction, the humerus rotated 33.6° externally relative to the scapula, and during external rotation motion in the adducted position, the humeral head centre translated an average of 2.5 mm posteriorly. Kinematic data will provide important insights into evaluating the kinematics of pathological shoulders. For clinical relevance, quantitative assessment of dynamic healthy shoulder kinematics might be a physiological indicator for the assessment of pathological shoulders.

Surgical technique and clinical results for scapular allograft reconstruction following resection of scapular tumors.

PubMed

Zhang, Kaiwei; Duan, Hong; Xiang, Zhou; Tu, Chongqi

2009-04-01

Progress in developing effective surgical techniques, such as scapular allograft reconstruction, enhance shoulder stability and extremity function, in patients following scapular tumor resection. Case details from seven patients who underwent scapular allograft reconstruction following scapular tumor resection were reviewed. A wide marginal resection (partial scapulectomy) was performed in all patients and all affected soft tissues were resected to achieve a clean surgical margin. The glenoid-resected and glenoid-saved reconstructions were performed in three and four patients, respectively. The residual host scapula were fixed to the size-matched scapular allografts with plates and screws. The rotator cuff was affected frequently and was mostly resected. The deltoid and articular capsule were infrequently involved, but reconstructed preferentially. The remaining muscles were reattached to the allografts. The median follow-up was 26 months (range, 14-50 months). The average function scores were 24 points (80%) according to the International Society of Limb Salvage criteria. The range of active shoulder abduction and forward flexion motion were 40 degrees -110 degrees and 30 degrees -90 degrees, respectively. There was no difference between the glenoid-saved and glenoid-resected reconstructions in the total scores (mean, 24.5 points/81% versus 24 points/79%), but the glenoid-saved procedure was superior to the later in terms of abduction/flexion motion (mean, 72 degrees /61 degrees versus 55 degrees /43 degrees). During the study follow-up period, one patient died following a relapse, one patient lived despite of local recurrence, and five patients survived with no evidence of recurrence of the original cancer. Post-surgical complications such as shoulder dislocations, non-unions, and articular degeneration were not noted during this study period. Scapular allograft reconstruction had a satisfactory functional, cosmetic, and oncological outcome in this case series. Preservation and reconstruction of the articular capsule and deltoid are proposed to be a prerequisite for using scapular allografts and rotator cuff reconstruction is recommended, although technically challenging to perform.

Surgical technique and clinical results for scapular allograft reconstruction following resection of scapular tumors

PubMed Central

Zhang, Kaiwei; Duan, Hong; Xiang, Zhou; Tu, Chongqi

2009-01-01

Background Progress in developing effective surgical techniques, such as scapular allograft reconstruction, enhance shoulder stability and extremity function, in patients following scapular tumor resection. Methods Case details from seven patients who underwent scapular allograft reconstruction following scapular tumor resection were reviewed. A wide marginal resection (partial scapulectomy) was performed in all patients and all affected soft tissues were resected to achieve a clean surgical margin. The glenoid-resected and glenoid-saved reconstructions were performed in three and four patients, respectively. The residual host scapula were fixed to the size-matched scapular allografts with plates and screws. The rotator cuff was affected frequently and was mostly resected. The deltoid and articular capsule were infrequently involved, but reconstructed preferentially. The remaining muscles were reattached to the allografts. Results The median follow-up was 26 months (range, 14–50 months). The average function scores were 24 points (80%) according to the International Society of Limb Salvage criteria. The range of active shoulder abduction and forward flexion motion were 40°–110° and 30°–90°, respectively. There was no difference between the glenoid-saved and glenoid-resected reconstructions in the total scores (mean, 24.5 points/81% versus 24 points/79%), but the glenoid-saved procedure was superior to the later in terms of abduction/flexion motion (mean, 72°/61° versus 55°/43°). During the study follow-up period, one patient died following a relapse, one patient lived despite of local recurrence, and five patients survived with no evidence of recurrence of the original cancer. Post-surgical complications such as shoulder dislocations, non-unions, and articular degeneration were not noted during this study period. Conclusion Scapular allograft reconstruction had a satisfactory functional, cosmetic, and oncological outcome in this case series. Preservation and reconstruction of the articular capsule and deltoid are proposed to be a prerequisite for using scapular allografts and rotator cuff reconstruction is recommended, although technically challenging to perform. PMID:19338652

[Anatomy of fractures of the inferior scapular angle].

PubMed

Bartoníček, J; Tuček, M; Malík, J

2018-01-01

The aim of this study is to describe the anatomy of fractures of the inferior angle and the adjacent part of the scapular body, based on 3D CT reconstructions. In a series of 375 scapular fractures, we identified a total of 20 fractures of the inferior angle of the scapular body (13 men, 7 women), with a mean patient age of 50 years (range 3373). In all fractures, 3D CT reconstructions were obtained, allowing an objective evaluation of the fracture pattern with a focus on the size and shape of the inferior angle fragment, propagation of the fracture line to the lateral and medial borders of the infraspinous part of the scapular body, fragment displacement and any additional fracture of the ipsilateral scapula and the shoulder girdle. We identified a total of 5 types of fracture involving the distal half of the infraspinous part of the scapular body. The first type, recorded in 5 cases, affected only the apex of the inferior angle, with a small part of the adjacent medial border. The second type, occurring in 4 cases, involved fractures separating the entire inferior angle. The third type, represented by 4 cases, was characterized by a fracture line starting medially close above the inferior angle and passing proximolaterally. The separated fragment had a shape of a big drop, carrying also the distal half of the lateral pillar in addition to the inferior angle. In the fourth type identified in 5 fractures, the separated fragment was formed both by the inferior angle and a variable part of the medial border. The fifth type, being by its nature a transition to the fracture of the infraspinous part of the body, was recorded in 2 cases, with the same V-shaped fragment. Fractures of the inferior angle and the adjacent part of the scapular body are groups of fractures differing from other infraspinous fractures of the scapular body. Although these fractures are highly variable in terms of shape, they have the same course of fracture line and the manner of displacement.Key words: scapula scapula fractures scapular body fractures inferior angle classification of scapular body fractures.

Effects of Crossed Brassiere Straps on Pain, Range of Motion, and Electromyographic Activity of Scapular Upward Rotators in Women With Scapular Downward Rotation Syndrome.

PubMed

Kang, Min-Hyeok; Choi, Ji-Young; Oh, Jae-seop

2015-12-01

Scapular downward rotation syndrome manifests as an abnormally downward-rotated scapula at rest or with arm motion and typically results in neck and shoulder pain. The brassiere strap has been suggested as a possible contributing factor to scapula downward rotation and pain in the upper trapezius because of increased downward rotational force on the lateral aspect of the scapula. No study, however, has examined the influences of a modified brassiere strap on pain in and the function of the scapular muscles. To examine the effects of crossed brassiere straps on the pressure pain threshold (PPT) of the upper trapezius, neck rotation range of motion (ROM), and electromyographic activity of the scapular upward rotators in females with scapular downward rotation syndrome. Cross-over design. Laboratory. In total, 15 female subjects with scapular downward rotation syndrome were recruited at hospitals and a local university. All participants performed neck rotation and humeral elevation under 2 different conditions: parallel and crossed brassiere straps. The PPT of the upper trapezius was measured using an analog algometer, whereas neck rotation ROM was quantified with a 3-dimensional ultrasonic motion analysis system. The electromyographic activities of the upper trapezius, serratus anterior, and lower trapezius during humeral elevation were assessed with a surface electromyography system. Outcome measures were assessed under parallel and crossed brassiere strap conditions, and differences in outcomes between the conditions were analyzed using a paired t-test. The PPT and neck rotation ROM were increased when the subject was wearing the brassiere with crossed versus parallel straps (P < .001). Greater electromyographic activities of the serratus anterior, lower trapezius, and lesser upper trapezius muscles during humeral elevation were found under the crossed strap condition than the parallel strap condition (P < .05). These findings provide useful information for clinicians when designing management programs to decrease pain and improve biomechanical function for females with scapular downward rotation syndrome. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Functional morphology of the douc langur (Pygathrix spp.) scapula.

PubMed

Bailey, Katie E; Lad, Susan E; Pampush, James D

2017-06-01

Most colobine monkeys primarily move through their arboreal environment quadrupedally. Douc langurs (Pygathrix spp.), however, are regularly observed to use suspensory behaviors at the Endangered Primate Rescue Center (EPRC) in Northern Vietnam. Previous work has linked variation in scapular morphology to different modes of primate arboreal locomotion. Here we investigate whether the shape of the Pygathrix scapula resembles obligate brachiators (gibbons) or obligate arboreal quadrupeds (other cercopithecoids). Using a MicroScribe G2X 3D digitizer, the positions of 17 landmarks were recorded on 15 different species of nonhuman primates (n = 100) from three categories of locomotor behavior: brachiator, arboreal quadruped, and unknown (Pygathrix). All analyses were conducted in the R package geomorph. A Procrustes analysis uniformly scaled the shape data and placed specimens into the same morphospace. A Principal Component Analysis was used to examine scapular shape and a Procrustes ANOVA was conducted to test for shape difference in the scapulae. A pairwise analysis was used to compare the means of the locomotor categories and identify any statistically significant differences. A phylogenetically controlled Procrustes ANOVA was also conducted using a phylogeny from 10kTrees. Results show Pygathrix scapular morphology is significantly different from both arboreal colobine quadrupeds (p < 0.01) and hylobatid brachiators (p < 0.01). It does, however, share some features with each including a long vertebral border, like other cercopithecoids, and a more laterally projecting acromion process, like the hylobatids. The principal difference segregating Pygathrix from both the arboreal quadrupeds and the brachiators is the more medially placed superior angle. These nuanced morphological characteristics associated with suspensory behaviors may be useful for inferring suspensory locomotion in the primate fossil record. © 2017 Wiley Periodicals, Inc.

Scapular kinematics during manual wheelchair propulsion in able-bodied participants.

PubMed

Bekker, Michel J; Vegter, Riemer J K; van der Scheer, Jan W; Hartog, Johanneke; de Groot, Sonja; de Vries, Wiebe; Arnet, Ursina; van der Woude, Lucas H V; Veeger, Dirkjan H E J

2018-05-01

Altered scapular kinematics have been associated with shoulder pain and functional limitations. To understand kinematics in persons with spinal cord injury during manual handrim wheelchair propulsion, a description of normal scapular behaviour in able-bodied persons during this specific task is a prerequisite for accurate interpretation. The primary aim of this study is to describe scapular kinematics in able-bodied persons during manual wheelchair propulsion. Sixteen able-bodied, novice wheelchair users without shoulder complaints participated in the study. Kinematic and kinetic data were collected during a standardized pose in the anatomic posture, frontal-plane arm elevation and low-intensity steady-state handrim wheelchair propulsion and upper-body Euler angles were calculated. Scapulothoracic joint orientations in a static position were 36.7° (SD 5.4°), 6.4° (SD 9.1°) and 9.1° (SD 5.7°) for respectively protraction, lateral rotation and anterior tilt. At 80° of arm elevation in the frontal plane, the respective values of 33.4° (SD 8.0°), 23.9° (SD 5.4°) and 4.1° (SD 11.3°) were found. During the push phase of manual wheelchair propulsion, the mean scapular rotations were respectively 32.7° (SD 7.1°), 7.1° (SD 9.2°) and 9.8° (SD 8.3°). The orientation of the scapula in a static pose, during arm elevation and in manual wheelchair propulsion in able-bodied participants showed similar patterns to a previous study in persons with para- and tetraplegia. These values provide a reference for the investigation of the scapular movement pattern in wheelchair-dependent persons and its relation to shoulder complex abnormalities. Copyright © 2018. Published by Elsevier Ltd.

Scapular kinematics and muscle activities during pushing tasks.

PubMed

Huang, Chun-Kai; Siu, Ka-Chun; Lien, Hen-Yu; Lee, Yun-Ju; Lin, Yang-Hua

2013-01-01

Pushing tasks are functional activities of daily living. However, shoulder complaints exist among workers exposed to regular pushing conditions. It is crucial to investigate the control of shoulder girdles during pushing tasks. The objective of the study was to demonstrate scapular muscle activities and motions on the dominant side during pushing tasks and the relationship between scapular kinematics and muscle activities in different pushing conditions. Thirty healthy adults were recruited to push a four-wheel cart in six pushing conditions. The electromyographic signals of the upper trapezius (UT) and serratus anterior (SA) muscles were recorded. A video-based system was used for measuring the movement of the shoulder girdle and scapular kinematics. Differences in scapular kinematics and muscle activities due to the effects of handle heights and weights of the cart were analyzed using two-way ANOVA with repeated measures. The relationships between scapular kinematics and muscle activities were examined by Pearson's correlation coefficients. The changes in upper trapezius and serratus anterior muscle activities increased significantly with increased pushing weights in the one-step pushing phase. The UT/SA ratio on the dominant side decreases significantly with increased handle heights in the one-step pushing phase. The changes in upward rotation, lateral slide and elevation of the scapula decreased with increased pushing loads in the trunk-forward pushing phase. This study indicated that increased pushing loads result in decreased motions of upward rotation, lateral slide and elevation of the scapula; decreased handle heights result in relatively increased activities of the serratus anterior muscles during pushing tasks.

Dorsal scapular neuropathy causing rhomboids palsy and scapular winging.

PubMed

Argyriou, Andreas A; Karanasios, Panagiotis; Makridou, Alexandra; Makris, Nicolaos

2015-01-01

Most cases of scapular winging (SW) are attributed to either long thoracic or spinal accessory nerve lesions. Dorsal scapular nerve lesions are quite rare and the literature contains very few case reports of SW secondary to rhomboid paralysis. We are reporting the unusual case of a young patient who developed right-side scapular winging due to dorsal scapular neuropathy and rhomboids palsy, and we highlight the role of conservative treatment and rehabilitation for cases of mild/medium injury to the dorsal scapular nerve or to the rhomboid muscles. For those cases, physiotherapy is recommended, and this is mainly aimed at strengthening the trapezius in order to compensate for rhomboids weakness.

The Effect of Shoulder Plyometric Training on Amortization Time and Upper-Extremity Kinematics.

PubMed

Swanik, Kathleen A; Thomas, Stephen J; Struminger, Aaron H; Bliven, Kellie C Huxel; Kelly, John D; Swanik, Charles B

2016-12-01

Plyometric training is credited with providing benefits in performance and dynamic restraint. However, limited prospective data exist quantifying kinematic adaptations such as amortization time, glenohumeral rotation, and scapulothoracic position, which may underlie the efficacy of plyometric training for upper-extremity rehabilitation or performance enhancement. To measure upper-extremity kinematics and plyometric phase times before and after an 8-wk upper-extremity strength- and plyometric-training program. Randomized pretest-posttest design. Research laboratory. 40 recreationally active men (plyometric group, age 20.43 ± 1.40 y, height 180.00 ± 8.80 cm, weight 73.07 ± 7.21 kg; strength group, age 21.95 ± 3.40 y, height 173.98 ± 11.91 cm, weight 74.79 ± 13.55 kg). Participants were randomly assigned to either a strength-training group or a strength- and plyometric-training group. Each participant performed the assigned training for 8 wk. Dynamic and static glenohumeral and scapular-rotation measurements were taken before and after the training programs. Dynamic measurement of scapular rotation and time spent in each plyometric phase (concentric, eccentric, and amortization) during a ball-toss exercise were recorded while the subjects were fitted with an electromagnetic tracking system. Static measures included scapular upward rotation at 3 different glenohumeral-abduction angles, glenohumeral internal rotation, and glenohumeral external rotation. Posttesting showed that both groups significantly decreased the time spent in the amortization, concentric, and eccentric phases of a ball-toss exercise (P < .01). Both groups also exhibited significantly decreased static external rotation and increased dynamic scapular upward rotation after the training period (P < .01). The only difference between the training protocols was that the plyometric-training group exhibited an increase in internal rotation that was not present in the strength-training group (P < .01). These findings support the use of both upper-extremity plyometrics and strength training for reducing commonly identified upper-extremity-injury risk factors and improving upper-extremity performance.

Resting Orientations of Dinosaur Scapulae and Forelimbs: A Numerical Analysis, with Implications for Reconstructions and Museum Mounts.

PubMed

Senter, Phil; Robins, James H

2015-01-01

The inclination of the scapular blade and the resting pose of the forelimb in dinosaurs differ among reconstructions and among skeletal mounts. For most dinosaurian taxa, no attempt has previously been made to quantify the correct resting positions of these elements. Here, we used data from skeletons preserved in articulation to quantify the resting orientations of the scapula and forelimb in dinosaurs. Specimens were included in the study only if they were preserved lying on their sides; for each specimen the angle between forelimb bones at a given joint was included in the analysis only if the joint was preserved in articulation. Using correlation analyses of the angles between the long axis of the sacrum, the first dorsal centrum, and the scapular blade in theropods and Eoraptor, we found that vertebral hyperextension does not influence scapular orientation in saurischians. Among examined taxa, the long axis of the scapular blade was found to be most horizontal in bipedal saurischians, most vertical in basal ornithopods, and intermediate in hadrosauroids. We found that in bipedal dinosaurs other than theropods with semilunate carpals, the resting orientation of the elbow is close to a right angle and the resting orientation of the wrist is such that the hand exhibits only slight ulnar deviation from the antebrachium. In theropods with semilunate carpals the elbow and wrist are more flexed at rest, with the elbow at a strongly acute angle and with the wrist approximately at a right angle. The results of our study have important implications for correct orientations of bones in reconstructions and skeletal mounts. Here, we provide recommendations on bone orientations based on our results.

Clinical assessment of scapula and hip joint function in preadolescent and adolescent baseball players.

PubMed

Beckett, Michael; Hannon, Michael; Ropiak, Christopher; Gerona, Christopher; Mohr, Karen; Limpisvasti, Orr

2014-10-01

Proper scapulothoracic and hip mechanics are essential aspects of the throwing kinetic chain. Little is known regarding these entities in preadolescent and adolescent baseball players. Scapular malposition and dyskinesis as well as hip dysfunction are highly prevalent in preadolescent and adolescent baseball players and may be identified by simple clinical testing. Descriptive laboratory study. A total of 112 baseball players aged 7 to 18 years were recruited from local Little Leagues, traveling teams, and high schools. Participants were divided into 2 groups: preadolescents (players aged 7-12 years) and adolescents (players aged 13-18 years). Scapular symmetry was tested with the yes/no method of Kibler and by measuring forward shoulder posture via the "coracoid distance." Hip abductor strength was measured by use of a handheld digital dynamometer. Functional gluteal and core strength was assessed by video analysis of the subjects performing the single-legged squat test. Hip range of motion was measured in the prone position by use of a handheld goniometer. Compared with the preadolescent group, the adolescent group had a significantly higher prevalence of scapular dyskinesis in the throwing shoulder (50% vs 25.9%, P = .011). The adolescents had significantly higher normalized hip abduction strength in both the stride (17.41 vs 12.62 N/kg, P < .001) and stance (17.82 vs 12.61 N/kg, P < .001) legs. The preadolescent group was unable to perform the single-legged squat test correctly in either the stance (0% preadolescent vs 13% adolescent, P = .0127) or stride (0% preadolescent vs 9.3% adolescent, P = .0567) leg. The mean coracoid distance was elevated in the dominant (throwing) shoulder after controlling for scapular dyskinesis (P < .0001). Presence of scapular dyskinesis was associated with a higher mean coracoid distance (P = .0067). There was a high prevalence of dominant shoulder scapular dyskinesis in the adolescent compared with the preadolescent group, as well as universally poor single-legged squat test performance. The mean coracoid distance was higher in the dominant or throwing side compared with the nondominant side independent of scapular dyskinesis. Presence of scapular dyskinesis was associated with higher mean coracoid distance. Identification of players thought to be at increased risk for throwing injuries and initiation of targeted rehabilitation programs may decrease injury rates in preadolescent and adolescent baseball players. © 2014 The Author(s).

Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review.

PubMed

Larsen, Camilla Marie; Juul-Kristensen, Birgit; Lund, Hans; Søgaard, Karen

2014-10-01

The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. From 50 articles, 54 method names were identified and categorized into three groups: (1) Static positioning assessment (n = 19); (2) Semi-dynamic (n = 13); and (3) Dynamic functional assessment (n = 22). Fifteen studies were excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was "fair" (57%) to "poor" (43%), with only one study rated as "good". The reliability domain was most often investigated. Few of the assessment methods in the included studies that had "fair" or "good" measurement property ratings demonstrated acceptable results for both reliability and validity. We found a substantially larger number of clinical scapular assessment methods than previously reported. Using the COSMIN checklist the methodological quality of the included measurement properties in the reliability and validity domains were in general "fair" to "poor". None were examined for all three domains: (1) reliability; (2) validity; and (3) responsiveness. Observational evaluation systems and assessment of scapular upward rotation seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties, and especially diagnostic accuracy and responsiveness, to increase utility for clinical practice.

Scapular muscle activity in a variety of plyometric exercises.

PubMed

Maenhout, Annelies; Benzoor, Maya; Werin, Maria; Cools, Ann

2016-04-01

Plyometric shoulder exercises are commonly used to progress from slow analytical strength training to more demanding high speed power training in the return to play phase after shoulder injury. The aim of this study was first, to investigate scapular muscle activity in plyometric exercises to support exercise selection in practice and second, to enhance understanding of how scapular muscles are recruited during the back and forth movement phase of these exercises. Thirty-two healthy subjects performed 10 plyometric exercises while surface EMG-activity of the scapular muscles (upper (UT), middle (MT) and lower trapezius (LT) and serratus anterior (SA)) was registered. A high speed camera tracked start and end of the back and forth movement. Mean scapular EMG activity during the 10 exercises ranged from 14.50% to 76.26%MVC for UT, from 15.19% to 96.55%MVC for MT, from 13.18% to 94.35%MVC for LT and from 13.50% to 98.50%MVC for SA. Anova for repeated measures showed significant differences in scapular muscle activity between exercises (p<0.001) and between the back and forth movement (p<0.001) within exercises. Plyometric shoulder exercises require moderate (31-60%MVC) to high (>60%MVC) scapular muscle activity. Highest MT/LT activity was present in prone plyometric external rotation and flexion. Highest SA activity was found in plyometric external rotation and flexion with Xco and plyometric push up on Bosu. Specific exercises can be selected that recruit minimal levels of UT activity (<15%): side lying plyometric external rotation and horizontal abduction or plyometric push up on the Bosu. The results of this study support exercise selection for clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Outcomes of nonoperatively treated displaced scapular body fractures.

PubMed

Dimitroulias, Apostolos; Molinero, Kenneth G; Krenk, Daniel E; Muffly, Matthew T; Altman, Daniel T; Altman, Gregory T

2011-05-01

Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

Scapular insertion of the rabbit latissimus dorsi muscle: gross anatomy and fibre-type composition.

PubMed

Barron, D J; Etherington, P J; Winlove, C P; Pepper, J R

2001-01-01

This paper defines the characteristics and significance of the scapular insertion of the latissimus dorsi muscle (LDM) of the rabbit. In a study of the New Zealand White species (n = 10) the scapular insertion was found to be a consistent anatomical feature of the LDM that made up 12.3% (+/-2.3) of the total muscle weight. The fibres arise from the medial aspect of the body of the LDM and run in a caudocranial direction to be inserted into a broad, thin tendon beneath the scapula ridge. This is morphologically different from the scapular component of the human LDM which is a well-recognized but inconsistent feature and consists of no more than a small leash of fibres running around the lower pole of the scapula. The scapular insertion was deeper red in colour than the body of the muscle and fibre-typing demonstrated a mean slow-fibre composition of 49% (+/-2.6) compared to 16% (+/-1.7) for the body of the muscle (p < 0.01). Mapping of the fibre types throughout the remainder of the LDM confirmed that the body of the muscle was of fast phenotype but with significantly more slow fibres in the superomedial segment of the muscle than elsewhere. This region of the muscle contributes mainly to the scapular insertion and it is proposed that this part of the muscle takes on a predominantly postural role in stabilising the scapula during movement of the forelimb.

Shoulder kinematics during the wall push-up plus exercise.

PubMed

Lunden, Jason B; Braman, Jonathan P; Laprade, Robert F; Ludewig, Paula M

2010-03-01

The push-up plus exercise is a common therapeutic exercise for improving shoulder function and treating shoulder pathology. To date, the kinematics of the push-up plus exercise have not been studied. Our hypothesis was that the wall push-up plus exercise would demonstrate increased scapular internal rotation and increased humeral anterior translation during the plus phase of the exercise, thereby potentially impacting the subacromial space. Bone pins were inserted in the humerus and scapula in 12 healthy volunteers with no history of shoulder pathology. In vivo motion during the wall push-up plus exercise was tracked using an electromagnetic tracking system. During the wall push-up plus exercise, from a starting position to the push-up plus position, there was a significant increase in scapular downward rotation (P < .05) and internal rotation (P < .05). The pattern of glenohumeral motion was humeral elevation (P < .05) and movement anterior to the scapular plane (P < .05), with humeral external rotation remaining relatively constant. We found that during a wall push-up plus exercise in healthy volunteers, the scapula was placed in a position potentially associated with shoulder impingement. Because of the shoulder kinematics of the wall push-up plus exercise, utilization of this exercise without modification early on in shoulder rehabilitation, especially in patients with subacromial impingement, should be considered cautiously. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Comparison of 3-Dimensional Shoulder Complex Kinematics in Individuals With and Without Shoulder Pain, Part 1: Sternoclavicular, Acromioclavicular, and Scapulothoracic Joints

PubMed Central

LAWRENCE, REBEKAH L.; BRAMAN, JONATHAN P.; LAPRADE, ROBERT F.; LUDEWIG, PAULA M.

2015-01-01

STUDY DESIGN Cross-sectional. OBJECTIVES To compare sternoclavicular, acromioclavicular, and scapulothoracic joint motion between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Differences in scapulothoracic kinematics are associated with shoulder pain. Several studies have measured these differences using surface sensors, but the results of this technique may be affected by skin-motion artifact. Furthermore, previous studies have not included the simultaneous measurement of sternoclavicular and acromioclavicular joint motion. METHODS Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals for direct, bone-fixed tracking using electromagnetic sensors. Angular positions for the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups were found for sternoclavicular and scapulothoracic joint positions. Symptomatic individuals consistently demonstrated less sternoclavicular posterior rotation, regardless of angle, phase, or plane of shoulder motion. Symptomatic individuals also demonstrated less scapulothoracic upward rotation at 30° and 60° of humerothoracic elevation during shoulder abduction and scapular plane abduction. CONCLUSION The results of this study show that differences in shoulder complex kinematics exist between symptomatic and asymptomatic individuals. However, the magnitude of these differences was small, and the resulting clinical implications are not yet fully understood. The biomechanical coupling of the sternoclavicular and acromioclavicular joints requires further research to better understand scapulothoracic movement deviations and to improve manual therapy and exercise-based physical therapy interventions. PMID:25103135

3D navigated implantation of the glenoid component in reversed shoulder arthroplasty. Feasibility and results in an anatomic study.

PubMed

Stübig, Timo; Petri, Maximilian; Zeckey, Christian; Hawi, Nael; Krettek, Christian; Citak, Musa; Meller, Rupert

2013-12-01

Reversed shoulder arthroplasty is an alternative to total shoulder arthroplasty for various indications. The long-term results depend on stable bone fixation, and correct positioning of the glenoid component. The potential contribution of image guidance for reversed shoulder arthroplasty procedures was tested in vitro. 27 positioning procedures (15 navigated, 12 non-navigated) of the glenoid baseplate in reverse shoulder arthroplasty were performed by a single experienced orthopaedic surgeon. A Kirschner wire was placed freehand or with the use of a navigated drill guide. For the navigated procedures, a flat detector 3D C-arm with navigation system was used. The Kirschner wire was to be inserted 12 mm from the inferior glenoid, with an inferior tilt of 10° and centrally in the axial scapular axis. The insertion point in the glenoid as well as the position of the K-wire in the axial and sagittal planes were measured. For statistical analysis, t-tests were performed with a significance level of 0.05. The inferior glenoid drilling distance was 14.1 ± 3.4 mm for conventional placement and 15.1 ± 3.4 mm for the navigated procedure (P = 0.19). The inferior tilt showed no significant difference between the two methods (conventional 7.4 ± 5.2°, navigated 7.7 ± 4.9°, P = 0.63). The glenoid version in the axial plane showed significantly higher accuracy for the navigated procedure, with a mean deviation of 1.6 ±4.5° for the navigated procedure compared with 11.5 ± 6.5° for the conventional procedure(P = 0.004). Accurate positioning of the glenoidal baseplate in the axial scapular plane can be improved using 3D C-arm navigation for reversed shoulder arthroplasty. However, computer navigation may not improve the inferior tilt of the component or the position in the inferior glenoid to avoid scapular notching. Nevertheless, further studies are required to confirm these findings in the clinical setup. Copyright © 2013 John Wiley & Sons, Ltd.

Mapping intended spinal site of care from the upright to prone position: an interexaminer reliability study.

PubMed

Cooperstein, Robert; Young, Morgan

2014-01-01

Upright examination procedures like radiology, thermography, manual muscle testing, and spinal motion palpation may lead to spinal interventions with the patient prone. The reliability and accuracy of mapping upright examination findings to the prone position is unknown. This study had 2 primary goals: (1) investigate how erroneous spine-scapular landmark associations may lead to errors in treating and charting spine levels; and (2) study the interexaminer reliability of a novel method for mapping upright spinal sites to the prone position. Experiment 1 was a thought experiment exploring the consequences of depending on the erroneous landmark association of the inferior scapular tip with the T7 spinous process upright and T6 spinous process prone (relatively recent studies suggest these levels are T8 and T9, respectively). This allowed deduction of targeting and charting errors. In experiment 2, 10 examiners (2 experienced, 8 novice) used an index finger to maintain contact with a mid-thoracic spinous process as each of 2 participants slowly moved from the upright to the prone position. Interexaminer reliability was assessed by computing Intraclass Correlation Coefficient, standard error of the mean, root mean squared error, and the absolute value of the mean difference for each examiner from the 10 examiner mean for each of the 2 participants. The thought experiment suggesting that using the (inaccurate) scapular tip landmark rule would result in a 3 level targeting and charting error when radiological findings are mapped to the prone position. Physical upright exam procedures like motion palpation would result in a 2 level targeting error for intervention, and a 3 level error for charting. The reliability experiment showed examiners accurately maintained contact with the same thoracic spinous process as the participant went from upright to prone, ICC (2,1) = 0.83. As manual therapists, the authors have emphasized how targeting errors may impact upon manual care of the spine. Practitioners in other fields that need to accurately locate spinal levels, such as acupuncture and anesthesiology, would also be expected to draw important conclusions from these findings.

Mapping intended spinal site of care from the upright to prone position: an interexaminer reliability study

PubMed Central

2014-01-01

Background Upright examination procedures like radiology, thermography, manual muscle testing, and spinal motion palpation may lead to spinal interventions with the patient prone. The reliability and accuracy of mapping upright examination findings to the prone position is unknown. This study had 2 primary goals: (1) investigate how erroneous spine-scapular landmark associations may lead to errors in treating and charting spine levels; and (2) study the interexaminer reliability of a novel method for mapping upright spinal sites to the prone position. Methods Experiment 1 was a thought experiment exploring the consequences of depending on the erroneous landmark association of the inferior scapular tip with the T7 spinous process upright and T6 spinous process prone (relatively recent studies suggest these levels are T8 and T9, respectively). This allowed deduction of targeting and charting errors. In experiment 2, 10 examiners (2 experienced, 8 novice) used an index finger to maintain contact with a mid-thoracic spinous process as each of 2 participants slowly moved from the upright to the prone position. Interexaminer reliability was assessed by computing Intraclass Correlation Coefficient, standard error of the mean, root mean squared error, and the absolute value of the mean difference for each examiner from the 10 examiner mean for each of the 2 participants. Results The thought experiment suggesting that using the (inaccurate) scapular tip landmark rule would result in a 3 level targeting and charting error when radiological findings are mapped to the prone position. Physical upright exam procedures like motion palpation would result in a 2 level targeting error for intervention, and a 3 level error for charting. The reliability experiment showed examiners accurately maintained contact with the same thoracic spinous process as the participant went from upright to prone, ICC (2,1) = 0.83. Conclusions As manual therapists, the authors have emphasized how targeting errors may impact upon manual care of the spine. Practitioners in other fields that need to accurately locate spinal levels, such as acupuncture and anesthesiology, would also be expected to draw important conclusions from these findings. PMID:24904747

Mechanical properties of the trapezius during scapular elevation in people with chronic whiplash associated disorders--A case-control ultrasound speckle tracking analysis.

PubMed

Landén Ludvigsson, Maria; Peterson, Gunnel; Jull, Gwendolen; Trygg, Johan; Peolsson, Anneli

2016-02-01

Approximately 50% of people with Whiplash Associated Disorders (WAD) report longstanding symptoms. The upper trapezius is commonly painful yet its mechanical properties are not fully understood. This study examined the deformation of different depths of the upper trapezius muscle during a scapular elevation task (shoulder shrugging) before and following loaded arm abduction. A cross-sectional case-control study of 36 people (26 female and 10 male, mean age 38 (SD 11)) with chronic WAD and 36 controls, matched for age and gender. Real-time ultrasound recordings of upper trapezius were taken during both scapular elevation tasks. Post-process speckle tracking analysis was undertaken of three different sections of the upper trapezius muscle (superficial, middle, deep). The WAD group had lower deformation of the superficial section of the upper trapezius compared to the control group in both concentric and eccentric phases of scapular elevation (p < 0.05) especially before the loaded arm abduction. After arm abduction, the deformation of the trapezius was reduced in both groups but only significantly in the WAD-group (p = 0.03). Within-group analysis revealed that the control group least engaged the deep section of upper trapezius during the task (p < 0.01). This study, measuring mechanical deformation of the upper trapezius during a scapular elevation task indicates that persons with WAD may display different patterns in engagement of the muscle sections than those in the control group. Further research is needed to replicate and understand the reasons for and implications of this possible change in motor strategy within upper trapezius. Clinical Trials.gov, Number: NCT01547624. Copyright © 2015 Elsevier Ltd. All rights reserved.

Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

PubMed Central

Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed; Al-Sadek, Lina

2016-01-01

AIM: The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries. MATERIAL AND METHODS: Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed. RESULTS: Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema. CONCLUSIONS: The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients. PMID:28028415

The effect of long and short head biceps loading on glenohumeral joint rotational range of motion and humeral head position.

PubMed

McGarry, Michelle H; Nguyen, Michael L; Quigley, Ryan J; Hanypsiak, Bryan; Gupta, Ranjan; Lee, Thay Q

2016-06-01

To evaluate the effect of loading the long and short heads of the biceps on glenohumeral range of motion and humeral head position. Eight cadaveric shoulders were tested in 60° abduction in the scapula and coronal plane. Muscle loading was applied based on cross-sectional area ratios. The short and long head of the biceps were loaded individually followed by combined loading. Range of motion was measured with 2.2 Nm torque, and the humeral head apex position was measured using a MicroScribe. A paired t test with Bonferroni correction was used for statistics. Long head loading decreased internal rotation in both the scapular (17.9 %) and coronal planes (5.7 %) and external rotation in the scapular plane (2.6 %) (P < 0.04). With only short head loading, maximum internal rotation was significantly increased in the scapular and coronal plane. Long head and short head loading shifted the humeral head apex posteriorly in maximum internal rotation in both planes with the long head shift being significantly greater than the short head. Long head loading also shifted the humeral apex inferiorly in internal rotation and inferiorly posteriorly in neutral rotation in the scapular plane. With the long head unloaded, there was a significant superior shift with short head loading in both planes. Loading the long head of the biceps had a much greater effect on glenohumeral range of motion and humeral head shift than the short head of the biceps; however, in the absence of long head loading, with the short head loaded, maximum internal rotation increases and the humeral head shifts superiorly, which may contribute to impingement following tenodesis of the long head of the biceps. These small changes in rotational range of motion and humeral head position with biceps tenodesis may not lead to pathologic conditions in low-demand patients; however, in throwers, biceps tenodesis may lead to increased contact pressures in late-cocking and deceleration that will likely translate to decreased performance therefore every effort should be made to preserve the biceps-labral complex.

Shoulder External Rotation Fatigue and Scapular Muscle Activation and Kinematics in Overhead Athletes

PubMed Central

Joshi, Mithun; Thigpen, Charles A.; Bunn, Kevin; Karas, Spero G.; Padua, Darin A.

2011-01-01

Context: Glenohumeral external rotation (GH ER) muscle fatigue might contribute to shoulder injuries in overhead athletes. Few researchers have examined the effect of such fatigue on scapular kinematics and muscle activation during a functional movement pattern. Objective: To examine the effects of GH ER muscle fatigue on upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscle activation and to examine scapular kinematics during a diagonal movement task in overhead athletes. Setting: Human performance research laboratory. Design: Descriptive laboratory study. Patients or Other Participants: Our study included 25 overhead athletes (15 men, 10 women; age = 20 ± 2 years, height = 180 ± 11 cm, mass = 80 ± 11 kg) without a history of shoulder pain on the dominant side. Interventions: We tested the healthy, dominant shoulder through a diagonal movement task before and after a fatiguing exercise involving low-resistance, high-repetition, prone GH ER from 0° to 75° with the shoulder in 90° of abduction. Main Outcome Measure(s): Surface electromyography was used to measure muscle activity for the upper trapezius, lower trapezius, serratus anterior, and infraspinatus. An electromyographic motion analysis system was used to assess 3-dimensional scapular kinematics. Repeated-measures analyses of variance (phase × condition) were used to test for differences. Results: We found a decrease in ascending-phase and descending-phase lower trapezius activity (F1,25 = 5.098, P = .03) and an increase in descending-phase infraspinatus activity (F1,25 = 5.534, P = .03) after the fatigue protocol. We also found an increase in scapular upward rotation (F1,24 = 3.7, P = .04) postfatigue. Conclusions: The GH ER muscle fatigue protocol used in this study caused decreased lower trapezius and increased infraspinatus activation concurrent with increased scapular upward rotation range of motion during the functional task. This highlights the interdependence of scapular and glenohumeral force couples. Fatigue-induced alterations in the lower trapezius might predispose the infraspinatus to injury through chronically increased activation. PMID:21944066

Three-dimensional shoulder kinematics normalize after rotator cuff repair.

PubMed

Kolk, Arjen; de Witte, Pieter Bas; Henseler, Jan Ferdinand; van Zwet, Erik W; van Arkel, Ewoud R A; van der Zwaal, Peer; Nelissen, Rob G H H; de Groot, Jurriaan H

2016-06-01

Patients with a rotator cuff (RC) tear often exhibit scapular dyskinesia with increased scapular lateral rotation and decreased glenohumeral elevation with arm abduction. We hypothesized that in patients with an RC tear, scapular lateral rotation, and thus glenohumeral elevation, will be restored to normal after RC repair. Shoulder kinematics were quantitatively analyzed in 26 patients with an electromagnetic tracking device (Flock of Birds) before and 1 year after RC repair in this observational case series. We focused on humeral range of motion and scapular kinematics during abduction. The asymptomatic contralateral shoulder was used as the control. Changes in scapular kinematics were associated with the gain in range of motion. Shoulder kinematics were analyzed using a linear mixed model. Mean arm abduction and forward flexion improved after surgery by 20° (95% confidence interval [CI], 2.7°-36.5°; P = .025) and 13° (95% CI, 1.2°-36.5°; P = .044), respectively. Kinematic analyses showed decreases in mean scapular protraction (ie, internal rotation) and lateral rotation (ie, upward rotation) during abduction by 3° (95% CI, 0.0°-5.2°; P = .046) and 4° (95% CI, 1.6°-8.4°; P = .042), respectively. Glenohumeral elevation increased by 5° (95% CI, 0.6°-9.7°; P = .028) at 80°. Humeral range of motion increased when scapular lateral rotation decreased and posterior tilt increased. Scapular kinematics normalize after RC repair toward a symmetrical scapular motion pattern as observed in the asymptomatic contralateral shoulder. The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Comparison of the use of scapular ultrasonography, physical examination, and measurement of serum biomarkers of bone turnover versus scintigraphy for detection of bone fragility syndrome in horses.

PubMed

Arens, Amanda M; Puchalski, Sarah M; Whitcomb, Mary Beth; Bell, Robin; Gardner, Ian A; Stover, Susan M

2013-01-01

To define scintigraphic, physical examination, and scapular ultrasonographic findings consistent with bone fragility syndrome (BFS) in horses; develop indices of BFS severity; and assess accuracy of physical examination, scapular ultrasonography, and serum biomarkers for BFS diagnosis. Prospective case-control study. 48 horses (20 horses with BFS and 28 control horses). Horses underwent forelimb scintigraphic evaluation, physical examination, scapular ultrasonography, and serum collection. Scintigraphy was used as a reference standard to which physical examination, scapular ultrasonography, and concentrations of serum biomarkers (carboxy-terminal telopeptide of collagen crosslinks and bone-specific alkaline phosphatase activity) were compared for assessing accuracy in BFS diagnosis. A diagnosis of BFS was strongly supported on scintigraphy by ≥ 2 regions of increased radiopharmaceutical uptake, including 1 region in the scapular spine and 1 region in the scapular body or ribs; on physical examination by lateral bowing of the scapulae; and on ultrasonography by widening of the scapular spine. None of the tests evaluated were accurate enough to replace scintigraphy for mild disease; however, physical examination and scapular ultrasonography were accurate in horses with moderate to severe BFS. Serum biomarkers were not accurate for BFS diagnosis. Scintigraphy remained the most informative diagnostic modality for BFS, providing insight into disease severity and distribution; however, physical examination and scapular ultrasonographic abnormalities were diagnostic in horses with moderate to severe disease. Proposed severity indices classified the spectrum of disease manifestations. Clearly defined criteria for interpretation of diagnostic tests aid in the detection of BFS. Severity indices may be useful for assessing disease progression and response to treatment.

Biomechanical competence of six different bone screws for reconstructive surgery in three different transplants: Fibular, iliac crest, scapular and artificial bone.

PubMed

Pietsch, Arnold P; Raith, Stefan; Ode, Jan-Eric; Teichmann, Jan; Lethaus, Bernd; Möhlhenrich, Stephan C; Hölzle, Frank; Duda, Georg N; Steiner, Timm

2016-06-01

The goal of this study was to determine a combination of screw and transplantation type that offers optimal primary stability for reconstructive surgery. Fibular, iliac crest, and scapular transplants were tested along with artificial bone substrate. Six different kinds of bone screws (Medartis(©)) were compared, each type utilized with one of six specimens from human transplants (n = 6). Controlled screw-in-tests were performed and the required torque was protocolled. Subsequently, pull-out-tests were executed to determine the retention forces. The artificial bone substitute material showed significantly higher retention forces than real bone samples. The self-drilling screws achieved the significantly highest retention values in the synthetic bone substitute material. Cancellous screws achieved the highest retention in the fibular transplants, while self-drilling and cancellous screws demonstrated better retention than cortical screws in the iliac crest. In the scapular graft, no significant differences were found between the screw types. In comparison to the human transplant types, the cortical screws showed the significantly highest values in the fibula and the lowest values in the iliac crest. The best retention was found in the combination of cancellous screws with fibular graft (514.8 N + -252.3 N). For the flat bones (i.e., scapular and illiac crest) we recommend the cancellous screws. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Influence of pectoralis minor and upper trapezius lengths on observable scapular dyskinesis.

PubMed

Yeşilyaprak, Sevgi Sevi; Yüksel, Ertuğrul; Kalkan, Serpil

2016-05-01

Although a relationship between short pectoralis minor and upper trapezius and scapular dyskinesis has been postulated, no studies have investigated this theory. Understanding the effect of these muscle lengths on observable scapular dyskinesis may aid in determining risks and therefore making treatment decisions. Being aware of the magnitude of this effect would help gauge the significance of risks involved. Our aim was to evaluate the influence of pectoralis minor and upper trapezius lengths on scapular dyskinesis. Cross-sectional study. University research laboratory. Asymptomatic participants (n = 148; 296 arms) were evaluated. Scapular Dyskinesis Test (SDT) was used to identify scapular dyskinesis, Pectoralis Minor Index (PMI) and Upper Trapezius Length Testing were used to determine muscle length. SDT+ arms had shorter pectoralis minor resting length (PMI: 7.49 ± 0.38) (p < 0.001) and greater incidence of short upper trapezius (ISUT) (66.7%) (p < 0.001) compared to SDT- arms (PMI:8.58 ± 0.75, ISUT:22.5%). With each decrease in PMI, the likelihood of having scapular dyskinesis increased 96% (p < 0.001). Arms with short upper trapezius were 2.049 times more likely to exhibit scapular dyskinesis than those with normal length (p = 0.042). Having a shorter pectoralis minor and upper trapezius length substantially increased the likelihood of having visually observable scapular dyskinesis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reliable harvest of a dorsal scapular artery perforator flap by augmenting its perfusion.

PubMed

Kim, So-Young; Lee, Kyeong-Tae; Mun, Goo-Hyun

2016-02-01

Despite confirmation of a reliable perforasome in the dorsal scapular artery in an anatomic study, a true perforator flap has not been recommended in previous clinical studies because of concerns regarding insufficient perfusion in the distal region. In this report, we present two cases of reconstruction for occipital defects caused by tumor extirpation using pedicled dorsal scapular artery perforator flaps without a muscle component. To secure the perfusion of the dorsal scapular artery perforator flap, inclusion of an additional perforator was attempted for perfusion augmentation. The second dorsal scapular artery perforator was harvested in one case. In an additional case, the sixth dorsal intercostal artery perforator with a branch that directly connected with the dorsal scapular artery within the trapezius muscle was additionally harvested. The flaps survived without any perfusion-related complications, including tip necrosis, and no donor site morbidities were observed. We suggest that a perfusion augmented dorsal scapular artery perforator flap by harvesting multiple perforators could be a safe and useful alternative for reconstructive surgery of head and neck defects. © 2014 Wiley Periodicals, Inc.

Pectoralis major tendon transfer for the treatment of scapular winging due to long thoracic nerve palsy.

PubMed

Streit, Jonathan J; Lenarz, Christopher J; Shishani, Yousef; McCrum, Christopher; Wanner, J P; Nowinski, R J; Warner, Jon J P; Gobezie, Reuben

2012-05-01

Painful scapular winging due to chronic long thoracic nerve (LTN) palsy is a relatively rare disorder that can be difficult to treat. Pectoralis major tendon (PMT) transfer has been shown to be effective in relieving pain, improving cosmesis, and restoring function. However, the available body of literature consists of few, small-cohort studies, and more outcomes data are needed. Outcomes of 26 consecutive patients with electromyelogram-confirmed LTN palsy who underwent direct (n = 4) or indirect transfer (n = 22) of the PMT for dynamic stabilization of the scapula were reviewed. All patients were followed up clinically for an average of 21.8 months (range, 3-62 months) with evaluations of active forward flexion, active external rotation, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and observation of scapular winging. Preoperative to postoperative results included increases in the mean active forward flexion from 112° to 149° (P < .001) an in mean active external rotation from 53.8° to 62.8° (P = .045), an improvement in the mean ASES score from 28 to 67.0 (P < .001), and an improvement in the mean VAS pain score from 7.7 to 3.0 (P < .001). Recurrent scapular winging occurred in 5 patients. There was no difference in outcome by length of follow-up. PMT transfer is an effective treatment for painful scapular winging resulting from LTN palsy. This is the largest reported series of consecutive patients treated with PMT transfer for the correction of scapular winging. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle.

PubMed

Umehara, Jun; Nakamura, Masatoshi; Fujita, Kosuke; Kusano, Ken; Nishishita, Satoru; Araki, Kojiro; Tanaka, Hiroki; Yanase, Ko; Ichihashi, Noriaki

2017-07-01

Stretching maneuvers for the pectoralis minor muscle, which involve shoulder horizontal abduction or scapular retraction, are performed in clinical and sports settings because the tightness of this muscle may contribute to scapular dyskinesis. The effectiveness of stretching maneuvers for the pectoralis minor muscle is unclear in vivo. The purpose of this study was to verify the effectiveness of stretching maneuvers for the pectoralis minor muscle in vivo using ultrasonic shear wave elastography. Eighteen healthy men participated in this study. Elongation of the pectoralis minor muscle was measured for 3 stretching maneuvers (shoulder flexion, shoulder horizontal abduction, and scapular retraction) at 3 shoulder elevation angles (30°, 90°, and 150°). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the 9 aforementioned stretching maneuver-angle combinations. The shear elastic modulus was highest in horizontal abduction at 150°, followed by horizontal abduction at 90°, horizontal abduction at 30°, scapular retraction at 30°, scapular retraction at 90°, scapular retraction at 150°, flexion at 150°, flexion at 90°, and flexion at 30°. The shear elastic moduli of horizontal abduction at 90° and horizontal abduction at 150° were significantly higher than those of other stretching maneuvers. There was no significant difference between horizontal abduction at 90° and horizontal abduction at 150°. This study determined that shoulder horizontal abduction at an elevation of 90° and horizontal abduction at an elevation of 150° were the most effective stretching maneuvers for the pectoralis minor muscle in vivo. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: A single-arm study.

PubMed

Avila, Mariana Arias; Camargo, Paula Rezende; Ribeiro, Ivana Leão; Alburquerque-Sendín, Francisco; Zamunér, Antonio Roberto; Salvini, Tania Fatima

2017-11-01

Although hydrotherapy is widely used to treat women with fibromyalgia, no studies have investigated the effects of this intervention on scapular kinematics in this population. This study verified the effectiveness of a hydrotherapy program on scapular kinematics, pain and quality of life in women with fibromyalgia. Twenty women completed the study and performed three evaluations before treatment (to establish a baseline), and two other evaluations (after 8 and 16weeks of hydrotherapy) at the end of treatment. Three-dimensional kinematics of the scapula was evaluated during arm elevation in two different planes with the Flock of Birds® system. Patients also answered quality of life and Fibromyalgia Impact Questionnaires and had pain assessed with a digital algometer. Treatment consisted of 2 weekly hydrotherapy sessions, lasting 45min each, for 16weeks. Data were analyzed with a two-way ANOVA (for kinematics results) and one-way ANOVA (for the other variables). Effect size was assessed with Cohen's d coefficient for all quantitative variables. Although an important improvement was achieved in terms of pain and quality of life (P<0.05, effect sizes varied from -1.93 to 1.61 depending on the variable), scapular kinematics did not change after treatment (P>0.05, effect sizes from -0.40 to 0.46 for all kinematic variables). The proposed program of hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact in women with fibromyalgia. However, scapular kinematics did not change after the period of treatment. Although symptoms improved after the treatment, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Rotator cuff tendinopathy alters the muscle activity onset and kinematics of scapula.

PubMed

Leong, Hio Teng; Ng, Gabriel Yin-Fat; Chan, Shing Chung; Fu, Siu Ngor

2017-08-01

Athletes with rotator cuff (RC) tendinopathy demonstrate an aberrant pattern of scapular motion which might relate to deficits in the scapular muscles. This study aimed to determine whether alteration in scapular kinematics is associated with deficits in the activity onset of scapular muscles. Forty-three male volleyball players (17 asymptomatic and 26 with RC tendinopathy) joined the study. Three-dimensional scapular kinematics was quantified using an acromial marker cluster method. The activity onset of the upper (UT), middle (MT), and lower trapezius (LT), and serratus anterior (SA) during arm abduction was assessed with electromyography. Athletes with RC tendinopathy demonstrated less scapular upward rotation (6.6±2.3 vs. 8.2±1.1°, p=0.021) in the early phase of shoulder abduction from 0° to 30° when compared to asymptomatic athletes. The tendinopathy group had delayed activity onset of LT (14.1±31.4ms vs. 74.4±45.1ms, p<0.001) and SA (-44.9±26.0ms vs. 23.0±25.2ms, p<0.001) relative to UT when compared to the asymptomatic group. In asymptomatic athletes, earlier activity onset of MT and LT relative to UT was associated with more scapular upward rotation during 0-30° of abduction (r=0.665, p=0.021) and 30-60° of abduction (r=0.680, p=0.015), respectively. Our findings showed the control of the scapular upward rotation is related to the activity onset of the scapular muscles in athletes. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures.

PubMed

Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

2015-01-01

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

PubMed Central

Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

2015-01-01

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity. PMID:26175916

Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review

PubMed Central

Chamata, Edward; Mahabir, Raman; Jupiter, Daniel; Weber, Robert A

2014-01-01

BACKGROUND: Studies investigating the prevalence of brachial plexus injuries associated with scapular fractures are sparse, and are frequently limited by small sample sizes and often restricted to single-centre experience. OBJECTIVE: To determine the prevalence of brachial plexus injuries associated with scapular fractures; to determine how the prevalence varies with the region of the scapula injured; and to assess which specific nerves of the brachial plexus were involved. METHODS: The present study was a retrospective review of data from the National Trauma Data Bank over a five-year period (2007 to 2011). RESULTS: Of 68,118 patients with scapular fractures, brachial plexus injury was present in 1173 (1.72%). In patients with multiple scapular fractures, the prevalence of brachial plexus injury was 3.12%, and ranged from 1.52% to 2.22% in patients with single scapular fractures depending on the specific anatomical location of the fracture. Of the 426 injuries with detailed information on nerve injury, 208 (49%) involved the radial nerve, 113 (26.5%) the ulnar nerve, 65 (15%) the median nerve, 36 (8.5%) the axillary nerve and four (1%) the musculocutaneous nerve. CONCLUSION: The prevalence of brachial plexus injuries in patients with scapular fractures was 1.72%. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The largest percentage of nerve injuries were to the radial nerve. PMID:25535462

Site, gender and age variation in normal skin colour on the back and the forearm: tristimulus colorimeter measurements.

PubMed

Fullerton, A; Serup, J

1997-02-01

To study whether anatomical location and age and gender of subjects had any influence on the objective skin colour measurements. Baseline colour in prone position was measured with the Minolta ChromaMeter® in the upper, middle and lower level of the upper back and on the forearm of 168 volunteers. These two sites are commonly used in skin testing. Higher basal a* and lower basal L* levels were found on the upper scapular region compared to the lower scapular region and the subscapular region. The basal b* level showed no variation relative to site. The basal a* and the basal b* levels were lower on the forearm compared to the upper back while the basal L* level was higher. Females above 65 years showed a less coloured skin with lower values as compared to those of younger age. Females were found to have a generally lower basal a* level than males both on the upper back and forearm skin. These relatively major differences and sources of variation have to be considered when planning irritancy studies where colour differences between erythema and normal skin is used.

An ex vivo mechanical evaluation of single versus double semitubular plate fixation of a transverse distal-third scapular osteotomy in the dog.

PubMed

Mair, Jacqueline J; Belkoff, Stephen M; Boudrieau, Randy J

2003-01-01

To compare single versus double semitubular plate fixation for scapular body fractures. Ex vivo mechanical study. Eighteen paired cadaveric canine scapulae. Transverse scapular body osteotomies were created in the distal third of 18 pairs of scapulae. One scapula of each pair was repaired with a single plate, whereas the contralateral scapula was repaired with 2 plates. Initial strength and stiffness of the constructs were measured in 10 pairs of scapulae. Eight pairs of scapulae underwent cyclic loading and then were subjected to failure testing. Double-plate fixation was significantly stronger (3,899 +/- 632 N) but not stiffer (614 +/- 130 N/mm) than the single-plate fixation (3,238 +/- 935 N and 537 +/- 202 N/mm, respectively). Cyclic loading variables were not significantly different between the 2 methods of fixation. After cyclic loading, double-plate fixation was significantly stronger (2,916 +/- 618 N) than single-plate fixation (2,347 +/- 495 N). There was no significant difference (P =.11) in stiffness between double- versus single-plate fixations: 734 +/- 247 N/mm and 595 +/- 139 N/mm, respectively. Double-plate fixation was generally stronger and stiffer than single-plate fixation. Because all constructs failed at loads that greatly exceeded those estimated to occur clinically, any difference between the 2 methods of fixation probably is not clinically relevant. Single-plate fixation may be of sufficient strength for fixation of scapular body fractures. Copyright 2003 by The American College of Veterinary Surgeons

Mandibular reconstruction in irradiated patients utilizing myosseous-cutaneous flaps

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pearlman, N.W.; Albin, R.E.; O'Donnell, R.S.

1983-10-01

Myosseous-cutaneous flaps were used for mandibular reconstruction in 16 irradiated patients. Three of six sternomastoid-clavicle flaps failed (all in conjunction with a neck dissection), as did one of 10 pectoralis major-anterior-fifth rib flaps. One trapezius-scapular flap was used and it succeeded. We found the blood supply of the sternomastoid-clavicle flap too tenuous for use in conjunction with a neck dissection. The trapezius-scapular flap had too short an arc of rotation to be used for defects other than those in the horizontal ramus. In addition, this flap required a change of position and created an undesirable functional deformity. The pectoralis major-fifthmore » rib flap, in contrast, could be used for a variety of defects, in conjunction with a neck dissection, and did not require a change of position during operation. We found it to be the most versatile and dependable of the flaps employed in this series.« less

Comparison of Clinical and Radiological Results according to Glenosphere Position in Reverse Total Shoulder Arthroplasty: A Short-term Follow-up Study.

PubMed

Choi, Chang Hyuk; Kim, Sung Guk; Lee, Jae Jun; Kwack, Byung Hoon

2017-03-01

In a previous biomechanical study, eccentric glenospheres with more inferior position of the center of rotation were shown to improve range of motion and reduce the incidence of scapular notching after reverse total shoulder arthroplasty (RSA). The purpose of this study was to compare the clinical and radiological results of RSA using an eccentric glenosphere to those using a concentric glenosphere and to determine the usefulness of the eccentric glenosphere. From 2009 to 2015, we performed a retrospective review of 20 consecutive patients who underwent RSA using a deltopectoral approach. Nine patients underwent RSA using a concentric glenosphere (group A) while 11 had an eccentric glenosphere (group B). The average follow-up period was 13.9 months (range, 12 to 18 months). All glenoid components were placed with 15° of inferior tilt. Clinical results were assessed using the visual analog pain scale score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, the Korean shoulder scoring system (KSS), and the Constant score. On radiological evaluation, prosthesisscapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenoshere rim distance (inferior glenoshpere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance, and severity of notching according to the Nerot-Sirveaux classification were assessed. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. A significant intergroup difference was observed with regard to PGRD (24.8 ± 1.6 mm for group A vs. 22.2 ± 1.9 mm for group B; p = 0.002) and inferior glenosphere overhang (2.0 ± 1.7 mm for group A vs. 5.8 ± 1.6 mm for group B; p = 0.000). Seven of 9 patients in group A developed notching compared with 2 of 11 patients in group B ( p = 0.022). The other radiological parameters such as inferior tilt and AT and GT distances were not significantly different between two groups. Complications such as loosening and scapular fractures did not occur. The eccentric glenosphere in RSA was more effective in reducing the rate of notching than the concentric glenosphere although clinical outcomes were not significantly different in the short-term follow-up.

Training induces scapular dyskinesis in pain-free competitive swimmers: a reliability and observational study.

PubMed

Madsen, Pernille H; Bak, Klaus; Jensen, Susanne; Welter, Ulrik

2011-03-01

Scapular dyskinesis is a major etiological factor in overhead athletes' shoulder problems. Our hypotheses were to evaluate if (1) visual observation of scapular dyskinesis during scaption has substantial interobserver reliability, and (2) scapular dyskinesis may be induced by swim training in pain-free swimmers. A reliability and observational study. Bachelor project at a college institution and at a private sports orthopedic hospital. Seventy-eight competitive swimmers with no history of shoulder pain were included in the study. Fourteen swimmers were evaluated regarding reliability. Inclusion criteria were competitive swimmers with high training volume who previously had no shoulder pain. Observations of scapular dyskinesis (yes/no) during simple scaption. The interobserver reliability of scaption and wall push-up was evaluated in 14 swimmers using kappa analysis. Prevalence of scapular dyskinesis at 4 time intervals during a swim training session. The scaption test resulted in a weighted kappa value of 0.75. Scapular dyskinesis was seen in 29 shoulders (37%) after the first time interval, in another 24 (cumulated prevalence 68%) after one-half of the training session, and in an additional 4 swimmers (cumulated prevalence 73%) after three-quarters of the training session. During the last quarter of the training session, another 7 swimmers had dyskinesis, resulting in a cumulated prevalence of 82%. The prevalence of abnormal scapular kinesis during a normal training session is high in previously pain-free swimmers. The prevalence increases with more training and occurs early during the training session.

Ipsilateral Closed Clavicle and Scapular spine Fracture with Acromioclavicular Joint Disruption.

PubMed

Kembhavi, Raghavendra S; James, Boblee

2015-01-01

Injuries around shoulder and clavicle are quite common. Injuries involving lateral end of clavicle involving acromioclavicular joints are commoner injuries. In this rare injury, we report about a case involving clavicle and scapular spine fracture with acromioclavicular disruption which has never been described in English literature as per our knowledge. A patient with closed clavicle and scapular spine fracture with acromioclavicular joint disruption was treated with open reduction and internal fixation of clavicle and scapular spine as a staged procedures. Six months post operatively, patient had excellent functional recovery with near full range of movements. Though rare complex injury, clavicle fracture with scapular spine fracture with acromioclavicular disruption, when managed properly with good physiotherapy protocol post operatively will result in good clinical and functional outcome.

Scapula fracture incidence in reverse total shoulder arthroplasty using screws above or below metaglene central cage: clinical and biomechanical outcomes.

PubMed

Kennon, Justin C; Lu, Caroline; McGee-Lawrence, Meghan E; Crosby, Lynn A

2017-06-01

Reverse total shoulder arthroplasty (RTSA) is a viable treatment option for rotator cuff tear arthropathy but carries a complication risk of scapular fracture. We hypothesized that using screws above the central glenoid axis for metaglene fixation creates a stress riser contributing to increased scapula fracture incidence. Clinical type III scapular fracture incidence was determined with screw placement correlation: superior screw vs. screws placed exclusively below the glenoid midpoint. Cadaveric RTSA biomechanical modeling was employed to analyze scapular fractures. We reviewed 318 single-surgeon single-implant RTSAs with screw correlation to identify type III scapular fractures. Seventeen cadaveric scapula specimens were matched for bone mineral density, metaglenes implanted, and fixation with 2 screw configurations: inferior screws alone (group 1 INF ) vs. inferior screws with one additional superior screw (group 2 SUP ). Biomechanical load to failure was analyzed. Of 206 patients, 9 (4.4%) from the superior screw group experienced scapula fractures (type III); 0 fractures (0/112; 0%) were identified in the inferior screw group. Biomechanically, superior screw constructs (group 2 SUP ) demonstrated significantly (P < .05) lower load to failure (1077 N vs. 1970 N) compared with constructs with no superior screws (group 1 INF ). There was no significant age or bone mineral density discrepancy. Clinical scapular fracture incidence significantly decreased (P < .05) for patients with no screws placed above the central cage compared with patients with superior metaglene screws. Biomechanical modeling demonstrates significant construct compromise when screws are used above the central cage, fracturing at nearly half the ultimate load of the inferior screw constructs. We recommend use of inferior screws, all positioned below the central glenoid axis, unless necessary to stabilize the metaglene construct. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Thera-Band application changes muscle activity and kyphosis and scapular winging during knee push-up plus in subjects with scapular winging: The cross-sectional study.

PubMed

Shin, A-Reum; Lee, Ji-Hyun; Kim, Da-Eun; Cynn, Heon-Seock

2018-04-01

Scapular winging (SW) is defined as increased prominence of the whole medial border of the scapula. Many researchers recently recommended knee push-up plus (KPP) for enhancing serratus anterior (SA) activation. However, during push-up plus, thoracic kyphosis (TK) may usually occur as a compensatory movement. Thus, the purpose of this study was to investigate the effect of Thera-Band application during KPP on rectus abdominis (RA) activity, TK angle (TKA), SA activity, and amount of SW in subjects with SW.Fifteen subjects performed KPP with Thera-Band applied to different posterior body parts (no Thera-Band, in the occiput, and in the thoracic region). Electromyography was used to record the RA and SA activities. Image J software was used to calculate the compensatory TKA during KPP, and a scapulometer was used to measure SW in the quadruped position. One-way repeated-measures analysis of variance was used to test for significance.KPP with Thera-Band in the occiput showed significantly lower RA activity (P = .001) and TKA (P < .001) than KPP with no Thera-Band. SA activity (P = .020, P = .047) and SW (P < .001, P < .001) were significantly lower with Thera-Band applied to the occiput and thoracic regions than in KPP with no Thera-Band.Thera-Band applied to the occiput and thorax can be beneficial as it decreases RA and SA muscle activity and reduces TKA and SW during KPP in subjects with SW.

The safe zone for avoiding suprascapular nerve injury during shoulder arthroscopy: an anatomical study on 500 dry scapulae.

PubMed

Gumina, Stefano; Albino, Paolo; Giaracuni, Marco; Vestri, Annarita; Ripani, Maurizio; Postacchini, Franco

2011-12-01

Suprascapular nerve injury may be a complication during shoulder arthroscopy. Our aim was to verify the reliability of the existing data, assess the differences between scapulae in the 2 genders and in the same subject, obtain a safe zone useful to avoid iatrogenic nerve lesions, and analyze the existing correlations between the scapular dimensions and the safe zone. We examined 500 dried scapulae, measuring 6 distances for each one, referring to the scapular body, glenoid, and the course of the suprascapular nerve, also catalogued according to gender and side. Differences due to gender were assessed comparing mean ± sd of each distance in males and females; paired t test was used to compare distances deriving from each couple. Successively, we calculated our safe zone and Pearson's correlation. We found nonsignificant differences between the right and left distances deriving from each couple; differences due to gender were stated. We defined 3 kinds of safe zones referring to: 500 scapulae; males (139 scapulae) and females (147 scapulae). The correlation indexes calculated between the axis of the scapular body and glenoid, and the posterosuperior distance (referring to the suprascapular nerve) were 0.624, 0.694, 0.675, 0.638; while those with the posterior distance were 0.230, 0.294, 0.232, 0.284. Knowledge of the safe zone, for avoiding suprascapular nerve injury, is important; gender and specific scapular dimensions should be evaluated, as they influence the dimensions of the safe zone. The linear predictors should be used to obtain specific values of the posterosuperior limit in each patient. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Scapular Bracing and Alteration of Posture and Muscle Activity in Overhead Athletes With Poor Posture

PubMed Central

Cole, Ashley K; McGrath, Melanie L; Harrington, Shana E; Padua, Darin A; Rucinski, Terri J; Prentice, William E

2013-01-01

Context Overhead athletes commonly have poor posture. Commercial braces are used to improve posture and function, but few researchers have examined the effects of shoulder or scapular bracing on posture and scapular muscle activity. Objective To examine whether a scapular stabilization brace acutely alters posture and scapular muscle activity in healthy overhead athletes with forward-head, rounded-shoulder posture (FHRSP). Design Randomized controlled clinical trial. Setting Applied biomechanics laboratory. Patients or Other Participants Thirty-eight healthy overhead athletes with FHRSP. Intervention(s) Participants were assigned randomly to 2 groups: compression shirt with no strap tension (S) and compression shirt with the straps fully tensioned (S + T). Posture was measured using lateral-view photography with retroreflective markers. Electromyography (EMG) of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) in the dominant upper extremity was measured during 4 exercises (scapular punches, W's, Y's, T's) and 2 glenohumeral motions (forward flexion, shoulder extension). Posture and exercise EMG measurements were taken with and without the brace applied. Main Outcome Measure(s) Head and shoulder angles were measured from lateral-view digital photographs. Normalized surface EMG was used to assess mean muscle activation of the UT, MT, LT, and SA. Results Application of the brace decreased forward shoulder angle in the S + T condition. Brace application also caused a small increase in LT EMG during forward flexion and Y's and a small decrease in UT and MT EMG during shoulder extension. Brace application in the S + T group decreased UT EMG during W's, whereas UT EMG increased during W's in the S group. Conclusions Application of the scapular brace improved shoulder posture and scapular muscle activity, but EMG changes were highly variable. Use of a scapular brace might improve shoulder posture and muscle activity in overhead athletes with poor posture. PMID:23672321

Comprehensive classification test of scapular dyskinesis: A reliability study.

PubMed

Huang, Tsun-Shun; Huang, Han-Yi; Wang, Tyng-Guey; Tsai, Yung-Shen; Lin, Jiu-Jenq

2015-06-01

Assessment of scapular dyskinesis (SD) is of clinical interest, as SD is believed to be related to shoulder pathology. However, no clinical assessment with sufficient reliability to identify SD and provide treatment strategies is available. The purpose of this study was to investigate the reliability of the comprehensive SD classification method. Cross-sectional reliability study. Sixty subjects with unilateral shoulder pain were evaluated by two independent physiotherapists with a visual-based palpation method. SD was classified as single abnormal scapular pattern [inferior angle (pattern I), medial border (pattern II), superior border of scapula prominence or abnormal scapulohumeral rhythm (pattern III)], a mixture of the above abnormal scapular patterns, or normal pattern (pattern IV). The assessment of SD was evaluated as subjects performed bilateral arm raising/lowering movements with a weighted load in the scapular plane. Percentage of agreement and kappa coefficients were calculated to determine reliability. Agreement between the 2 independent physiotherapists was 83% (50/60, 6 subjects as pattern III and 44 subjects as pattern IV) in the raising phase and 68% (41/60, 5 subjects as pattern I, 12 subjects as pattern II, 12 subjects as pattern IV, 12 subjects as mixed patterns I and II) in the lowering phase. The kappa coefficients were 0.49-0.64. We concluded that the visual-based palpation classification method for SD had moderate to substantial inter-rater reliability. The appearance of different types of SD was more pronounced in the lowering phase than in the raising phase of arm movements. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Effects of Rigid Scapular Taping on the Subacromial Space in Athletes With and Without Rotator Cuff Tendinopathy: A Randomized-Controlled Study.

PubMed

Leong, Hio Teng; Fu, Siu Ngor

2018-02-21

Reduction of the subacromial space (SAS) during arm elevation may contribute to rotator cuff tendinopathy. The effects of scapular taping on the SAS in athletes with and without RC tendinopathy is unknown. To investigate the immediate effects of scapular taping on the SAS in athletes with and without RC tendinopathy. Randomized-controlled with repeated measures. University laboratory. Forty-three male volleyball players (17 asymptomatic and 26 with RC tendinopathy, mean age = 22.9±3.5 years) participated in the study. Three scapular taping protocols - no taping (control), taping with tension (therapeutic taping) and taping without tension (sham taping). Ultrasound measurements of the SAS with the arm at 0° and 60° of shoulder abduction, and the change in the SAS between 0° and 60° of shoulder abduction (SAS 0°-60° ) were calculated. Athletes with RC tendinopathy demonstrated larger SAS with therapeutic taping at 60° of shoulder abduction (6.9±1.9 mm vs. 5.8±1.7 mm, mean difference = 1.1 mm, 95% CI = -1.80 - -0.39, p=0.002) when compared to the no taping condition. The tendinopathy group also showed less reduction in the SAS with therapeutic taping during SAS 0°-60° (2.0±1.4 mm vs. 2.8±1.4 mm, p=0.023) when compared to the no taping condition. When tape was applied to the scapula in asymptomatic athletes, our results showed a relatively small increase in the SAS with therapeutic taping during arm resting at 0° of abduction when compared to the no taping condition (8.7±0.9 mm vs. 8.3±0.8 mm, mean difference = 0.4 mm, 95% CI = -0.71 - -0.11, p=0.008). Athletes with RC tendinopathy demonstrated less reduction of the SAS with rigid scapular taping during early arm abduction. Such observation was not evidenced in asymptomatic athletes.

The use of a latissimus dorsi muscle flap for scapular reconstruction in a cat following fibrosarcoma excision.

PubMed

Canapp, S O; Mann, F A; Henry, C J; Lattimer, J C

2001-01-01

A latissimus dorsi muscle flap was used to reconstruct a proximal scapular defect in a cat after excision of a fibrosarcoma that had recurred after eight surgeries, radiation therapy, and chemotherapy. To obtain appropriate surgical margins, infraspinatus and supraspinatus myectomy and scapular spinous ostectomy were performed. The latissimus dorsi muscle flap was rotated into the defect and anchored to four holes placed in the cranial border of the scapula. The cat showed no lameness at 6, 21, 42, and 147 days after surgery. The latissimus dorsi muscle flap was successful for proximal scapular reconstruction in this cat.

[POKING REDUCTION TREATMENT OF DISPLACED SCAPULAR NECK FRACTURE WITH SHOULDER ARTHROSCOPY-ASSISTED SURGERY].

PubMed

Qu, Feng; Yuan, Bangtuo; Qi, Wei; Wang, Junliang; Shen, Xuezhen; Wang, Jiangtao; Zhao, Gang; Liu, Yujie

2014-07-01

To discuss the effectiveness of Poking reduction with shoulder arthroscopy-assisted surgery for displaced scapular neck fracture. Between January 2009 and January 2012, 9 cases of displaced scapular neck fracture underwent shoulder arthroscopy-assisted surgery for Poking reduction treatment. Of 9 cases, 6 were men, and 3 were women, aged 21-54 years (mean, 39 years). The causes were traffic accident injury in 7 cases, falling injury from height in 1 case, and hurt injury in 1 case. The shoulder abduction, flexion, and external rotation were obviously limited. X-ray films showed all cases had obvious displaced scapular neck fracture. Three-dimensional reconstruction of CT showed a grossly displaced of fracture. The time of injury to surgery was 4-27 days (mean, 11 days). Patients obtained healing of incision by first intension, without infection, neurovascular injury, or other surgery-related complications. All patients were followed up 19- 31 months (mean, 23 months). X-ray films showed scapular neck fractures healed from 7 to 11 weeks (mean, 8 weeks). At last follow-up, the shoulder abduction, flexion, and external rotation activity were improved significantly when compared with ones at preoperation (P < 0.05); the shoulder Constant score, American Shoulder and Elbow Surgenos (ASES) score, and Rowe score were significantly better than preoperative scores (P < 0.05). The reduction of displaced scapular neck fracture is necessary, and arthroscopic Poking reduction and fixation for displaced scapular neck fracture can reconstruct the shoulder stability and reduce complications.

Activation of the serratus anterior and upper trapezius in a population with winged and tipped scapulae during push-up-plus and diagonal shoulder-elevation.

PubMed

Park, Se-Yeon; Yoo, Won-Gyu

2015-01-01

Scapular winging and tipping are types of abnormal scapular kinematics, which is caused by not only the entrapment of peripheral nerve, but also imbalance of the scapulothoracic musculatures. The purpose of this study was to investigate the presence of muscular imbalance in the middle and lower parts of the serratus anterior and upper trapezius in people with scapular winging and tipping. Twenty male participants (age, 23.0 ± 1.92 y) were placed into symptomatic group (n = 10) and control group (n = 10). Participants completed two individual trials of a push-up plus, and a diagonal shoulder elevation, while electromyography (EMG) recorded muscle activity of the low and middle serratus anterior and upper trapezius. The root mean squared EMG values for three muscles were normalized using maximum voluntary isometric contractions (%MVIC). The value was calculated using modified isolation equation for comparing activation of middle and lower serratus anterior (%isolation). During a diagonal shoulder elevation, the % maximal voluntary isometric contraction (%MVIC) data showed that the symptomatic participants had significantly greater activation of the middle serratus anterior compared to the control group (P = 0.01). During a diagonal shoulder elevation, the symptomatic participants had not only significantly increased %isolation of the middle serratus anterior, but also significantly decreased for the lower serratus anterior compare with the control group (p = 0.00). Present result indicated that different muscle activation between middle and lower serratus anterior could represent in group with scapular dyskinesis, and need for selective activation of the lower serratus anterior in patients with scapular winging and tipping.

Morphometric study of suprascapular notch in Indian dry scapulae with specific reference to the incidence of completely ossified superior transverse scapular ligament.

PubMed

Kannan, Usha; Kannan, N S; Anbalagan, J; Rao, Sudha

2014-03-01

The suprascapular notch, a depression on the lateral part of the superior border of the scapula, medial to the coracoid process, is bridged by the superior transverse scapular ligament, which is sometimes ossified and the foramen which is thus completed, transmits the suprascapular nerve to the supraspinatus fossa. Variations in the morphology of suprascapular notch have been identified as one of the causes of suprascapular nerve entrapment. Rengachary et al. classified this notch into six types, based on its shape. To study morphological variations of suprascapular notch in Indian dry scapulae and to analyze the incidence of completely ossified superior transverse scapular ligament with other ethnic populations which have been cited earlier. A total of 400 human dry scapulae which were obtained from the Department of Anatomy of selected eight medical colleges were analyzed. The type of suprascapular notch was noted and it was recorded as per the description given by Rengachary et al. The results of the present study were compared with the results of previous authors in different populations. In our study, out of 400 scapulae, 40 (10%), were identified to have completely ossified superior transverse scapular ligaments. The frequencies of various types of suprascapular notches were: Type I -20%, Type II -10%, Type III -52%, Type IV -4%, Type V -4%, Type VI -10%. Since the suprascapular nerve entrapment syndrome might be caused by complete ossification of superior transverse scapular ligament with formation of suprascapular foramen and other morphometric variations of suprascapular notch, the knowledge on such variations is essential for clinicians, for making a proper diagnosis and for planning the most suitable surgical intervention.

THE ROLE OF THE SCAPULA

PubMed Central

Voight, Michael L.

2013-01-01

Previously, the scapular musculature was often neglected in designing a rehabilitation protocol for the shoulder. In the past two decades a significant amount of research has been performed in order to help identify the role of the scapula in upper extremity function. Weakness of the scapular stabilizers and resultant altered biomechanics could result in: 1) abnormal stresses to the anterior capsular structures of the shoulder, 2) increased possibility of rotator cuff compression, and 3) decreased shoulder complex neuromuscular performance. This clinical commentary presents facts about the anatomy and biomechanics of the scapula and surrounding musculature, and describes the pathomechanics of scapular dysfunction. The focus is upon the assessment of dysfunction and retraining of the scapular musculature. Level of Evidence: 5 PMID:24175141

Scapular Stabilization and Muscle Strength in Manual Wheelchair Users with Spinal Cord Injury and Subacromial Impingement.

PubMed

Wilbanks, Susan R; Bickel, C Scott

2016-01-01

Background: Manual wheelchair users with spinal cord injury (SCI) are frequently diagnosed with subacromial impingement. Objective: To determine whether the pattern of muscle imbalance and impaired scapular stabilization in able-bodied (AB) adults with impingement is different from that in manual wheelchair users with SCI and impingement. Methods: The following measurements were collected from 22 adults with subacromial impingement (11 SCI, 11 AB): ratio of normalized muscle electrical activity of upper and lower trapezius (UT:LT) during arm abduction; force during abduction, adduction, internal rotation, external rotation, and push and pull; ratios of force for abduction to adduction (AB:ADD), internal to external rotation (IR:ER), and push to pull (PUSH:PULL). Results: Shoulders with impingement had significantly higher UT:LT activation (1.46 ± 0.52) than shoulders without impingement (0.93 ± 0.45) ( P = .006), regardless of wheelchair user status. Significant differences between AB participants and those with SCI were observed for ABD:ADD ( P = .005), PUSH:PULL ( P = .012), and pull strength ( P = .043). Participants with SCI had a significantly greater ABD:ADD (1.37 ± 0.36) than AB participants (1.04 ± 0.22) ( P = .002) and a significantly greater PUSH:PULL (1.53 ± 0.36) than AB participants (1.26 ± 0.18) ( P = .005) because of decreased strength in adduction ( P = .021) and pull ( P = .013). Conclusions: Strategies targeting the posterior shoulder girdle for AB adults are appropriate for manual wheelchair users with SCI and impingement and should focus on scapular retractors and arm adductors with emphasis on scapular depression and posterior tilting.

Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals.

PubMed

Umehara, Jun; Nakamura, Masatoshi; Nishishita, Satoru; Tanaka, Hiroki; Kusano, Ken; Ichihashi, Noriaki

2018-07-01

Pectoralis minor tightness may be seen in individuals with scapular dyskinesis, and stretching is used for the treatment of altered scapular motion in sports and clinical fields. However, few researchers have reported on the effects of pectoralis minor stiffness on scapular motion during arm elevation. This study investigated whether an acute decrease of pectoralis minor stiffness after stretching changes the scapular motion during arm elevation. The study allocated 15 dominant and 15 nondominant upper limbs in healthy men as control and interventional limbs, respectively. In the intervention limb group, the shoulder was passively and horizontally abducted at 150° of elevation for 5 minutes to stretch the pectoralis minor muscle. Before and after stretching, an electromagnetic sensor was used to examine 3-dimensional scapular motion during abduction and scaption. Ultrasonic shear wave elastography was used to measure pectoralis minor stiffness before and immediately after stretching and after arm elevation. In the interventional limb, pectoralis minor stiffness decreased by 3.2 kPa immediately after stretching and by 2.5 kPa after arm elevation. The maximal changes in scapular kinematics after stretching were 4.8° of external rotation and 3.3° of posterior tilt in abduction, and 4.5° of external rotation and 3.7° of posterior tilt in scaption. Upward rotation in abduction or scaption did not change. Stretching for the pectoralis minor muscle increases external rotation and posterior tilt of the scapula during arm elevation. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Correlation between morphometry of the suprascapular notch and anthropometric measurements of the scapula.

PubMed

Polguj, M; Jędrzejewski, K S; Podgórski, M; Topol, M

2011-05-01

The concept of the study was to find the correlation between the morphometry of the suprascapular notch and basic anthropometric measurements of the human scapula. The measurements of the human scapulae included: morphological length and width, maximal width and length projection of scapular spine, length of acromion, and maximal length of the coracoid process. The glenoid cavity was measured in two perpendicular directions to evaluate its width and length. The width-length scapular and glenoid cavity indexes were calculated for every bone. In addition to standard anthropometric measurements two other measurements were defined and evaluated for every suprascapular notch: maximal depth (MD) and superior transverse diameter (STD). The superior transverse suprascapular ligament was completely ossified in 7% of cases. Ten (11.6%) scapulae had a discrete notch. In the studied material, in 21 (24.4%) scapulae the MD was longer than the STD. Two (2.3%) scapulae had equal maximal depth and superior transverse diameter. In 47 (57.7%) scapulae the superior transverse diameter was longer than the maximal depth. There was no statistically significant difference between anthropometric measurements in the group with higher MD and the group with higher STD. The maximal depth of the suprascapular notch negatively correlated with the scapular width-length index. The maximal depth of the scapular notch correlated with the morphological length of the scapulae.

Fixation of supraglenoid tubercle fractures using distal femoral locking plates in three Warmblood horses.

PubMed

Frei, Sina; Fürst, Anton E; Sacks, Murielle; Bischofberger, Andrea S

2016-05-18

Three horses that were presented with supraglenoid tubercle fractures were treated with open reduction and internal fixation using distal femoral locking plates (DFLP). Placing the DFLP caudal to the scapular spine in order to preserve the suprascapular nerve led to a stable fixation, however, it resulted in infraspinatus muscle atrophy and mild scapulohumeral joint instability (case 1). Placing the DFLP cranial to the scapular spine and under the suprascapular nerve resulted in a stable fixation, however, it resulted in severe atrophy of the supraspinatus and infraspinatus muscles and scapulohumeral joint instability (case 2). Placing the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage site resulted in the best outcome (case 3). Only a mild degree of supraspinatus and infraspinatus muscle atrophy was apparent, which resolved quickly and with no effect on scapulohumeral joint stability. In all cases, fixation of supraglenoid tubercle fractures using DFLP in slightly different techniques led to stable fixations with good long-term outcome. One case suffered from a mild incisional infection and plates were removed in two horses. Placement of the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage prevented major nerve damage. Further cases investigating the degree of muscle atrophy following the use of the DFLP placed in the above-described technique are justified to improve patient outcome.

A multi-subject evaluation of uncertainty in anatomical landmark location on shoulder kinematic description.

PubMed

Langenderfer, Joseph E; Rullkoetter, Paul J; Mell, Amy G; Laz, Peter J

2009-04-01

An accurate assessment of shoulder kinematics is useful for understanding healthy normal and pathological mechanics. Small variability in identifying and locating anatomical landmarks (ALs) has potential to affect reported shoulder kinematics. The objectives of this study were to quantify the effect of landmark location variability on scapular and humeral kinematic descriptions for multiple subjects using probabilistic analysis methods, and to evaluate the consistency in results across multiple subjects. Data from 11 healthy subjects performing humeral elevation in the scapular plane were used to calculate Euler angles describing humeral and scapular kinematics. Probabilistic analyses were performed for each subject to simulate uncertainty in the locations of 13 upper-extremity ALs. For standard deviations of 4 mm in landmark location, the analysis predicted Euler angle envelopes between the 1 and 99 percentile bounds of up to 16.6 degrees . While absolute kinematics varied with the subject, the average 1-99% kinematic ranges for the motion were consistent across subjects and sensitivity factors showed no statistically significant differences between subjects. The description of humeral kinematics was most sensitive to the location of landmarks on the thorax, while landmarks on the scapula had the greatest effect on the description of scapular elevation. The findings of this study can provide a better understanding of kinematic variability, which can aid in making accurate clinical diagnoses and refining kinematic measurement techniques.

Mouse shoulder morphology responds to locomotor activity and the kinematic differences of climbing and running.

PubMed

Green, David J; Richmond, Brian G; Miran, Sara L

2012-12-01

Mechanical loads play a significant role in determining long bone shape and strength, but less work has explored how these loads influence flat bones like the scapula, which has been shown to vary with locomotor preference among primate taxa. Here, we tested the effects of voluntary running and climbing exercise in mice to examine how the mechanical loads borne from different locomotor patterns influence shoulder morphological development. Ninety-nine female wild-type mice were distributed equally among sedentary control, activity-wheel running, and vertical climbing experimental conditions. Running mice had the lowest body masses, larger intrinsic shoulder muscles, and the most pronounced differences in scapular size and shape relative to the other groups. Climbing mouse scapular morphology also differed significantly from the control individuals, but these differences were not as marked as those between the running and control mice. This might be attributable in part to greater levels of activity in the wheel-runners relative to the climbers. Additionally, climbing mice held their bodies closer to the substrate and maintained more flexed limbs and posterior hand positions compared with the kinematics of running. As a result, climbers differed significantly from both the running and control mice in developing a relatively broader infraspinous region, which is likely related to preferential recruitment of the infraspinatus and teres minor muscles to maintain flexed shoulder postures. The results of this study demonstrate that variation in activity level and type of locomotor regime over a significant portion of the life history influences muscle and bone development in the shoulder. Copyright © 2012 Wiley Periodicals, Inc.

Scapulo-humeral arthrodesis using a pedicled scapular pillar graft following resection of the proximal humerus.

PubMed

Padiolleau, G; Marchand, J B; Odri, G A; Hamel, A; Gouin, F

2014-04-01

Scapulo-humeral arthrodesis (SHA) is a proven reconstruction method in patients with proximal humerus malignancies requiring resection of the shoulder abduction apparatus (rotator cuff and deltoid muscles) or its nerve supply. Standard practice consists in using a pedicled fibular flap. We use instead a pedicled autologous bone graft harvested from the ipsilateral scapular pillar. The objective of this study was to assess functional outcomes and radiological healing after SHA using a pedicled scapular pillar graft. We retrospectively reviewed the charts of the 12 patients managed at a single center by a single surgeon between 1994 and 2011. SHA was performed using a vascularised ipsilateral scapular pillar graft after proximal humerus resection to treat a bone malignancy. The graft was harvested from the ipsilateral scapular pillar, pedicled on the circumflex scapular artery, fitted into the remaining proximal humerus, and secured to the glenoid using screws. A humerus-scapular spine plate was added to stabilize the arthrodesis. Radiographic results were assessed on standard radiographs obtained at last follow-up. Functional outcomes were evaluated using the MusculoSkeletalTumour Society (MSTS) score and Toronto Extremity Salvage Score (TESS). After a mean follow-up of 4.9 years, 87.5% of SHA junctions were healed, mean MSTS score was 71%, and mean TESS score was 70%. The outcomes in our patients were similar to those reported after SHA using a pedicled fibular flap. However, our technique does not require microsurgery. It is simple, reproducible, and effective. Its indications of choice are intra- or extra-articular resection of the proximal humerus including the attachments of the rotator cuff and deltoid muscle tendons or the nerves supplying these muscles. Level IV (retrospective study). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Surgical treatment for non-union of the mid-shaft clavicle using a reconstruction plate: scapular malposition is related to poor results.

PubMed

Huang, Teng-Le; Lin, Feng-Huei; Hsu, Horng-Chaung

2009-03-01

A retrospective study was performed to evaluate the use of an AO reconstruction plate in open reduction and internal fixation for non-union of the mid-shaft clavicle, examining the relationship between the position of the scapula and final functional results and whether perioperative variables such as clavicular reconstruction ratio and period of non-union influence the position of the scapula. From January 1998 to January 2005, data on 21 people with symptomatic non-union of the mid-shaft clavicle were collected; 17 non-unions were atrophic and 4 were hypertrophic. Initially, treatment was conservative with a figure-of-eight bandage in 19 cases, and cerclage wire fixation in 2 cases. The follow-up period was 65.7 (24-108) months. Outcome analyses included standard clinical follow-up, plain radiography, the Constant-Murley scoring and subjective assessment. All non-unions united well in 13.6 (11-27) weeks. All patients were satisfied with their surgical results. Greater age and longer period of non-union resulted in a larger amount of scapular malposition, which related to poor functional results.

Rotator cuff exercises

MedlinePlus

... activities, including your shoulder joint and your shoulder blade Observe your spine and posture as you stand ... band Isometric shoulder exercises Wall push-ups Shoulder blade (scapular) retraction - no tubing Shoulder blade (scapular) retraction - ...

Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report.

PubMed

Bhatt, Jiten B; Glaser, Randal; Chavez, Andre; Yung, Emmanuel

2013-11-01

Case report. Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established. The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period. Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner. The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia. Therapy, level 4.

Shoulder Muscle Activation Levels During the Push-Up-Plus Exercise on Stable and Unstable Surfaces.

PubMed

Torres, Rafaela J B; Pirauá, André L T; Nascimento, Vinícius Y S; Dos Santos, Priscila S; Beltrão, Natália B; de Oliveira, Valéria M A; Pitangui, Ana Carolina R; de Araújo, Rodrigo C

2017-07-01

The aim of this study was to evaluate the acute effect of the use of stable and unstable surfaces on electromyography (EMG) activity and coactivation of the scapular and upper-limb muscles during the push-up plus (with full protraction of the scapula). Muscle activation of anterior deltoid (AD), posterior deltoid (PD), pectoralis major, biceps brachii (BB), triceps brachii (TB), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) levels and coactivation index were determined by surface EMG in 20 young men during push-up plus performed on a stable and unstable condition (2 unstable devices applied to hands and feet). The paired t test and Cohen d were used for statistical analysis. The results showed that during the execution of the push-up plus on the unstable surface an increased EMG activity of the scapular stabilizing muscles (SA, MT, and LT) was observed, while AD and PD muscles showed a decrease. During exercise execution on the unstable surface there was a higher index of coactivation of the scapular muscles (SA-MT and UT-LT pairs). No significant differences were observed in TB-BB and AD-PD pairs. These results suggest that the push-up-plus exercise associated with unstable surfaces produced greater EMG activity levels and coactivation index of the scapular stabilizing muscle. On the other hand, the use of an unstable surface does not promote the same effect for the shoulder muscles.

Effect of shoulder girdle strengthening on trunk alignment in patients with stroke.

PubMed

Awad, Amina; Shaker, Hussien; Shendy, Wael; Fahmy, Manal

2015-07-01

[Purpose] This study investigated the effect of shoulder girdle strengthening, particularly the scapular muscles, on poststroke trunk alignment. [Subjects and Methods] The study involved 30 patients with residual hemiparesis following cerebrovascular stroke. Patient assessment included measuring shoulder muscle peak torque, scapular muscles peak force, spinal lateral deviation angle, and motor functional performance. Patients were randomly allocated either to the control group or the study group and received an 18-session strengthening program including active resisted exercises for shoulder abductors and external rotators in addition to trunk control exercises. The study group received additional strengthening exercises for the scapular muscles. [Results] The two groups showed significant improvement in strength of all shoulder and scapular muscles, with higher improvement in the study group. Similarly, the lateral spinal deviation angles significantly improved in both groups, with significantly higher improvement in the study group. Transfer activity, sitting balance, upper limb functions, and hand movements significantly improved in the two groups, with higher improvement in the latter two functions in the study group. [Conclusion] Strengthening of shoulder girdle muscles, particularly scapular muscles, can significantly contribute to improving the postural alignment of the trunk in patients with poststroke hemiparesis.

Different weight bearing push-up plus exercises with and without isometric horizontal abduction in subjects with scapular winging: A randomized trial.

PubMed

Choi, Woo-Jeong; Yoon, Tae-Lim; Choi, Sil-Ah; Lee, Ji-Hyun; Cynn, Heon-Seock

2017-07-01

The aim of the present study was to determine whether the application of isometric horizontal abduction (IHA) differentially affected two weight-bearing push-up plus exercises by examining activation of the scapulothoracic muscles in subjects with scapular winging. Fifteen male subjects performed standard push-up plus (SPP) and wall push-up plus (WPP), with and without IHA. Two-way analyses of variance using two within-subject factors were used to determine the statistical significance of observed differences in upper trapezius (UT), pectoralis major (PM), and serratus anterior (SA) muscle activities and UT/SA and PM/SA muscle activity ratios. UT and SA muscle activities were greater during SPP than WPP. PM muscle activity was lower with IHA application. The UT/SA and PM/SA muscle activity ratios were lower during SPP than WPP. The PM/SA muscle activity ratio was lower with IHA application. The results suggest that IHA application using a Thera-Band can effectively reduce PM muscle activity during SPP and WPP exercises. Moreover, the SPP exercise can be used to increase UT and SA muscle activity and reduce the UT/SA and PM/SA muscle activity ratios in subjects with scapular winging. Copyright © 2016 Elsevier Ltd. All rights reserved.

Three-dimensional assessment of the asymptomatic and post-stroke shoulder: intra-rater test-retest reliability and within-subject repeatability of the palpation and digitization approach.

PubMed

Pain, Liza A M; Baker, Ross; Sohail, Qazi Zain; Richardson, Denyse; Zabjek, Karl; Mogk, Jeremy P M; Agur, Anne M R

2018-03-23

Altered three-dimensional (3D) joint kinematics can contribute to shoulder pathology, including post-stroke shoulder pain. Reliable assessment methods enable comparative studies between asymptomatic shoulders of healthy subjects and painful shoulders of post-stroke subjects, and could inform treatment planning for post-stroke shoulder pain. The study purpose was to establish intra-rater test-retest reliability and within-subject repeatability of a palpation/digitization protocol, which assesses 3D clavicular/scapular/humeral rotations, in asymptomatic and painful post-stroke shoulders. Repeated measurements of 3D clavicular/scapular/humeral joint/segment rotations were obtained using palpation/digitization in 32 asymptomatic and six painful post-stroke shoulders during four reaching postures (rest/flexion/abduction/external rotation). Intra-class correlation coefficients (ICCs), standard error of the measurement and 95% confidence intervals were calculated. All ICC values indicated high to very high test-retest reliability (≥0.70), with lower reliability for scapular anterior/posterior tilt during external rotation in asymptomatic subjects, and scapular medial/lateral rotation, humeral horizontal abduction/adduction and axial rotation during abduction in post-stroke subjects. All standard error of measurement values demonstrated within-subject repeatability error ≤5° for all clavicular/scapular/humeral joint/segment rotations (asymptomatic ≤3.75°; post-stroke ≤5.0°), except for humeral axial rotation (asymptomatic ≤5°; post-stroke ≤15°). This noninvasive, clinically feasible palpation/digitization protocol was reliable and repeatable in asymptomatic shoulders, and in a smaller sample of painful post-stroke shoulders. Implications for Rehabilitation In the clinical setting, a reliable and repeatable noninvasive method for assessment of three-dimensional (3D) clavicular/scapular/humeral joint orientation and range of motion (ROM) is currently required. The established reliability and repeatability of this proposed palpation/digitization protocol will enable comparative 3D ROM studies between asymptomatic and post-stroke shoulders, which will further inform treatment planning. Intra-rater test-retest repeatability, which is measured by the standard error of the measure, indicates the range of error associated with a single test measure. Therefore, clinicians can use the standard error of the measure to determine the "true" differences between pre-treatment and post-treatment test scores.

A computerized photographic method to evaluate changes in head posture and scapular position following rapid palatal expansion: a pilot study.

PubMed

Cerruto, Carmen; Di Vece, Luca; Doldo, Tiziana; Giovannetti, Agostino; Polimeni, Antonella; Goracci, Cecilia

2012-01-01

To assess the applicability of a computerized method to measure on digital photographs the changes in head and scapular posture following rapid palatal expansion (RPE) treatment. Randomized controlled trial. Twenty-three children (age 9.2 +/- 70.88 years) diagnosed with maxillary constriction were randomly divided into two groups: 1. Study group (n = 12): patients receiving RPE treatment; 2. Untreated controls (n = 11). Postural measurements were taken on frontal, lateral, and dorsal views of each subject. In the study group measurements were taken at T0 (the day orthodontic records were taken), T1 (end of RPE active phase), and T2 (RPE removal). In controls the same observations were conducted at T0 and T1(98.18 +/- 36.01 days after T0). Measurements were statistically analyzed (Intraclass Correlation Coefficient, t-tests, Signed Rank test, One-Way Repeated Measures Analysis of Variance, Tukey test; p < 0.05). In the study group a significant reduction in forward head posture (FHP) occurred between T0 and T1. Forward shoulder posture (FSP) decreased significantly between T1 and T2. At T1 treated patients exhibited significantly lower values of the measurements indicating FHP and FSP than controls. Changes in head and scapular posture following RPE treatment can be documented with computerized measurements on digital photographs.

Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads.

PubMed

de Toledo, Joelly Mahnic; Loss, Jefferson Fagundes; Janssen, Thomas W; van der Scheer, Jan W; Alta, Tjarco D; Willems, W Jaap; Veeger, DirkJan H E J

2012-10-01

Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe shoulder kinematics and determine the contribution of the scapulothoracic joint to total shoulder motion of patients with total and reverse shoulder arthroplasties and of healthy individuals during rehabilitation exercises (anteflexion and elevation in the scapular plane) using different loading conditions (without external load, 1 kg and elastic resistance). Shoulder motions were measured using an electromagnetic tracking device. A force transducer was used to record force signals during loaded conditions using elastic resistance. Statistical comparisons were made using a three-way repeated-measures analysis of variance with a Bonferroni post hoc testing. The scapula contributed more to movement of the arm in subjects with prostheses compared to healthy subjects. The same applies for loaded conditions (1 kg and elastic resistance) relative to unloaded tasks. For scapular internal rotation, upward rotation and posterior tilt no significant differences among groups were found during both exercises. Glenohumeral elevation angles during anteflexion were significantly higher in the total shoulder arthroplasty group compared to the reverse shoulder arthroplasty group. Differences in contribution of the scapula to total shoulder motion between patients with different types of arthroplasties were not significant. However, compared to healthy subjects, they were. Furthermore, scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. Copyright © 2012 Elsevier Ltd. All rights reserved.

Short-Term Effects of Thoracic Spine Manipulation on Shoulder Impingement Syndrome: A Randomized Controlled Trial.

PubMed

Haik, Melina N; Alburquerque-Sendín, Francisco; Camargo, Paula R

2017-08-01

To investigate the short-term effects of thoracic spine manipulation (TSM) on pain, function, scapular kinematics, and scapular muscle activity in individuals with shoulder impingement syndrome. Randomized controlled trial with blinded assessor and patient. Laboratory. Patients with shoulder impingement syndrome (N=61). Participants were randomly allocated to TSM group (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. Scapular kinematics and muscle activity were measured at day 1 (baseline, before the first intervention), day 2 preintervention (before second intervention), day 2 postintervention (after the second intervention), and day 3 (follow-up). Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff Index at baseline, day 2 preintervention, and follow-up. An assessor blinded to group assignment measured all outcomes. Pain decreased by 0.7 points (95% confidence interval, 1.3-0.1 points) at day 2 preintervention and 0.9 points (95% confidence interval, 1.5-0.3 points) at day 2 postintervention in the TSM group. The Disability of the Arm, Shoulder and Hand questionnaire (P=.01) and Western Ontario Rotator Cuff Index (P=.02) scores improved in both groups. Scapular upward rotation increased during arm lowering (P<.01) at day 2 postintervention (5.3°) and follow-up (3.5°) in the TSM group. Upper trapezius activity increased (P<.05) in the sham-TSM group. Middle trapezius, lower trapezius, and serratus anterior decreased activities in both groups during elevation and lowering of the arm. TSM may increase scapular upward rotation during arm lowering. TSM does not seem to influence activity of the scapular muscles. The results concerning shoulder pain, function, scapular tilt, and internal rotation are not conclusive. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Glenosphere size in reverse shoulder arthroplasty: is larger better for external rotation and abduction strength?

PubMed

Müller, Andreas M; Born, Marian; Jung, Christian; Flury, Matthias; Kolling, Christoph; Schwyzer, Hans-Kaspar; Audigé, Laurent

2018-01-01

The role of glenosphere size in reverse shoulder arthroplasty (RSA) may be important in prosthetic stability, joint kinematics, rotator cuff tension and excursion, scapular impingement, humeral lateralization, deltoid wrap, and the occurrence of "notching." This study compared short- and midterm clinical and radiographic outcomes for 2 different glenosphere sizes of a single RSA type with respect to implant positioning, glenoid size, and morphology. This retrospective analysis included 68 RSA procedures that were prospectively documented in a local register during a 5-year postoperative period. Two glenosphere diameter sizes of 36 mm (n = 33) and 44 mm (n = 35) were used. Standard radiographs were made preoperatively (ie, baseline) and at 6, 12, 24, and 60 months after surgery. Range of motion, strength, the Constant-Murley score, and the Shoulder Pain and Disability Index were also assessed at all follow-up visits. The effect of glenosphere size on measured outcomes was adjusted for baseline values, patient gender, and humeral head diameter. No significant differences were found in the functional scores between treatment groups at all follow-up assessments. At the 12-month follow-up, patients with a 44-mm glenosphere had greater external rotation in adduction (mean difference, 12°; P = .001) and abduction strength (mean difference, 1.4 kg; P = .026) compared with those with the smaller implant. These differences remained at 60 months. Scapular notching was observed in 38% of all patients, without any relevant difference between the groups. An increase in glenosphere diameter leads to a clinically moderate but significant increase in external rotation in adduction and abduction strength at midterm follow-up. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Characteristic scapular and rib changes on chest radiographs of children with ADA-deficiency SCIDS in the first year of life.

PubMed

Manson, David; Diamond, Lauren; Oudjhane, Kamaldine; Hussain, Faisal Bin; Roifman, Chaim; Grunebaum, Eyal

2013-03-01

We describe radiographic changes in the ribs and scapulae seen in the first 6 months of life in children with ADA (adenosine deaminase) deficiency severe combined immundeficiency syndrome (SCIDS). We suggest that these changes are reversible with appropriate enzyme replacement therapy. The purpose of this study was to describe characteristic rib and scapular radiographic changes in infants with ADA-deficiency SCIDS. This was a retrospective review of chest radiographs of nine children with ADA-deficiency SCIDS performed in the first year of life by two experienced pediatric radiologists. A control cohort of unaffected children was used for comparison. All children with ADA-deficiency SCIDS manifested unusual scapular spurring and anterior rib cupping. None of the control children manifested these changes. Characteristic and reversible scapular and rib changes in the correct clinical setting should suggest an early diagnosis of ADA deficiency, prompting appropriate diagnostic and therapeutic measures.

Electromyography of 3 scapular muscles: a comparative analysis of the cuff link device and a standard push-up.

PubMed

Tucker, W Steven; Campbell, Brian M; Swartz, Erik E; Armstrong, Charles W

2008-01-01

The Cuff Link is a closed kinetic chain rehabilitation apparatus for the upper extremity. Limited research has established its effectiveness to elicit muscle activation of the scapular muscles. To determine if scapular muscle activation differs in response to 2 upper extremity closed kinetic chain exercises: Cuff Link and standard push-up. A single-group, repeated-measures design. Controlled laboratory. Twenty-eight healthy individuals (13 women: age = 19.69 +/- 1.55 years, height = 167.44 +/- 9.52 cm, mass = 61.00 +/- 8.79 kg; 15 men: age = 22.00 +/- 3.91 years, height = 181.44 +/- 6.60 cm, mass = 82.36 +/- 13.23 kg) with no history of shoulder or low back injury volunteered to participate in this study. Participants performed 10 trials of complete revolutions on the Cuff Link and 10 full-weight-bearing push-ups. We controlled trial velocity and randomized order. Trunk and shoulder positions were normalized to the participant's height. Using surface electromyography, we recorded muscle activity of the serratus anterior, middle trapezius, and lower trapezius. Rectified and smoothed electromyography data for the serratus anterior, middle trapezius, and lower trapezius were normalized as a percentage of the maximal voluntary isometric contractions (%MVIC). Mean muscle activity of the serratus anterior, middle trapezius, and lower trapezius. We used paired-samples t tests to analyze the mean data for each condition. The alpha level was adjusted to .016 to avoid a type I error. Middle trapezius %MVIC was greater during push-ups (27.01 +/- 20.40%) than during use of the Cuff Link (11.49 +/- 9.46%) (P = .001). Lower trapezius %MVIC was greater during push-ups (36.07 +/- 18.99%) than during use of the Cuff Link (16.29 +/- 8.64%) (P = .001). There was no difference in %MVIC for the serratus anterior between conditions. The push-up demonstrated greater middle trapezius and lower trapezius activation levels compared with the Cuff Link. However, the push-up had a high participant failure rate. Because serratus anterior activation levels were similar, the Cuff Link may be an appropriate alternative for individuals lacking the upper body strength to perform a push-up.

Evaluation of a new baseplate in reverse total shoulder arthroplasty - comparison of biomechanical testing of stability with roentgenological follow up criteria.

PubMed

Irlenbusch, U; Kohut, G

2015-04-01

To minimize notching problem associated with reversed prostheses, inferior positioning of base plate is recommended. This reduces the risk of notching, but does not eliminate it completely. Both polyethylene/PE-induced osteolysis and implant-to-bone or implant-to-implant contact may still occur, contributing to the risk of screw-breakage and resulting long-term failure. Therefore, the stability and integration of a newly developed base plate without inferior screw and inversion of bearing materials was investigated. Biomechanical assessment of primary stability of the two types of glenoid baseplate (1- and 2-pegged) was carried out according to ASTM F-2028-02 (American Society for Testing and Materials). Patients with a follow-up period of at least 2 years were clinically (n=78) and for most of them radiologically (n=61) examined. The X-rays were evaluated for loosening and scapular notching. The mean values of micromotions after 100,000 cycles showed no relevant differences between the 2-peg and the 1-peg base plates (47 μm for the 2-peg design and 43 μm for the 1-peg design), i.e. both were below the borderline for secure Osseointegration of 150 μm. Radiologically, no signs of loosening or radiolucent lines/RLL were found for both base plates. The mean incidence of inferior scapular notching was 23.6% (42 mm glenoid sphere: 15.8%). Only grade 1 and grade 2 notching was observed. Additionally as result of absence of PE-induced osteolysis shape, size, borderline and location of notching differed from those observed with conventional reverse total shoulder arthroplasty bearing materials. In combination with modified inferior operating technique, the newly designed implant has the potential to reduce the incidence of scapular notching and to avoid both PE-induced osteolysis and metal-screw contact. The new design did not compromise stability of the base plate in any way during the investigation period, as demonstrated both by the data from the biomechanical investigation and also by the radiological follow-up. Level III, case-control study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Reconstruction of the maxilla following hemimaxillectomy defects with scapular tip grafts and dental implants.

PubMed

Mertens, Christian; Freudlsperger, Christian; Bodem, Jens; Engel, Michael; Hoffmann, Jürgen; Freier, Kolja

2016-11-01

Treatment of post-resective defects of the maxilla can be challenging and usually requires dental obturation or microvascular reconstruction. As compared to soft-tissue microvascular grafts, bone reconstruction can additionally allow for facial support and retention of dental implants. The aim of this study was to evaluate scapular tip grafts with respect to their applicability for maxillary reconstruction and their potential to retain dental implants for later dental rehabilitation. In this retrospective study, 14 patients with hemimaxillectomy defects were reconstructed with free scapular tip grafts, oriented horizontally, to rebuild the palate and alveolar ridge. After bone healing, three-dimensional virtual implant planning was performed, and a radiographic guide was fabricated to enable implant placement in the optimal anatomic and prosthetic position. All patients' mastication and speech were evaluated, along with the extent of defect closure, suitability of the graft sites for implant placement, and soft-tissue stability. Pre- and postsurgical radiographs were also evaluated. A good postoperative outcome was achieved in all patients, with complete closure of maxillary defects that were class II, according to the system of Brown and Shaw. Additional bone augmentation was necessary in two patients in order to increase vertical bone height. Patients were subsequently treated with 50 dental implants to retain dental prostheses. In all cases, additional soft-tissue surgery was necessary to achieve a long-term stable periimplant situation. No implants were lost during the mean observation period of 34 months. Due to its specific form, the scapular tip graft is well suited to reconstruct the palate and maxillary alveolar ridge and to enable subsequent implant-retained rehabilitation. Due to the limited bone volume, an accurate three-dimensional graft orientation is essential. Furthermore, most cases require additional soft-tissue surgery to achieve a long-term stable periimplant situation. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Early history of scapular fractures.

PubMed

Bartoníček, Jan; Kozánek, Michal; Jupiter, Jesse B

2016-01-01

The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939.

The posterior two-portal approach for reconstruction of scapula fractures: results of 39 patients.

PubMed

Pizanis, A; Tosounidis, G; Braun, C; Pohlemann, T; Wirbel, R J

2013-11-01

The purpose of this study was to describe the so-called posterior two-portal approach to the scapula in detail and to investigate the clinical outcome of patients with displaced glenoid and scapular neck fractures who were surgically treated using this approach. From February 1992 to August 2008, 39 patients (30 men and nine women; mean age: 53 years) with scapular fractures underwent surgical fixation at our institution. Thirty-three patients had glenoid fractures and six had unstable scapular neck fractures. All patients were treated via the two-portal approach. The reduction was evaluated radiographically, and the clinical results were analysed using the Constant score. The mean follow-up period was 78 months (range: 6-168). In 24 of the 33 glenoid fractures, the reduction was anatomical. The mean Constant score was 82.3 (range: 35-100) points. In one case, an early postoperative wound infection was cured by local revision, and one patient developed posttraumatic osteoarthritis of the acromioclavicular joint after 2 years. Only one patient developed specific glenohumeral degeneration after non-anatomical reduction. The posterior two-portal approach allows for a good visualisation of the posterior scapular neck and the glenoid area, facilitating the reduction and safe internal fixation of dislocated scapular neck and glenoid fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

Influence of fatigue and velocity on the latency and recruitment order of scapular muscles.

PubMed

Mendez-Rebolledo, Guillermo; Gatica-Rojas, Valeska; Guzman-Muñoz, Eduardo; Martinez-Valdes, Eduardo; Guzman-Venegas, Rodrigo; Berral de la Rosa, Francisco Jose

2018-07-01

To determine the influence of velocity and fatigue on scapular muscle activation latency and recruitment order during a voluntary arm raise task, in healthy individuals. Cross-sectional study. University laboratory. Twenty three male adults per group (high-velocity and low-velocity). Onset latency of scapular muscles [Anterior deltoid (AD), lower trapezius (LT), middle trapezius (MT), upper trapezius (UT), and serratus anterior (SA)] was assessed by surface electromyography. The participants were assigned to one of two groups: low-velocity or high-velocity. Both groups performed a voluntary arm raise task in the scapular plane under two conditions: no-fatigue and fatigue. The UT showed early activation (p < 0.01) in the fatigue condition when performing the arm raise task at a high velocity. At a low velocity and with no muscular fatigue, the recruitment order was MT, LT, SA, AD, and UT. However, the recruitment order changed in the high-velocity with muscular fatigue condition, since the recruitment order was UT, AD, SA, LT, and MT. The simultaneous presence of fatigue and high-velocity in an arm raise task is associated with a decrease in the UT activation latency and a modification of the recruitment order of scapular muscles. Copyright © 2018 Elsevier Ltd. All rights reserved.

Fractures of the scapula: long-term results after conservative treatment.

PubMed

Schofer, Markus D; Sehrt, Axel C; Timmesfeld, Nina; Störmer, Sabine; Kortmann, Horst R

2009-11-01

The aim of this study was to determine the long-term prognoses for conservatively treated fractures of the scapula. Ascertainment of functional long-term results in 50 patients treated for a total of 51 scapular fractures in a retrospective cohort study with an average follow-up period of 65 months. The breakdown of these scapular fractures was as follows: simple (22%) and fragmented (51%) fractures of the scapular body, fractures through the scapular neck (41%), fractures of the coracoid process, spine and acromion of the scapula (10%) and glenoid fractures (8%). In 17 of these cases of scapular fracture two or more types were present. At the follow-up examination a restricted range of movement was found in all directions. In abduction, flexion and external rotation the range of motion on the affected as against the unaffected side was significantly restricted, but the observed restriction did not substantially affect the functional results. The Constant score on the affected side was 79 points, with 23% very good, 51% good, 20% satisfactory and 6% poor results. Isokinetic testing carried out on both sides for comparison revealed lower peak torque values and lower mean power output in all planes of movement, and lower speeds on the affected side. There was a correlation between extent of restriction on movement and diminution of isokinetic muscular strength. Determination of the external rotation is recommended as a clinical test value, as it highlights significant deficits both in restriction of range of motion and in isokinetic test measurements. The outcome of treatment was not influenced by fracture type, associated injuries or handedness. After conservative treatment, scapular fractures heal with a good functional result despite measurable restrictions.

Acute effects of scapular Kinesio Taping® on shoulder rotator strength, ROM and acromiohumeral distance in asymptomatic overhead athletes.

PubMed

Harput, Gulcan; Guney, Hande; Toprak, Ugur; Colakoglu, Filiz; Baltaci, Gul

2017-11-01

There is limited information in the literature that shows whether scapular taping has an effect on the acromiohumeral distance (AHD) and shoulder functions. The aim of this study was to investigate the acute effects of scapular Kinesio Taping® on shoulder internal rotation (IR) and external rotation (ER) strength, IR and ER range of motion (ROM) and AHD in asymptomatic overhead athletes. Forty-one volleyball athletes (24 men, 17 women; mean age: 16.1±1.5 years, body mass: 66.5±9.6 kg, body height: 179.6±8.4 cm, Body Mass Index: 20.5±2.3 kg/m2, time participating in overhead sports activity: 6.2±1.4 h/week, experience in sport: 4.1±2.4 years) were included in this study. Shoulder IR and ER ROM, total rotation ROM, AHD, shoulder isometric IR and ER strength and ER:IR strength ratio of the dominant side were tested before and after taping. Scapular taping increased the shoulder IR (P<0.001) and total ROM (P<0.001), AHD (P<0.001), shoulder IR (P=0.002) and ER (P=0.006) strength. ER ROM and ER:IR ratio did not change after taping (P=0.26, P=0.98, respectively). The results of this study suggest that scapular taping could be an effective method for enhancing the acromiohumeral distance, shoulder rotator strength and range of motion. Therefore, scapular taping could be recommended for not only in the asymptomatic athletes' shoulder exercise training but also in the prevention of subacromial impingement syndrome.

Dorsal scapular nerve neuropathy: a narrative review of the literature

PubMed Central

Muir, Brad

2017-01-01

Objective The purpose of this paper is to elucidate this little known cause of upper back pain through a narrative review of the literature and to discuss the possible role of the dorsal scapular nerve (DSN) in the etiopathology of other similar diagnoses in this area including cervicogenic dorsalgia (CD), notalgia paresthetica (NP), SICK scapula and a posterolateral arm pain pattern. Background Dorsal scapular nerve (DSN) neuropathy has been a rarely thought of differential diagnosis for mid scapular, upper to mid back and costovertebral pain. These are common conditions presenting to chiropractic, physiotherapy, massage therapy and medical offices. Methods The methods used to gather articles for this paper included: searching electronic databases; and hand searching relevant references from journal articles and textbook chapters. Results One hundred-fourteen articles were retrieved. After removing duplicates, there were 57 articles of which 29 were retrieved. There were 26 articles and textbook chapters retrieved by hand searching equaling 55 articles retrieved of which 47 relevant articles were used in this report. Discussion The anatomy, pathway and function of the dorsal scapular nerve can be varied and exceptionally rarely may include a sensory component. The signs and symptoms, therefore, may include pain, atrophy, scapular winging, and dysesthesia. The mechanism of injury to the DSN is also quite varied ranging from postural to overuse in overhead work and sport. Other conditions in this area, including CD, NP, SICK scapula and a posterolateral arm pain pattern bear a striking resemblance to DSN neuropathy. Conclusion DSN neuropathy should be included in the list of common differential diagnoses of upper and mid-thoracic pain, stiffness, dysesthesia and dysfunction. The study also brings forward interesting connections between DSN neuropathy, CD, NP, SICK scapula and a posterolateral arm pain pattern. PMID:28928496

Scapular tip and latissimus dorsi osteomyogenous free flap for the reconstruction of a maxillectomy defect: A minimally invasive transaxillary approach.

PubMed

Park, Sung Joon; Jeong, Woo-Jin; Ahn, Soon-Hyun

2017-11-01

The purpose of this study was to propose a novel, minimally invasive transaxillary approach for harvesting the scapular tip and latissimus dorsi osteomyogenous free flap for the reconstruction of a maxillectomy defect. A retrospective case series study of 4 patients who underwent reconstruction using a scapular tip composite free flap through the transaxillary approach was conducted. The data (age, sex, pathology, previous treatment and adjuvant treatment) were collected and analysed. Total operation time, number of hospital days and the cosmetic and functional outcome of reconstruction were analysed. Two male and two female patients were enrolled in this study. The patients' ages ranged from 52 to 59 years. All the patients had maxillectomy defects, with at least a classification of Okay type II, which were successfully reconstructed using a scapular tip and latissimus dorsi free flap through a minimally invasive transaxillary approach. The entire operation time for the primary tumour surgery and reconstruction ranged from 6.2 to 12.1 h (mean, 11.1 h). The average length of the hospital stay was 13 days (range, 10-16 days). No major donor site morbidity was observed, and there was no graft failure that required revision or exploration surgery. The minimally invasive transaxillary approach for harvesting the scapular tip and latissimus dorsi osteomyogenous free flap for the reconstruction of maxillectomy defect is a promising approach for more favourable functional and aesthetic outcomes when compared to the use of other bone containing free flaps and the classic approach for harvesting scapular tip and latissimus dorsi free flap. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Stretching position can affect levator scapular muscle activity, length, and cervical range of motion in people with a shortened levator scapulae.

PubMed

Jeong, Hyo-Jung; Cynn, Heon-Seock; Yi, Chung-Hwi; Yoon, Jang-Whon; Lee, Ji-Hyun; Yoon, Tae-Lim; Kim, Bo-Been

2017-07-01

Levator scapulae (LS) muscle stretching exercises are a common method of lengthening a shortened muscle; however, the appropriate stretching position for lengthening the LS in people with a shortened LS remains unclear. The purpose of this study was to compare the effects of different stretching exercise positions on the LS and introduce effective stretching exercise methods to clinicians. Twenty-four university students (12 men, 12 women) with a shortened LS were recruited. LS muscle activity, LS index (LSI), and cervical range of motion (ROM) were measured pre (baseline) and post three different stretching exercise positions (sitting, quadruped, and prone). The LSI and cervical ROM exceeded the minimal detectable change and had significant changes. The LSI was greater in the sitting position than at the baseline (p = 0.01), quadruped position (p < 0.01); the LSI in the prone position presented a higher increase than the quadruped position (p = 0.01). The cervical ROM increased in the sitting position when compared to the baseline (p < 0.01) and quadruped position (p < 0.01). Stretching the LS in the sitting position was the most effective exercise for improving LS muscle length and cervical ROM. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prevention of shoulder injuries in overhead athletes: a science-based approach

PubMed Central

Cools, Ann M.; Johansson, Fredrik R.; Borms, Dorien; Maenhout, Annelies

2015-01-01

The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength. PMID:26537804

Comparative shoulder kinematics during free standing, standing depression lifts and daily functional activities in persons with paraplegia: considerations for shoulder health.

PubMed

Riek, L M; Ludewig, P M; Nawoczenski, D A

2008-05-01

Case series; nonparametric repeated-measures analysis of variance. To compare and contrast three-dimensional shoulder kinematics during frequently utilized upper extremity weight-bearing activities (standing depression lifts used in brace walking, weight-relief raises, transfers) and postures (sitting rest, standing in a frame) in spinal cord injury (SCI). Movement Analysis Laboratory, Department of Physical Therapy, Ithaca College, Rochester, NY, USA. Three female and two male subjects (39.2+/-6.1 years old) at least 12 months post-SCI (14.6+/-6.7 years old), SCI distal to T2 and with an ASIA score of A. The Flock of Birds magnetic tracking device was used to measure three-dimensional positions of the scapula, humerus and thorax during various activities. Standing in a frame resulted in significantly less scapular anterior tilt (AT) and greater glenohumeral external rotation (GHER) than standing depression lifts and weight-relief raises. Standing frame posture offers the most favorable shoulder joint positions (less scapular AT and greater GHER) when compared to sitting rest posture, weight-relief raises, transfers and standing depression lifts. Knowledge of kinematic patterns associated with each activity is an essential first step to understanding the potential impact on shoulder health. Choosing specific activities or modifying techniques within functional activities that promote favorable shoulder positions may preserve long-term shoulder health.

Effects of the humeral tray component positioning for onlay reverse shoulder arthroplasty design: a biomechanical analysis.

PubMed

Berhouet, Julien; Kontaxis, Andreas; Gulotta, Lawrence V; Craig, Edward; Warren, Russel; Dines, Joshua; Dines, David

2015-04-01

Recent shoulder prostheses have introduced a concept of a universal humeral stem component platform that has an onlay humeral tray for the reverse total shoulder arthroplasty (RTSA). No studies have reported how humeral tray positioning can affect the biomechanics of RTSA. The Newcastle Shoulder Model was used to investigate the biomechanical effect of humeral tray positioning in the Biomet Comprehensive Total Shoulder System (Biomet, Warsaw, IN, USA) RTSA. Five humeral tray configuration positions were tested: no offset, and 5 mm offset in the anterior, posterior, medial, and lateral positions. Superior and inferior impingement were evaluated for abduction, scapular plane elevation, forward flexion, and external/internal rotation with the elbow at the side (adduction) and at 90° of shoulder abduction. Muscle lengths and moment arms (elevating and rotational) were calculated for the deltoid, the infraspinatus, the teres minor, and the subscapularis. Inferior impingement was not affected by the humeral tray position. There was less superior impingement during abduction, scapular plane elevation, and rotation with the shoulder when the tray was placed laterally or posteriorly. The subscapularis rotational moment arm was increased with a posterior offset, whereas infraspinatus and teres minor rotational moment arms were increased with an anterior offset. Very little change was observed for the deltoid elevating moment arm or for its muscle length. Positioning the humeral tray with posterior offset offers a biomechanical advantage for patients needing RTSA by decreasing superior impingement and increasing the internal rotational moment arm of the subscapularis, without creating inferior impingement. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up.

PubMed

Merolla, Giovanni; Walch, Gilles; Ascione, Francesco; Paladini, Paolo; Fabbri, Elisabetta; Padolino, Antonio; Porcellini, Giuseppe

2018-04-01

There are few investigations comparing lateralized and medialized reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy. This study assessed the outcomes of 2 RTSA designs. Sixty-eight consecutive cuff tear arthropathy patients (74 shoulders) with a follow-up of at least 24 months received a Grammont or an onlay curved short-stem humeral component, with or without glenoid lateralization; a cementless humeral stem was implanted in >90%. Clinical outcome measures included active range of motion (anterior and lateral elevation, external and internal rotation), pain, and the Constant-Murley score. Radiologic outcomes included radiolucency, condensation lines, cortical thinning, spot weld, loosening and subsidence, and tuberosity resorption for the humeral component and radiolucency, scapular notching, formation of scapular bone spurs, ossifications, and loosening for the glenoid component. Both prostheses provided significant differences between preoperative and postoperative scores and showed a similar complication rate. Scapular fractures were found only in the patients who received the curved short-stem implant. Glenoid bone grafting did not significantly affect clinical scores. Both implants provided similar postoperative shoulder mobility, even though the lateralized curved stem was associated with higher delta scores for external rotation (P = .002) and lower rates of scapular notching (P = .0003), glenoid radiolucency (P = .016), and humeral bone remodeling (P = .004 and P = .030 for cortical thinning and spot weld, respectively). Medialized and short-stem lateralized RTSA implants provided similar midterm clinical outcomes and range of motion. The curved short stem was associated with higher delta scores for external rotation and a lower rate of radiographic risk factors. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Increased strength of the scapular stabilizer and lumbar muscles after twelve weeks of Pilates training using the Reformer machine: A pilot study.

PubMed

Dos Santos, Núbia Tomain Otoni; Raimundo, Karoline Cipriano; da Silva, Sheila Aparecida; Souza, Lara Andrade; Ferreira, Karoline Carregal; Borges Santo Urbano, Zuleika Ferreira; Gasparini, Andréa Licre Pessina; Bertoncello, Dernival

2017-01-01

The aim of this work was to analyze muscle strength in Pilates novices who used the Reformer equipment during twelve training sessions. Twenty-four healthy young female volunteers, who were non-smokers and did not exercise regularly, were split into a control group (mean age 28 ± 4 years and BMI 24.55 ± 3.21 kg/m 2 ) and a training group (mean age 29 ± 4 years and BMI 22.69 ± 2.87 kgm 2 ). The data were checked for normality using the Kolmogorov-Smirnov test, and were then analyzed using the t-test (p < 0.05). After the training sessions, there were statistically significant differences between the groups for the scapular stabilizer muscles (p = 0.0263) and the lumbar muscles (p = 0.0001). For the scapular stabilizers, the initial/final values were 14.69 ± 2.80/14.79 ± 2.89 (control group) and 15.99 ± 3.54/17.44 ± 2.88 (Pilates group). The corresponding values for the lumbar muscles were 53.83 ± 11.66/53.28 ± 11.14 (control group) and 54.75 ± 10.27/64.80 ± 10.20 (Pilates group). After twelve sessions of Pilates with the Reformer equipment, there were improvements in lumbar extensor and scapular stabilizer strength. Several benefits are reported by practitioners of Pilates, but until now, there has been limited scientific evidence of the improvement of strength in the trunk and limbs after application of the technique. Published by Elsevier Ltd.

Scapular Resting Position and Gleno-Humeral Movement Dysfunction in Asymptomatic Racquet Players: A Case-Control Study

PubMed Central

Shimpi, Apurv P.; Bhakti, Shah; Roshni, Karnik; Rairikar, Savita A.; Shyam, Ashok; Sancheti, Parag K.

2015-01-01

Background: Racquet sports, especially lawn tennis and badminton have been gaining popularity in Asian countries like India. With this increase in popularity, the injury rate in the sport has also increased. Objectives: The study will help detect the presence of gleno-humeral movement dysfunction and scapular resting position abnormality in asymptomatic racquet players, thus providing basis for screening the players and allow the clinician to determine if the asymmetry is a normal adaptation in the player or an abnormal change associated with injury. Materials and Methods: 46 asymptomatic professional players were divided into a study group of 23 players (16 tennis and 7 badminton) and control group of 23 football players. Assessment of passive gleno-humeral range of motion and distance of spine and inferior angle of scapula from corresponding spinous process were measured bilaterally and between groups. Results: There was statistically significant reduction in range of internal rotation (62.17 ± 8.09), extension (39.78 ± 4.12) and an increase in the external rotation (106.95 ± 7.49) of dominant compared to non-dominant arm of racquet players and a statistically significant decrease in internal rotation (78.69 ± 10.24), extension (44.78 ± 3.19), adduction (37.39 ± 6.54) and an increase in external rotation (102.6 ± 5.19) of dominant arm of racquet players compared to football players. Study also showed statistically significant increase in the spino-scapular distance at the level of inferior angle of scapula (10.23 ± 1.43) on dominant side compared to non-dominant. Conclusions: The dominant side scapula of asymptomatic racquet players showed increased external rotation and elevation as compared to the non-dominant side. Also, reduced shoulder internal rotation, extension and adduction and gain in shoulder external rotation was observed on the dominant side of racquet players when compared to the control group. PMID:26715968

Scapular Resting Position and Gleno-Humeral Movement Dysfunction in Asymptomatic Racquet Players: A Case-Control Study.

PubMed

Shimpi, Apurv P; Bhakti, Shah; Roshni, Karnik; Rairikar, Savita A; Shyam, Ashok; Sancheti, Parag K

2015-12-01

Racquet sports, especially lawn tennis and badminton have been gaining popularity in Asian countries like India. With this increase in popularity, the injury rate in the sport has also increased. The study will help detect the presence of gleno-humeral movement dysfunction and scapular resting position abnormality in asymptomatic racquet players, thus providing basis for screening the players and allow the clinician to determine if the asymmetry is a normal adaptation in the player or an abnormal change associated with injury. 46 asymptomatic professional players were divided into a study group of 23 players (16 tennis and 7 badminton) and control group of 23 football players. Assessment of passive gleno-humeral range of motion and distance of spine and inferior angle of scapula from corresponding spinous process were measured bilaterally and between groups. There was statistically significant reduction in range of internal rotation (62.17 ± 8.09), extension (39.78 ± 4.12) and an increase in the external rotation (106.95 ± 7.49) of dominant compared to non-dominant arm of racquet players and a statistically significant decrease in internal rotation (78.69 ± 10.24), extension (44.78 ± 3.19), adduction (37.39 ± 6.54) and an increase in external rotation (102.6 ± 5.19) of dominant arm of racquet players compared to football players. Study also showed statistically significant increase in the spino-scapular distance at the level of inferior angle of scapula (10.23 ± 1.43) on dominant side compared to non-dominant. The dominant side scapula of asymptomatic racquet players showed increased external rotation and elevation as compared to the non-dominant side. Also, reduced shoulder internal rotation, extension and adduction and gain in shoulder external rotation was observed on the dominant side of racquet players when compared to the control group.

Congruency of scapula locking plates: implications for implant design.

PubMed

Park, Andrew Y; DiStefano, James G; Nguyen, Thuc-Quyen; Buckley, Jenni M; Montgomery, William H; Grimsrud, Chris D

2012-04-01

We conducted a study to evaluate the congruency of fit of current scapular plate designs. Three-dimensional image-processing and -analysis software, and computed tomography scans of 12 cadaveric scapulae were used to generate 3 measurements: mean distance from plate to bone, maximum distance, and percentage of plate surface within 2 mm of bone. These measurements were used to quantify congruency. The scapular spine plate had the most congruent fit in all 3 measured variables. The lateral border and glenoid plates performed statistically as well as the scapular spine plate in at least 1 of the measured variables. The medial border plate had the least optimal measurements in all 3 variables. With locking-plate technology used in a wide variety of anatomical locations, the locking scapula plate system can allow for a fixed-angle construct in this region. Our study results showed that the scapular spine, glenoid, and lateral border plates are adequate in terms of congruency. However, design improvements may be necessary for the medial border plate. In addition, we describe a novel method for quantifying hardware congruency, a method that can be applied to any anatomical location.

Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis.

PubMed

Pirauá, André Luiz Torres; Pitangui, Ana Carolina Rodarti; Silva, Juliana Pereira; Pereira dos Passos, Muana Hiandra; Alves de Oliveira, Valéria Mayaly; Batista, Laísla da Silva Paixão; Cappato de Araújo, Rodrigo

2014-10-01

The present study was performed to assess the electromyographic activity of the scapular muscles during push-ups on a stable and unstable surface, in subjects with scapular dyskinesis. Muscle activation (upper trapezius [UT]; lower trapezius [LT]; upper serratus anterior [SA_5th]; lower serratus anterior [SA_7th]) and ratios (UT/LT; UT/SA_5th; UT/ SA_7th) levels were determined by surface EMG in 30 asymptomatic men with scapular dyskinesis, during push-up performed on a stable and unstable surface. Multivariate analysis of variance with repeated measures was used for statistical analyses. The unstable surface caused a decrease in the EMG activity of the serratus anterior and an increase in EMG activity of the trapezius (p=0.001). UT/SA_5th and UT/ SA_7th ratios were higher during unstable push-ups (p=0.001). The results suggest that, in individuals with scapular dyskinesis, there is increased EMG activity of the trapezius and decreased EMG activity of the serratus anterior in response to an unstable surface. These results suggest that the performance of the push up exercise on an unstable surface may be more favorable to produce higher levels of trapezius activation and lower levels of serratus anterior activation. However, if the goal of the exercise program is the strengthening of the SA muscle, it is suggested to perform the push up on a stable surface. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interest in the glenoid hull method for analyzing humeral subluxation in primary glenohumeral osteoarthritis.

PubMed

Bouacida, Soufyane; Gauci, Marc-Olivier; Coulet, Bertrand; Lazerges, Cyril; Cyteval, Catherine; Boileau, Pascal; Chammas, Michel

2017-07-01

Posterior humeral subluxation is the main cause of failure of total shoulder arthroplasty. We aimed to compare humeral head subluxation in various reference planes and to search for a correlation with retroversion, inclination, and glenoid wear. We included 109 computed tomography scans of primary glenohumeral osteoarthritis and 97 of shoulder problems unrelated to shoulder osteoarthritis (controls); all computed tomography scans were reconstructed in the anatomic scapular plane and the glenoid hull plane that we defined. In both planes, we measured retroversion, inclination, glenohumeral offset (Walch index), and scapulohumeral offset. Retroversion in the scapular plane (Friedman method) was lower than that in the glenoid hull plane for controls and for arthritic shoulders. The threshold of scapulohumeral subluxation was 60% and 65% in the scapular plane and glenoid hull plane, respectively. The mean upward inclination was lower in the scapular plane (Churchill method) than in the glenoid hull plane (Maurer method). In the glenoid hull plane, 35% of type A2 glenoids showed glenohumeral offset greater than 75%, with mean retroversion of 25.6° ± 6° as compared with 7.5° ± 7.2° for the "centered" type A2 glenoids (P < .0001) and an upward inclination of -1.4° ± 8° and 6.3° ± 7° (P = .03), respectively. The correlation between retroversion and scapulohumeral offset was r = 0.64 in the glenoid hull plane and r = 0.59 in the scapular plane (P < .05). Measurement in the glenoid hull plane may be more accurate than in the scapular plane. Thus, the glenoid hull method allows for better understanding type B3 of the modified Walch classification. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Clinical Comparison of Scapular, Fibular, and Iliac Crest Osseal Free Flaps in Maxillofacial Reconstructions.

PubMed

Wilkman, T; Husso, A; Lassus, P

2018-05-01

This study compared the three most used composite flaps in maxillofacial reconstructions in our institute. Between 2000 and 2012, a total of 163 patients with mandibular, maxillary, and orbital defects received either scapular, fibular, or iliac crest osseal reconstructions in Helsinki University Hospital, Departments of Plastic Surgery and Maxillofacial Surgery. Data regarding the patient demographics, complications, and outcomes were analyzed. There were 92 deep circumflex iliac artery flaps (56%), followed by 42 scapular (26%) and 29 fibular flaps (18%). The rate of flap loss was the highest in the deep circumflex iliac artery group (p = 0.001). Reconstructions using fibula were fastest (p = 0.001) and had lowest perioperative blood loss (p = 0.013). There were no significant differences in the number of early or late complications between the flaps, but donor site complications were more severe in deep circumflex iliac artery. Osteotomies as well as dental implants were safely performed in all flaps with equal results. All three flaps of this study can be performed with awareness of the deep circumflex iliac artery flap being the least reliable alternative. The knowledge of the advantages and disadvantages of several osseal-free flap alternatives is beneficial in selecting the best suitable method for each individual patient requiring maxillofacial osseal reconstruction.

Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty.

PubMed

Oh, Joo Han; Shin, Sang-Jin; McGarry, Michelle H; Scott, Jonathan H; Heckmann, Nathanael; Lee, Thay Q

2014-08-01

The variability in functional outcomes and the occurrence of scapular notching and instability after reverse total shoulder arthroplasty remain problems. The objectives of this study were to measure the effect of reverse humeral component neck-shaft angle on impingement-free range of motion, abduction moment, and anterior dislocation force and to evaluate the effect of subscapularis loading on dislocation force. Six cadaveric shoulders were tested with 155°, 145°, and 135° reverse shoulder humeral neck-shaft angles. The adduction angle at which bone contact occurred and the internal and external rotational impingement-free range of motion angles were measured. Glenohumeral abduction moment was measured at 0° and 30° of abduction, and anterior dislocation forces were measured at 30° of internal rotation, 0°, and 30° of external rotation with and without subscapularis loading. Adduction deficit angles for 155°, 145°, and 135° neck-shaft angle were 2° ± 5° of abduction, 7° ± 4° of adduction, and 12° ± 2° of adduction (P < .05). Impingement-free angles of humeral rotation and abduction moments were not statistically different between the neck-shaft angles. The anterior dislocation force was significantly higher for the 135° neck-shaft angle at 30° of external rotation and significantly higher for the 155° neck-shaft angle at 30° of internal rotation (P < .01). The anterior dislocation forces were significantly higher when the subscapularis was loaded (P < .01). The 155° neck-shaft angle was more prone to scapular bone contact during adduction but was more stable at the internally rotated position, which was the least stable humeral rotation position. Subscapularis loading gave further anterior stability with all neck-shaft angles at all positions. Published by Mosby, Inc.

The dorsal thoracic fascia: anatomic significance with clinical applications in reconstructive microsurgery.

PubMed

Kim, P S; Gottlieb, J R; Harris, G D; Nagle, D J; Lewis, V L

1987-01-01

The anatomic distribution and potential arterial flow patterns of the circumflex scapular artery were investigated by Microfil injection. These studies demonstrated that the circumflex scapular artery lies within the dorsal thoracic fascia, which plays a significant role in the circulation of the overlying skin and subcutaneous tissue. We conclude that scapular/parascapular flaps are fasciocutaneous flaps, the dorsal thoracic fascia can be transferred as a free flap without its overlying skin and subcutaneous tissue, and intercommunication exists between the myocutaneous perforators of the latissimus dorsi myocutaneous flap and the vascular plexus of the dorsal thoracic fascia. We present microvascular cases in which the vascular properties of the dorsal thoracic fascia facilitated wound closure with free fascia flaps or expanded cutaneous or myocutaneous flaps.

The immediate effect of muscle release intervention on muscle activity and shoulder kinematics in patients with frozen shoulder: a cross-sectional, exploratory study.

PubMed

Shih, Yi-Fen; Liao, Pei-Wen; Lee, Chun-Shou

2017-11-28

Contractile tissue plays an important role in mobility deficits in frozen shoulder (FS). However, no study has assessed the effect of the muscle release technique on the muscle activation and kinematics in individuals with FS. The purposes of this study were to assess the differences in shoulder muscle activity and kinematics between the FS and asymptomatic groups; and to determine the immediate effects of muscle release intervention in the FS group. Twenty patients with FS and 20 asymptomatic controls were recruited. The outcome measures included muscle activity of the upper and lower trapezius (UT and LT), infraspinatus (ISp), pectoralis major (PM), and teres major (TM), shoulder kinematics (humeral elevation, scapular posterior tilt (PT) and upward rotation (UR), shoulder mobility, and pain. Participants in the FS group received one-session of heat and manual muscle release. Measurements were obtained at baseline, and immediately after intervention. Multivariate analysis of variance was used for data analysis. The level of significance was set at α=0.05. Compared to the controls, the FS group revealed significantly decreased LT (difference =55.89%, P=0.001) and ISp muscle activity (difference =26.32%, P =0.043) during the scaption task, and increased PM activity (difference =6.31%, P =0.014) during the thumb to waist task. The FS group showed decreased humeral elevation, scapular PT, and UR (difference = 35.36°, 10.18°, 6.73° respectively, P <0.05). Muscle release intervention immediately decreased pain (VAS drop 1.7, P <0.001); improved muscle activity during scaption (UT: 12.68% increase, LT: 35.46% increase, P <0.05) and hand to neck (UT: 12.14% increase, LT: 34.04% increase, P <0.05) task; and increased peak humeral elevation and scapular PT during scaption (95.18°±15.83° to 98.24°±15.57°, P=0.034; 11.06°±3.94° to 14.36°±4.65°, P=0.002), and increased scapular PT during the hand to neck (9.47°±3.86° to 12.80°±8.33°, P=0.025) task. No statistical significance was found for other group comparisons or intervention effect. Patients with FS presented with altered shoulder muscle activity and kinematics, and one-session of heat and manual muscle release showed beneficial effects on shoulder muscle performance, kinematics, mobility, and pain. Retrospectively registered on Jan 18, 2016 (ACTRN 12616000031460 ).

Allograft reconstruction after resection of malignant tumors of the scapula.

PubMed

Mnaymneh, Walid A; Temple, H Thomas; Malinin, Theodore I

2002-12-01

The oncologic and functional outcomes of six patients who had scapular allograft reconstruction after scapulectomy for malignant tumors were reviewed. Five patients had Stage IIB and one patient had Stage IB tumors. Total scapulectomy was done in five patients, and partial scapulectomy (glenoid and neck) was done in one patient. Frozen glycerolized scapular allografts were implanted and fixed with plates and screws. The scapular muscles were reattached to the allograft. Tendon reconstruction to replace the excised muscles was done in two patients. The patients were followed up for an average of 3.8 years (range, 2-6 years). Cosmesis, elbow, and hand function were good in all patients. There were no infections, nonunions, or shoulder dislocations. One patient fractured the body of the allograft after a fall. One patient had local recurrence and had scapulectomy 5 years postoperatively. Two patients died 3 and 5 years postoperatively with lung metastases but with functioning grafts. The mean functional result using the Musculoskeletal Tumor Society functional score was 82 (range, 77-87). In this series, scapular allograft reconstruction restored cosmesis, shoulder stability, and function. Preservation or reconstruction of rotator cuff muscles is recommended.

Intraoperative reduction of the scapular body--a technical trick.

PubMed

Bartonícek, Jan; Fric, Vladimír; Tucek, Michal

2009-04-01

When internal fixation of the scapular neck and body fractures is performed, a problem may occur with reduction and retention of position of the lateral border of the scapula during surgery. For this purpose, the authors have developed their own technique of stabilization using a K-wire in a novel way. The technique is indicated in a 2-part shear unstable fracture of the lateral border. It cannot be used in fractures with an intercalated segment. A 2.5-mm drill bit is used to drill a 1.5-cm deep hole into the "medullary cavity" of each of the 2 fragments of the lateral border. A K-wire, 1.5 mm in diameter and 2.5-cm long, is inserted into the distal fragment. The protruding end of the K-wire is inserted into the hole in the proximal fragment. This intramedullary peg helps to maintain reduction and keeps both fragments stable. Subsequently, the lateral border is stabilized with a 3.5-mm reconstruction plate. This technique is quite simple and allows for a temporary stabilization of fragments without compromising the subsequent fixation by plate screws.

Optimal screw placement for base plate fixation in reverse total shoulder arthroplasty.

PubMed

DiStefano, James Guido; Park, Andrew Y; Nguyen, Thuc-Quyen D; Diederichs, Gerd; Buckley, Jenni M; Montgomery, William H

2011-04-01

Scapular cortical thickness has not been fully characterized from the perspective of determining optimal screw placement for securing the glenoid base plate in reverse shoulder arthroplasty. Twelve fresh frozen cadaveric scapulae underwent high resolution CT scans with 3-dimensional reconstructions and wall thickness analysis. Digital base plates were positioned and virtual screws were placed according to 2 scenarios: A - intraosseous through the entire course and exits a "safe region" with no known neurovascular structures; B - may leave and re-enter the bone and penetrates the thickest cortical region accessible regardless of adjacent structures. For scenario A, the optimal screw configurations were: (superior screw) length = 35 mm, 9° superior, 2° posterior; (inferior screw-A) length = 34 mm, 16° inferior, 5° anterior; (inferior screw-B) length = 31 mm, 31 inferior, 4 posterior; (posterior screw) length 19 mm, 29° inferior, 3° anterior. For scenario B: (superior screw) length = 36 mm, 28° superior, 10° anterior; (inferior screw) length = 35 mm, 19° inferior, 4° anterior; (posterior screw) length 37 mm, 23° superior, 3° anterior. The anterior screw was consistent between scenarios A and B, averaged 29 mm in length and was directed 16° inferior and 14° posterior. Thicker cortical regions were present in the lateral aspect of the suprascapular notch, scapular spine base, anterior/superior aspect of inferior pillar and junction of glenoid neck and scapular spine. Regions with high cortical thickness were accessible for both scenarios except for the posterior screw in scenario A. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Muscular Activation During Plyometric Exercises in 90° of Glenohumeral Joint Abduction

PubMed Central

Ellenbecker, Todd S.; Sueyoshi, Tetsuro; Bailie, David S.

2015-01-01

Background: Plyometric exercises are frequently used to increase posterior rotator cuff and periscapular muscle strength and simulate demands and positional stresses in overhead athletes. The purpose of this study was to provide descriptive data on posterior rotator cuff and scapular muscle activation during upper extremity plyometric exercises in 90° of glenohumeral joint abduction. Hypothesis: Levels of muscular activity in the posterior rotator cuff and scapular stabilizers will be high during plyometric shoulder exercises similar to previously reported electromyographic (EMG) levels of shoulder rehabilitation exercises. Study Design: Descriptive laboratory study. Methods: Twenty healthy subjects were tested using surface EMG during the performance of 2 plyometric shoulder exercises: prone external rotation (PERP) and reverse catch external rotation (RCP) using a handheld medicine ball. Electrode application included the upper and lower trapezius (UT and LT, respectively), serratus anterior (SA), infraspinatus (IN), and the middle and posterior deltoid (MD and PD, respectively) muscles. A 10-second interval of repetitive plyometric exercise (PERP) and 3 repetitions of RCP were sampled. Peak and average normalized EMG data were generated. Results: Normalized peak and average IN activity ranged between 73% and 102% and between 28% and 52% during the plyometric exercises, respectively, with peak and average LT activity measured between 79% and 131% and between 31% and 61%. SA activity ranged between 76% and 86% for peak and between 35% and 37% for average activity. Muscular activity levels in the MD and PD ranged between 49% and 72% and between 12% and 33% for peak and average, respectively. Conclusion: Moderate to high levels of muscular activity were measured in the rotator cuff and scapular stabilizers during these plyometric exercises with the glenohumeral joint abducted 90°. PMID:25553216

Muscular activation during plyometric exercises in 90° of glenohumeral joint abduction.

PubMed

Ellenbecker, Todd S; Sueyoshi, Tetsuro; Bailie, David S

2015-01-01

Plyometric exercises are frequently used to increase posterior rotator cuff and periscapular muscle strength and simulate demands and positional stresses in overhead athletes. The purpose of this study was to provide descriptive data on posterior rotator cuff and scapular muscle activation during upper extremity plyometric exercises in 90° of glenohumeral joint abduction. Levels of muscular activity in the posterior rotator cuff and scapular stabilizers will be high during plyometric shoulder exercises similar to previously reported electromyographic (EMG) levels of shoulder rehabilitation exercises. Descriptive laboratory study. Twenty healthy subjects were tested using surface EMG during the performance of 2 plyometric shoulder exercises: prone external rotation (PERP) and reverse catch external rotation (RCP) using a handheld medicine ball. Electrode application included the upper and lower trapezius (UT and LT, respectively), serratus anterior (SA), infraspinatus (IN), and the middle and posterior deltoid (MD and PD, respectively) muscles. A 10-second interval of repetitive plyometric exercise (PERP) and 3 repetitions of RCP were sampled. Peak and average normalized EMG data were generated. Normalized peak and average IN activity ranged between 73% and 102% and between 28% and 52% during the plyometric exercises, respectively, with peak and average LT activity measured between 79% and 131% and between 31% and 61%. SA activity ranged between 76% and 86% for peak and between 35% and 37% for average activity. Muscular activity levels in the MD and PD ranged between 49% and 72% and between 12% and 33% for peak and average, respectively. Moderate to high levels of muscular activity were measured in the rotator cuff and scapular stabilizers during these plyometric exercises with the glenohumeral joint abducted 90°.

Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study.

PubMed

Clarsen, Benjamin; Bahr, Roald; Andersson, Stig Haugsboe; Munk, Rikke; Myklebust, Grethe

2014-09-01

To determine whether rotator cuff strength, glenohumeral joint range of motion and scapular control are associated with shoulder injuries among elite male handball players. A total of 206 players in the Norwegian elite handball league for men were tested prior to the 2011-2012 season. Measures included: (1) glenohumeral internal and external rotation range of motion, (2) isometric internal rotation, external rotation and abduction strength and (3) assessment of scapular dyskinesis. Players were followed prospectively for the entire regular season (30 weeks), with shoulder problems registered bi-weekly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A cumulative severity score was calculated for each player based on their questionnaire responses. This was used as the outcome measure in risk factor analyses. The average prevalence of shoulder problems throughout the season was 28% (95% CI 25% to 31%). The prevalence of substantial shoulder problems, defined as those leading to moderate or severe reductions in handball participation or performance, or to time loss, was 12% (95% CI 11% to 13%). Significant associations were found between obvious scapular dyskinesis (OR 8.41, 95% CI 1.47 to 48.1, p<0.05), total rotational motion (OR 0.77 per 5° change, 95% CI 0.56 to 0.995, p<0.05) and external rotation strength (OR 0.71 per 10 Nm change, 95% CI 0.44 to 0.99, p<0.05) and shoulder injury. Injury prevention programmes should incorporate interventions aimed at improving glenohumeral rotational range of motion, external rotation strength and scapular control. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

An isolated long thoracic nerve injury in a Navy Airman.

PubMed

Oakes, Michael J; Sherwood, Daniel L

2004-09-01

A palsy of the long thoracic nerve of Bell is a cause of scapular winging that has been reported after trauma, surgery, infection, electrocution, chiropractic manipulation, exposure to toxins, and various sports-related injuries that include tennis, hockey, bowling, soccer, gymnastics, and weight lifting. Scapular winging can result from repetitive or sudden external biomechanical forces that may either exert compression or place extraordinary traction in the distribution of the long thoracic nerve. We describe an active duty Navy Airman who developed scapular winging secondary to traction to the long thoracic nerve injury while working on the flight line. A thorough history and physical is essential in determining the mechanism of injury. Treatment should initially include refraining from strenuous use of the involved extremity, avoidance of the precipitating activity, and physical therapy to focus on maintaining range of motion and strengthening associated muscles, with most cases resolving within 9 months.

Association between scapula bony morphology and snapping scapula syndrome.

PubMed

Spiegl, Ulrich J; Petri, Maximilian; Smith, Sean W; Ho, Charles P; Millett, Peter J

2015-08-01

Scapular incongruity has been described as a contributing factor to the development of snapping scapula syndrome (SSS). The purpose of this retrospective case-control study was to determine the association between scapula bony morphology on magnetic resonance imaging (MRI) and the diagnosis of SSS. Bony morphologies of the scapula were evaluated on MRI scans of 26 patients with SSS and 19 patients with non-SSS pathologies. The medial scapula corpus angle (MSCA) was measured on axial MRI sequences. Scapulae were categorized as straight, S shaped, or concave. Two independent observers performed the measurements. Interobserver and intraobserver agreements of MSCA measurements were determined with intraclass correlation coefficients. Axial scapula bony morphology identified 28 scapulae of the straight type, 14 S-shaped scapulae, and 5 concave scapulae. All 5 concave scapulae had confirmed SSS. Measurement of the MSCA showed excellent interobserver agreement of 0.80 (95% confidence interval [CI], 0.67 to 0.89) and intraobserver agreement of 0.70 (95% CI, 0.52 to 0.82). There were significant differences in the mean MSCAs between shoulders with SSS (14.4° ± 19.3°) and non-SSS shoulders (-3.3° ± 15.3°, P = .001). The odds ratio was 8.4 (95% CI, 2.2 to 31.8) for positive MSCA and SSS. The scapulothoracic distance was significantly decreased in the SSS group (14.9 ± 5.8 mm) compared with the non-SSS patients (24.0 ± 6.7 mm, P < .001). Anterior angulation of the medial scapula in the axial plane was associated with SSS. Patients with a concave-shaped scapula and a positive MSCA have a 12-fold increased risk of SSS. The MSCA may prove helpful in determining the location and amount of scapular resection needed for patients with SSS. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A study of right shoulder injury in collegiate and professional orchestral cellists: an investigation using questionnaires and physical assessment.

PubMed

Rickert, Dale; Barrett, Margaret; Halaki, Mark; Driscoll, Tim; Ackermann, Bronwen

2012-06-01

Cellists sustain high levels of playing-related injury and are particularly susceptible to right shoulder pain, yet no studies have attempted to propose a mechanism for disease or establish possible causal factors. The aim of this study was to investigate shoulder injury levels and causes in two populations: professional orchestral cellists and college-level student cellists. A questionnaire and physical testing protocol was applied to both groups of participants, eliciting information on lifestyle, playing habits, and self-reported injury rates as well as physical data on shoulder strength, range of motion, and signs of injury. Right shoulder injuries are common among both student (20%) and professional (42%) cellists and seem to be associated with measures indicating potential lack of strength in the scapular stabilisers as well as potential degenerative changes in the rotator cuff. Significant differences were found in the lifestyle and playing habits of the two groups. There were increased signs of pain and stiffness in the professionals and evidence of decreased muscular support in the students. Male cellists showed less scapular stability; female cellists, however, generally had higher levels of pain. These results indicate that injuries at the shoulder, potentially involving impingement-type pathologies, are a common cause of pain in cellists. Based on this study, future research for cello players could focus on targeted interventions, such as exercises for the scapular stabilisers and muscles of the rotator cuff.

Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: Short term effect.

PubMed

Pekyavas, Nihan Ozunlu; Ergun, Nevin

2017-05-01

The aim of this study was to compare the short term effects of home exercise program and virtual reality exergaming in patients with subacromial impingement syndrome (SAIS). A total of 30 patients with SAIS were randomized into two groups which are Home Exercise Program (EX Group) (mean age: 40.6 ± 11.7 years) and Virtual Reality Exergaming Program (WII Group) (mean age: 40.33 ± 13.2 years). Subjects were assessed at the first session, at the end of the treatment (6 weeks) and at 1 month follow-up. The groups were assessed and compared with Visual Analogue Scale (based on rest, activity and night pain), Neer and Hawkins Tests, Scapular Retraction Test (SRT), Scapular Assistance Test (SAT), Lateral Scapular Slide Test (LSST) and shoulder disability (Shoulder Pain and Disability Index (SPADI)). Intensity of pain was significantly decreased in both groups with the treatment (p < 0.05). The WII Group had significantly better results for all Neer test, SRT and SAT than the EX Group (p < 0.05). Virtual reality exergaming programs with these programs were found more effective than home exercise programs at short term in subjects with SAIS. Level I, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Electromyographic analysis of knee push up plus variations: what is the influence of the kinetic chain on scapular muscle activity?

PubMed

Maenhout, A; Van Praet, K; Pizzi, L; Van Herzeele, M; Cools, A

2010-11-01

First, to look for appropriate closed kinetic chain exercises to restore intramuscular imbalance between upper trapezius (UT) and serratus anterior (SA) in overhead athletes. Second, to determine the influence of using diagonal pattern muscle recruitment during knee push up plus (KPP) exercises on scapular electromyographic activity. Single group repeated-measures design. Controlled laboratory study. Thirty-two physically active individuals in good general health who did not have a history of neck and/or shoulder injury or surgery nor participated in high-level overhead sports or performed upper limb strength training for more than 5 h/week. Interventions Subjects performed the standard KPP and six variations. Electromyographic activity of the three trapezius parts and the SA. Four exercises with a low UT/SA can be selected for rehabilitation of intramuscular balance: standard KPP, KPP with homolateral leg extension, KPP with a wobble board and homolateral leg extension and one-handed KPP. The use of a wobble board during KPP exercises and performance on one hand has no influence on SA electromyographic activity. Heterolateral leg extension during KPP stimulates lower trapezius activity, whereas homolateral leg extension stimulates SA activity. In case of intramuscular scapular imbalance, some exercises are preferable over others because of their low UT/SA ratio. The use of a kinetic chain approach during KPP exercises influences scapular muscle activity.

Exercises focusing on rotator cuff and scapular muscles do not improve shoulder joint position sense in healthy subjects.

PubMed

Lin, Yin-Liang; Karduna, Andrew

2016-10-01

Proprioception is essential for shoulder neuromuscular control and shoulder stability. Exercise of the rotator cuff and scapulothoracic muscles is an important part of shoulder rehabilitation. The purpose of this study was to investigate the effect of rotator cuff and scapulothoracic muscle exercises on shoulder joint position sense. Thirty-six healthy subjects were recruited and randomly assigned into either a control or training group. The subjects in the training group received closed-chain and open-chain exercises focusing on rotator cuff and scapulothoracic muscles for four weeks. Shoulder joint position sense errors in elevation, including the humerothoracic, glenohumeral and scapulothoracic joints, was measured. After four weeks of exercise training, strength increased overall in the training group, which demonstrated the effect of exercise on the muscular system. However, the changes in shoulder joint position sense errors in any individual joint of the subjects in the training group were not different from those of the control subjects. Therefore, exercises specifically targeting individual muscles with low intensity may not be sufficient to improve shoulder joint position sense in healthy subjects. Future work is needed to further investigate which types of exercise are more effective in improving joint position sense, and the mechanisms associated with those changes. Copyright © 2016 Elsevier B.V. All rights reserved.

Exercises focusing on rotator cuff and scapular muscles do not improve shoulder joint position sense in healthy subjects

PubMed Central

Lin, Yin-Liang; Karduna, Andrew

2016-01-01

Proprioception is essential for shoulder neuromuscular control and shoulder stability. Exercise of the rotator cuff and scapulothoracic muscles is an important part of shoulder rehabilitation. The purpose of this study was to investigate the effect of rotator cuff and scapulothoracic muscle exercises on shoulder joint position sense. Thirty-six healthy subjects were recruited and randomly assigned into either a control or training group. The subjects in the training group received closed-chain and open-chain exercises focusing on rotator cuff and scapulothoracic muscles for four weeks. Shoulder joint position sense errors in elevation, including the humerothoracic, glenohumeral and scapulothoracic joints, was measured. After four weeks of exercise training, strength increased overall in the training group, which demonstrated the effect of exercise on the muscular system. However, the changes in shoulder joint position sense errors in any individual joint of the subjects in the training group were not different from those of the control subjects. Therefore, exercises specifically targeting individual muscles with low intensity may not be sufficient to improve shoulder joint position sense in healthy subjects. Future work is needed to further investigate which types of exercise are more effective in improving joint position sense, and the mechanisms associated with those changes. PMID:27475714

Reduction of the subacromial space in athletes with and without rotator cuff tendinopathy and its association with the strength of scapular muscles.

PubMed

Leong, Hio Teng; Tsui, Sammi Sin Mei; Ng, Gabriel Yin-Fat; Fu, Siu Ngor

2016-12-01

To compare the reduction of subacromial space (SAS) during arm abduction between overhead athletes with and without rotator cuff (RC) tendinopathy, and to explore the relationship between the strength of scapular muscles with the SAS. Cross-sectional study. Sixty-six athletes (33 healthy and 33 with RC tendinopathy, mean age=22.3 years) participated in the study. Ultrasound measurement of the SAS with arm at 0°, 30° and 60° of shoulder abduction were taken, and the maximal isometric force in upper, middle and lower trapezius, and serratus anterior with manual muscle tests (MMT) were assessed using a handheld dynamometer. The change in SAS during arm abduction from 0° to 30° (SAS 0°-30° ), 30° to 60° (SAS 30°-60° ) and 0° to 60° (SAS 0°-60° ) was compared between groups. Differences in force produced with scapular muscles MMT between groups and relationships with reduction in SAS were explored. We found more reduction of the SAS during SAS 0°-30° in athletes with RC tendinopathy (0.44±1.22mm) than healthy athletes (-0.06±1.41mm) (p=0.045). Athletes with RC tendinopathy demonstrated significant decrease in all scapular muscles MMT strength when compared to their healthy counterparts (p<0.05). In healthy athletes, a lower middle and lower trapezius MMT strength were moderately associated with a greater reduction in SAS during 0° to 30° (r=-0.445, p=0.016 and r=-0.423, p=0.022, respectively) and 0° to 60° of shoulder abduction (r=-0.415, p=0.018 and r=-0.504, p=0.003, respectively). Athletes with RC tendinopathy demonstrated more reduction in the SAS during early arm abduction. Decreased strength of middle and lower trapezius was related to reduction of the SAS. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Effect of scapular external rotation on the axillary nerve during the arthroscopic Latarjet procedure: an anatomical investigation.

PubMed

Reinares, Felipe; Werthel, Jean-David; Moraiti, Constantina; Valenti, Philippe

2017-10-01

The first purpose of this study is to measure the distance between the axillary nerve and the exit point of K-wires placed retrograde through the glenoid in the setting of an arthroscopic Latarjet procedure. The second objective is to evaluate whether manual external rotation of the scapula alters that distance. In seven fresh-frozen specimens, two 2.0-mm K-wires were drilled through the glenoid using an arthroscopic Latarjet retrograde glenoid guide. These were drilled into the glenoid at the 7- and 8-o'clock positions (right shoulders) and at the 4- and 5-o'clock positions (left). K-wires were oriented parallel to the glenoid articular surface and perpendicular to the long superoinferior axis of the glenoid, 7 mm medial to the joint surface. Two independent evaluators measured the distances between the axillary nerve and the exit point of the K-wires in the horizontal plane (AKHS for the superior K-wire and AKHI for the inferior K-wire) and in the vertical plane (AKV). Measurements were taken with the scapula left free and were repeated with the scapula placed at 15° and 30° of external rotation. With the scapula left free, scapular external rotation was 34° ± 2.3°. In this position, the AKHS was 2.5 ± 1.6, 6.3 ± 1.2 mm at 15° of external rotation (ER) and 11.4 ± 1.4 mm at 30° ER. The AKHI distance was 0.37 ± 1.6, 3.4 ± 1.4 and 10.6 ± 2.1 mm, respectively, for the scapula left free, at 15° ER and 30° of ER. The AKV distances were, respectively, 0.12 ± 0.2, 4.9 ± 1.6 and 9.9 ± 1.7 mm. The increase in all distances was statistically significant (p < 0.001). Increasing scapular external rotation significantly increases the distance between the axillary nerve and the exit point of the K-wires, increasing the margin of safety during this procedure. Therefore, increased external rotation of the scapula could be an effective tool to decrease the risk of iatrogenic axillary nerve injury. Cadaveric study, Level V.

Comparison of 3-Dimensional Shoulder Complex Kinematics in Individuals With and Without Shoulder Pain, Part 2: Glenohumeral Joint

PubMed Central

LAWRENCE, REBEKAH L.; BRAMAN, JONATHAN P.; STAKER, JUSTIN L.; LAPRADE, ROBERT F.; LUDEWIG, PAULA M.

2015-01-01

STUDY DESIGN Cross-sectional. OBJECTIVES To compare differences in glenohumeral joint angular motion and linear translations between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Numerous clinical theories have linked abnormal glenohumeral kinematics, including decreased glenohumeral external rotation and increased superior translation, to individuals with shoulder pain and impingement diagnoses. However, relatively few studies have investigated glenohumeral joint angular motion and linear translations in this population. METHODS Transcortical bone pins were inserted into the scapula and humerus of 12 a symptomatic and 10 symptomatic participants for direct bone-fixed tracking using electromagnetic sensors. Glenohumeral joint angular positions and linear translations were calculated during active shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups in angular positions were limited to glenohumeral elevation, coinciding with a reduction in scapulothoracic upward rotation. Symptomatic participants demonstrated 1.4 mm more anterior glenohumeral translation between 90° and 120° of shoulder flexion and an average of 1 mm more inferior glenohumeral translation throughout shoulder abduction. CONCLUSION Differences in glenohumeral kinematics exist between symptomatic and a symptomatic individuals. The clinical implications of these differences are not yet understood, and more research is needed to understand the relationship between abnormal kinematics, shoulder pain, and pathoanatomy. PMID:25103132

Iterations of computer- and template assisted mandibular or maxillary reconstruction with free flaps containing the lateral scapular border--Evolution of a biplanar plug-on cutting guide.

PubMed

Cornelius, Carl-Peter; Giessler, Goetz Andreas; Wilde, Frank; Metzger, Marc Christian; Mast, Gerson; Probst, Florian Andreas

2016-03-01

Computer-assisted planning and intraoperative implementation using templates have become appreciated modalities in craniofacial reconstruction with fibula and DCIA flaps due to saving in operation time, improved accuracy of osteotomies and easy insetting. Up to now, a similar development for flaps from the subscapular vascular system, namely the lateral scapular border and tip, has not been addressed in the literature. A cohort of 12 patients who underwent mandibular (n = 10) or maxillary (n = 2) reconstruction with free flaps containing the lateral scapular border and tip using computer-assisted planning, stereolithography (STL) models and selective laser sintered (SLS) templates for bone contouring and sub-segmentation osteotomies was reviewed focussing on iterations in the design of computer generated tools and templates. The technical evolution migrated from hybrid STL models over SLS templates for cut out as well as sub-segmentation with a uniplanar framework to plug-on tandem template assemblies providing a biplanar access for the in toto cut out from the posterior aspect in succession with contouring into sub-segments from the medial side. The latest design version is the proof of concept that virtual planning of bone flaps from the lateral scapular border can be successfully transferred into surgery by appropriate templates. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed.

PubMed

Andersson, Stig Haugsboe; Bahr, Roald; Clarsen, Benjamin; Myklebust, Grethe

2017-08-07

Shoulder injuries are common among handball players and predominantly characterised by overuse characteristics. Reduced total glenohumeral rotation, external rotation weakness and scapular dyskinesis have been identified as risk factors among elite male handball players. To assess whether previously identified risk factors are associated with overuse shoulder injuries in a large cohort of elite male and female handball players. 329 players (168 male, 161 female) from the two upper divisions in Norway were included and tested prior to the 2014-2015 season. Measures included glenohumeral internal and external rotation range of motion, isometric internal and external rotation strength, and assessment of scapular dyskinesis. Players were followed prospectively for one competitive season, with prevalence and severity of shoulder problems registered monthly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A severity score based on players' questionnaire responses was used as the outcome measure in multivariable logistic regression to investigate associations between candidate risk factors and overuse shoulder injury. No significant associations were found between total rotation (OR 1.05 per 5° change, 95% CI 0.98 to 1.13), external rotation strength (OR 1.05 per 10 N change, 95% CI 0.92 to 1.20) or obvious scapular dyskinesis (OR 1.23, 95% CI 0.25 to 5.99) and overuse shoulder injury. A significant positive association was found between greater internal rotation (OR 1.16 per 5° change, 95% CI 1.00 to 1.34) and overuse shoulder injury. None of the previously identified risk factors were associated with overuse shoulder injuries in a mixed-sex cohort of elite handball players. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Three-dimensional scapular dyskinesis in hook-plated acromioclavicular dislocation including hook motion.

PubMed

Kim, Eugene; Lee, Seunghee; Jeong, Hwa-Jae; Park, Jai Hyung; Park, Se-Jin; Lee, Jaewook; Kim, Woosub; Park, Hee Jin; Lee, So Yeon; Murase, Tsuyoshi; Sugamoto, Kazuomi; Ikemoto, Sumika

2018-06-01

The purpose of this study is to analyze the 3-dimensional scapular dyskinesis and the kinematics of a hook plate relative to the acromion after hook-plated acromioclavicular dislocation in vivo. Reported complications of acromioclavicular reduction using a hook plate include subacromial erosion and impingement. However, there are few reports of the 3-dimensional kinematics of the hook and scapula after the aforementioned surgical procedure. We studied 15 cases of acromioclavicular dislocation treated with a hook plate and 15 contralateral normal shoulders using computed tomography in the neutral and full forward flexion positions. Three-dimensional motion of the scapula relative to the thorax during arm elevation was analyzed using a computer simulation program. We also measured the distance from the tip of the hook plate to the greater tuberosity, as well as the angular motion of the plate tip in the subacromial space. Decreased posterior tilting (22° ± 10° vs 31° ± 8°) in the sagittal plane and increased external rotation (19° ± 9° vs 7° ± 5°) in the axial plane were evident in the affected shoulders. The mean values of translation of the hook plate and angular motion against the acromion were 4.0 ± 1.6 mm and 15° ± 8°, respectively. The minimum value of the distance from the hook plate to the humeral head tuberosity was 6.9 mm during arm elevation. Acromioclavicular reduction using a hook plate may cause scapular dyskinesis. Translational and angular motion of the hook plate against the acromion could lead to subacromial erosion. However, the hook does not seem to impinge directly on the humeral head. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Surgical anatomy of the lower trapezius tendon transfer.

PubMed

Omid, Reza; Cavallero, Matthew J; Granholm, Danielle; Villacis, Diego C; Yi, Anthony M

2015-09-01

The precise surgical anatomy of the lower trapezius tendon transfer has not been well described. A precise anatomic description of the different trapezius segments and the associated neurovascular structures is crucial for operative planning and execution. We aimed (1) to establish a reliable demarcation between the middle and lower trapezius, (2) to establish the precise relationship of the main neurovascular pedicle to the muscle belly, and (3) to evaluate the utility of the relationships established in (1) and (2) by using the results of this study to perform cadaveric lower trapezius tendon harvest. In phase 1, a single surgeon performed all measurements using 10 cadavers. In phase 2, 10 cadaveric shoulders were used to harvest the tendon by using the relationships established in phase 1. We found anatomically distinct insertion sites for the lower and middle trapezius. The lower trapezius inserted at the scapular spine dorsum and the middle trapezius inserted broadly along the superior surface of the scapular spine. The distance from tip of tendon insertion to the nearest nerve at the most superior portion of the lower trapezius was 58 mm (standard deviation ± 18). By use of these relationships, there were no cases of neurovascular injury during our cadaveric tendon harvests. The lower trapezius can be reliably and consistently identified without violating fibers of the middle trapezius. Muscle splitting can be performed safely without encountering the spinal accessory nerve (approximately 2 cm medial to the medial scapular border). Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes.

PubMed

Torrens, Carlos; Alentorn-Geli, Eduard; Mingo, Felipe; Gamba, Carlo; Santana, Fernando

2018-01-01

To investigate the influence of greater tuberosity healing on the functional outcomes of reverse shoulder arthroplasty (RSA) for the treatment of acute complex proximal humeral fractures (PHFs), and to investigate the influence of patient- and surgery-related factors in the healing of the greater tuberosity. Retrospective study including 41 consecutive PHFs treated using RSA with minimum 2-year follow-up. In all the cases, tuberosities were reattached with a standardized technique. All the patients were assessed at the last follow-up with constant score. Body mass index, surgery delay, comorbidities, polyethylene size, glenosphere size, overhanging of glenosphere, and scapular notch were recorded, and their influence in final constant score and in greater tuberosity healing was analyzed. Mean final constant score was of 60.7 points (standard deviation (SD) = 9.9). Greater tuberosity healed in proper position in 68% of the cases. There were no significant differences in constant score between patients with (mean = 61; SD = 9.5) and without (mean = 61; SD = 11.3) the healing of greater tuberosity. All patients scored above 90° in forward elevation. Scapular notch was reported in 14.6% of the cases. Age significantly affected the constant score ( p = 0.008). Comorbidities significantly interfered with greater tuberosity healing ( p = 0.03). There was one reoperation after dislocation. In spite of expecting good functional outcome with low complication rate after RSA for acute PHFs, the influence of greater tuberosity healing on shoulder function could not be demonstrated. The presence of comorbidities, but not age or gender, negatively influenced the healing of the greater tuberosity.

Glenoid morphology and the safe zone for protecting the suprascapular nerve during baseplate fixation in reverse shoulder arthroplasty.

PubMed

Yang, Yuhui; Zuo, Jianlin; Liu, Tong; Shao, Pu; Wu, Haihe; Gao, Zhongli; Xiao, Jianlin

2018-03-01

The purpose of this study was to investigate glenoid morphology and define the safe zone for protecting the suprascapular nerve baseplate screw during baseplate fixation in reverse shoulder arthroplasty (RSA) in a Chinese population. Shoulder computed tomography (CT) scans from 56 subjects were retrospectively reviewed. Three-dimensional (3D) reconstruction was performed using Mimics software, and corresponding bony references were used to evaluate glenoid morphology. To standardize evaluation, the coronal scapular plane was defined. Safe fixation distances and screw placements were investigated by constructing a simulated cutting plane of the baseplate during RSA. Mean glenoid height was 35.83 ± 2.95 mm, and width was 27.32 ± 2.78 mm, with significant sexual dimorphism (p < 0.01). According to the cutting plane morphology, the average baseplate radius was 13.84 ± 1.34 mm. The distances from the suprascapular notch and from two bony reference points at the base of the scapular spine to the cutting plane were 30.27 ± 2.77 mm, 18.39 ± 1.67 mm and 16.52 ± 1.52 mm, respectively, with a gender-related difference. Based on the clock face indication system, the danger zone caused by the suprascapular nerve projection was oriented between the two o'clock and eight o'clock positions in reference to the right shoulder. Glenoid size and the safe zone for screw fixation during RSA were characterized in a Chinese population. Careful consideration of baseplate fixation and avoidance of suprascapular nerve injury are important for improved clinical outcome.

Neoplastic pleural effusion and intrathoracic metastasis of a scapular osteosarcoma in a dog: a multidisciplinary integrated diagnostic approach.

PubMed

Mesquita, Luis; Mortier, Jeremy; Ressel, Lorenzo; Finotello, Riccardo; Silvestrini, Paolo; Piviani, Martina

2017-06-01

A 10-year-old, female spayed mixed-breed or cross-bred dog was referred to the Small Animal Teaching Hospital of the University of Liverpool due to tachypnea, dyspnea, and pleural effusion not responding to diuretics and antibiotics. The chest was drained and cytology of the pleural fluid was consistent with a modified transudate with presence of atypical cells initially attributed to mesothelial hyperplasia and dysplasia. Computed tomography detected, in addition to the bilateral pleural effusion, diffuse pleural thickening, multiple pleural and pulmonary nodules, and a mineralized and lytic mass in the left scapula. Imaging findings were suggestive of a primary bone tumor with intrathoracic metastasis. Cytology of the left scapular and pleural masses revealed a malignant neoplasm highly suggestive of osteosarcoma. The diagnosis was confirmed by demonstration of a positive cytochemical reaction for alkaline phosphatase on prestained cytology slides. This finding prompted review of the initial interpretation of the pleural effusion cytology. The presence of neoplastic osteoblasts in the thoracic fluid was identified by a combination of cytochemistry, cell pellet immunohistochemistry, and transmission electron microscopy findings. In this report, a multidisciplinary integrated diagnostic approach was used to diagnose and confirm a neoplastic pleural effusion due to osteosarcoma metastasis in a dog. © 2017 American Society for Veterinary Clinical Pathology.

Quality assessment of shoulder plyometric exercises: Examining the relationship to scapular muscle activity.

PubMed

Calé-Benzoor, Maya; Maenhout, Annelies; Arnon, Michal; Tenenbaum, Gershon; Werrin, Mia; Cools, Ann

2017-07-01

The purpose of the study was to evaluate performance quality of shoulder plyometric exercises, and examine the relationship to scapular muscle activation during an intense exercise bout. Observational study. University laboratory. 32 healthy university students (male/female: 14/18) volunteers. Subjects performed 10 plyometric exercises. Surface EMG of upper (UT), middle (MT) and lower (LT) trapezius and serratus anterior (SA) was registered. A quality assessment questionnaire was administered at the beginning and end of the exercise bout. Muscle activation at the beginning and end was evaluated by t-test. Mixed repeated measures ANOVA was conducted to test the effects of criterion-quality, time, muscles, exercises, and their interactions. Increased EMG activation was noted in 34/40 cases, (21/40 significant (p < 0.05) changes). Quality assessment revealed a decline in the ability to maintain initial position (43% of subjects), failure to keep a consistent and symmetrical arc of motion (62% of subjects), and performance with trick movements (48% of subjects). Inability to keep a consistent arc of motion was significant in 4 exercises. The novel questionnaire may aid quality assessment during plyometric exercises. Ability to keep a consistent arc of motion was the most sensitive marker of decline of performance quality. Copyright © 2017 Elsevier Ltd. All rights reserved.

Duocentric® reversed shoulder prosthesis and Personal Fit® templates: innovative strategies to optimize prosthesis positioning and prevent scapular notching.

PubMed

Trouilloud, P; Gonzalvez, M; Martz, P; Charles, H; Handelberg, F; Nyffeler, R W; Baulot, E

2014-05-01

We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.

Surgical treatment of severe or moderate axillary burn scar contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients--A clinical experience of 15 cases.

PubMed

Chen, Baoguo; Xu, Minghuo; Chai, Jiake; Song, Huifeng; Gao, Quanwen

2015-06-01

Axillary burn scar contracture is common and troublesome. With the aim of restoring the function of the upper extremities, a proper local flap with minor damage and preclusion from recurrence should be developed to guarantee satisfactory results. A minor webbed scar contracture was rectified by Z-plasty. However, severe or moderate contracture must be constructed by a local flap. An island scapular flap has been used in pediatric patients for repairing axillary contracture. However, no detailed description of the use of a transverse island scapular flap (TISF) was reported to correct the deformity. Moreover, an expanded transverse island scapular flap (ETISF) used for increasing the volume of skin for severe axillary contracture in adults and developing children was also not presented. From 2006 to 2013, TISFs were harvested for 12 pediatric patients (5-12 years of age) with 15 sides of severe or moderate axillary burn scar contractures. Four ETISFs were designed for two adult patients (38 and 32 years of age). The flap size was between 10 cm×5 cm and 20 cm×10 cm. In one pediatric patient, a cicatrix was observed on the surface of the flap's donor site. Handheld Doppler was applied to detect the pedicle. The patients were required to lift their upper arms regularly each day after the operation. All 19 flaps survived completely. Axillary burn scar contractures were corrected successfully in 11 patients with no expander implantation. The lifting angle was enhanced considerably with 1-3 years of follow-up in the 11 patients. Only one pediatric patient with cicatrix on the donor site displayed tight skin on the back and a little restraint on the shoulder. The patient's parents were told to intensify the chin-up movement on the horizontal bar. She was in the process of a 3-month follow-up. The lifting angle was also improved significantly in the latter three cases of expander implantation although they were followed up for a short duration of 3 months. Due to poor flap design, the donor site of one adult patient was not closed directly with the help of skin grafting on the left side of her back. Considering the flap's negligible level of later contracture and minimal trauma, local TISF based on the transverse branch of the circumflex scapular artery is a good choice for reconstruction of axillary burn scar contractures. If the TISF is not able to meet the demand, the expander implanted in advance can be more beneficial. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Relationship of individual scapular anatomy and degenerative rotator cuff tears.

PubMed

Moor, Beat K; Wieser, Karl; Slankamenac, Ksenija; Gerber, Christian; Bouaicha, Samy

2014-04-01

The etiology of rotator cuff disease is age related, as documented by prevalence data. Despite conflicting results, growing evidence suggests that distinct scapular morphologies may accelerate the underlying degenerative process. The purpose of the present study was to evaluate the predictive power of 5 commonly used radiologic parameters of scapular morphology to discriminate between patients with intact rotator cuff tendons and those with torn rotator cuff tendons. A pre hoc power analysis was performed to determine the sample size. Two independent readers measured the acromion index, lateral acromion angle, and critical shoulder angle on standardized anteroposterior radiographs. In addition, the acromial morphology according to Bigliani and the acromial slope were determined on true outlet views. Measurements were performed in 51 consecutive patients with documented degenerative rotator cuff tears and in an age- and sex-matched control group of 51 patients with intact rotator cuff tendons. Receiver operating characteristic analyses were performed to determine cutoff values and to assess the sensitivity and specificity of each parameter. Patients with degenerative rotator cuff tears demonstrated significantly higher acromion indices, smaller lateral acromion angles, and larger critical shoulder angles than patients with intact rotator cuffs. However, no difference was found between the acromial morphology according to Bigliani and the acromial slope. With an area under the receiver operating characteristic curve of 0.855 and an odds ratio of 10.8, the critical shoulder angle represented the strongest predictor for the presence of a rotator cuff tear. The acromion index, lateral acromion angle, and critical shoulder angle accurately predict the presence of degenerative rotator cuff tears. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Impaired positioning of the gape in whiplash-associated disorders.

PubMed

Zafar, Hamayun; Nordh, Erik; Eriksson, Per-Olof

2006-01-01

We have previously introduced a new concept for natural jaw function suggesting that "functional jaw movements" are the result of coordinated jaw and neck muscle activation, leading to simultaneous movements in the temporomandibular, atlanto-occipital and cervical spine joints. Thus, jaw function requires a healthy state of both the jaw and the neck motor systems. The aim of this study was to examine the positioning of the gape in space during maximal jaw opening at fast and slow speed in healthy as well as whiplash-associated disorders (WAD) individuals. A wireless optoelectronic technique for three-dimensional movement recording was used. Subjects were seated in an upright position, with back support up to the mid-scapular level without headrest. The position of the gape in space was defined as the vertical midpoint position of the gape at maximal jaw opening (MP). In healthy, the MP generally coincided with the reference position at the start of jaw opening. In the WAD group, the MP was significantly lower than the reference position. No sex or speed related differences were found. The results suggest that both the width and orientation of the gape in space relies on coordinated jaw and neck muscle activation and mandibular and head-neck movements. This study also suggests an association between neck pain and dysfunction following trauma, and reduced width and impaired positioning of the gape in space. Finally, the MP seems to be a useful marker in evaluation of the functional state of the jaw-neck motor system.

Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?

PubMed

Seitz, Amee L; McClure, Philip W; Finucane, Sheryl; Boardman, N Douglas; Michener, Lori A

2011-01-01

The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased extensibility of pectoralis minor or posterior shoulder. A unique extrinsic mechanism, internal impingement, is attributed to compression of the posterior articular surface of the tendons between the humeral head and glenoid and is not related to subacromial space narrowing. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. The varied nature of these mechanisms indicates that rotator cuff tendinopathy is not a homogenous entity, and thus may require different treatment interventions. Treatment aimed at addressing mechanistic factors appears to be beneficial for patients with rotator cuff tendinopathy, however, not for all patients. Classification of rotator cuff tendinopathy into subgroups based on underlying mechanism may improve treatment outcomes. 2010 Elsevier Ltd. All rights reserved.

Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation.

PubMed

Boileau, Pascal; Moineau, Grégory; Roussanne, Yannick; O'Shea, Kieran

2011-09-01

Scapular notching, prosthetic instability, limited shoulder rotation and loss of shoulder contour are associated with conventional medialized design reverse shoulder arthroplasty. Prosthetic (ie, metallic) lateralization increases torque at the baseplate-glenoid interface potentially leading to failure. We asked whether bony lateralization of reverse shoulder arthroplasty would avoid the problems caused by humeral medialization without increasing torque or shear force applied to the glenoid component. We prospectively followed 42 patients with rotator cuff deficiency treated with bony increased-offset reverse shoulder arthroplasty. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate. Graft and baseplate fixation was achieved using a lengthened central peg (25 mm) and four screws. Patients underwent clinical, radiographic, and CT assessment at a minimum of 2 years after surgery. The humeral graft incorporated completely in 98% of cases (41 of 42) and partially in one. At a mean of 28 months postoperatively, no graft resorption, glenoid loosening, or postoperative instability was observed. Inferior scapular notching occurred in 19% (eight of 42). The absolute Constant-Murley score improved from 31 to 67. Thirty-six patients (86%) were able to internally rotate sufficiently to reach their back over the sacrum. Grafting of the glenoid surface during reverse shoulder arthroplasty effectively creates a long-necked scapula, providing the benefits of lateralization. Bony increased-offset reverse shoulder arthroplasty is associated with low rates of inferior scapular notching, improved shoulder rotation, no prosthetic instability and improved shoulder contour. In contrast to metallic lateralization, bony lateralization has the advantage of maintaining the prosthetic center of rotation at the prosthesis-bone interface, thus minimizing torque on the glenoid component. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results.

PubMed

Capanna, Rodolfo; Totti, Francesca; Van der Geest, Ingrid C M; Müller, Daniel A

2015-08-01

Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws. The periscapular muscles and the residual joint capsule were sutured to the corresponding insertions of the allograft. The mean follow-up was 5.5 years (range, 24-175 months). In all patients, a wide surgical margin was achieved. The average functional scores were 20 points for the International Society of Limb Salvage score and 60 points for the American Shoulder and Elbow Surgeons score. Mean active shoulder flexion of 60° (range, 30°-90°) and mean active abduction of 62° (range, 30°-90°) were achieved. During the follow-up, 1 patient (16.6%) had a local recurrence and lung metastasis, whereas the remaining 5 patients (83.3%) were disease free. Two breakages of the osteosynthesis and 2 allograft fractures were observed, necessitating a revision surgery in 2 cases (33.3%). In this series, no infection, allograft resorption, or shoulder instability occurred. Allograft substitution of a completely removed scapula is an oncologically safe procedure, with good functional results, avoiding common complications in prosthetic replacements such as infection and dislocation of the shoulder joint. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The long-term outcome of displaced mid-third clavicle fractures on scapular and shoulder function: variations between immediate surgery, delayed surgery, and nonsurgical management.

PubMed

George, Daniel M; McKay, Bartholomew P; Jaarsma, Ruurd L

2015-05-01

Conservative management for uncomplicated displaced clavicle fractures is common practice. Delay of surgical fixation may result in less favorable outcomes. A retrospective cohort study was conducted of 60 patients with a closed mid-third clavicle fracture that did not meet current operative or nonoperative guidelines; 20 primary (plate fixation <6 weeks), 20 delayed (plate fixation >6 weeks), and 20 matched conservative patients were included. Each patient completed 2 questionnaires, the Disabilities of the Arm, Shoulder, and Hand and the American Shoulder and Elbow Surgeons, as well as visual analog scales for pain, cosmetic satisfaction, and overall satisfaction. In addition, 10 patients from each group underwent clinical review of scapular rotation by the lateral scapular slide test, clinical impingement, range of motion assessment, and radiologic review of clavicle union and length. The American Shoulder and Elbow Surgeons patient self-reported questionnaire demonstrated a median score of 5.5 for the delayed group, 2 for the primary group, and 1 for the conservative group (P = .032). The median Disabilities of the Arm, Shoulder, and Hand score was 7.92 for the delayed group, 3.32 for the primary group, and 1.67 for the conservative group (P = .212). Six patients in the delayed group had scapular malrotation compared with 2 in the primary group and none in the conservative group (P = .008). Flexion and external rotation in 90° abduction were decreased in the conservative group (P = .049 and .041, respectively). We support the conservative management of uncomplicated displaced clavicle fractures but recognize that a lower threshold for early surgery should be considered where optimal shoulder function is required. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Optimizing glenosphere position and fixation in reverse shoulder arthroplasty, Part One: The twelve-mm rule.

PubMed

Kelly, James D; Humphrey, C Scott; Norris, Tom R

2008-01-01

The Aequalis Reversed Shoulder Prosthesis (Tornier, Inc., Edina, MN) is a successful treatment option for older, low-demand patients with rotator cuff arthropathy. Scapular notching is the most common radiographic complication and is associated with poorer intermediate-term clinical outcomes. Aligning the lower border of the glenosphere baseplate with the inferior glenoid rim has been recommended to reduce this complication, but guidelines for achieving this positioning are currently lacking. The purpose of this study is to develop a rule of thumb that will facilitate proper glenosphere component positioning intraoperatively. Utilizing a computed tomography-templating protocol, we found that the ideal location of the drill hole for the baseplate post was 11.5 +/- 1.0 mm above the inferior glenoid rim. On the basis of measurements from 10 implanted cadaveric specimens, we concluded that drilling the baseplate posthole 12 mm above the inferior glenoid rim-the 12-mm rule-will result in excellent glenosphere position in most cases.

Classification and Morphological Parameters of the Scapular Spine

PubMed Central

Wang, Hua-Jun; Giambini, Hugo; Hou, Da-Biao; Huan, Song-Wei; Liu, Ning; Yang, Jie; Chen, Chao; Gao, Yan-Ping; Shang, Ru-Guo; Li, Yi-Kai; Zha, Zhen-gang

2015-01-01

Abstract Incidence of scapular spine (SS) fractures as a result of complications of reverse total shoulder arthroplasty is relatively high leading to inferior clinical outcomes and an increased risk of revision and dislocation. Fractures of SS because of trauma, including the acromion, constitute 6% to 23% of scapula fractures. The purpose of this study was to classify the SS and present specific geometrical parameters according to osteologic features. A total of 319 intact dry scapulae were collected and classified based on morphological characteristics and shape of the SS. Nine bony landmarks were also chosen and described for their relevance to regions of interest for scapular fixation. Five specific types of SS were noted and the most prevalent groups were Type 1 (Fusiform shape) (47.17%) and Type 5 (Horizontal S-shape) (19.18%). Overall, Types 3, 4, and 1 showed thicker landmark values compared to Type 5, with Type 2 having smaller values. Our classification into 5 distinct types allowed appreciation of the anatomical variance of SSs. The contours of Types 5 and 1 presented a more complex morphology and may lead to a worse surgical approach due to a fracture. As Types 2 and 5 were much thinner than the other types, these may be more susceptible to fractures. PMID:26559282

Cadaveric and three-dimensional computed tomography study of the morphology of the scapula with reference to reversed shoulder prosthesis

PubMed Central

Torrens, Carlos; Corrales, Monica; Gonzalez, Gemma; Solano, Alberto; Cáceres, Enrique

2008-01-01

Purpose The purpose of this study is to analyze the morphology of the scapula with reference to the glenoid component implantation in reversed shoulder prosthesis, in order to improve primary fixation of the component. Methods Seventy-three 3-dimensional computed tomography of the scapula and 108 scapular dry specimens were analyzed to determine the anterior and posterior length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula and the angle between the major craneo-caudal glenoid axis and the base of the coracoid process and the upper posterior column. Results The anterior and posterior length of glenoid neck was classified into two groups named "short-neck" and "long-neck" with significant differences between them. The angle between the glenoid surface and the upper posterior column of the scapula was also classified into two different types: type I (mean 50°–52°) and type II (mean 62,50°–64°), with significant differences between them (p < 0,001). The angle between the major craneo-caudal glenoid axis and the base of the coracoid process averaged 18,25° while the angle with the upper posterior column of the scapula averaged 8°. Conclusion Scapular morphological variability advices for individual adjustments of glenoid component implantation in reversed total shoulder prosthesis. Three-dimensional computed tomography of the scapula constitutes an important tool when planning reversed prostheses implantation. PMID:18847487

Cadaveric and three-dimensional computed tomography study of the morphology of the scapula with reference to reversed shoulder prosthesis.

PubMed

Torrens, Carlos; Corrales, Monica; Gonzalez, Gemma; Solano, Alberto; Cáceres, Enrique

2008-10-10

The purpose of this study is to analyze the morphology of the scapula with reference to the glenoid component implantation in reversed shoulder prosthesis, in order to improve primary fixation of the component. Seventy-three 3-dimensional computed tomography of the scapula and 108 scapular dry specimens were analyzed to determine the anterior and posterior length of the glenoid neck, the angle between the glenoid surface and the upper posterior column of the scapula and the angle between the major craneo-caudal glenoid axis and the base of the coracoid process and the upper posterior column. The anterior and posterior length of glenoid neck was classified into two groups named "short-neck" and "long-neck" with significant differences between them. The angle between the glenoid surface and the upper posterior column of the scapula was also classified into two different types: type I (mean 50 degrees-52 degrees ) and type II (mean 62.50 degrees-64 degrees ), with significant differences between them (p < 0.001). The angle between the major craneo-caudal glenoid axis and the base of the coracoid process averaged 18,25 degrees while the angle with the upper posterior column of the scapula averaged 8 degrees . Scapular morphological variability advices for individual adjustments of glenoid component implantation in reversed total shoulder prosthesis. Three-dimensional computed tomography of the scapula constitutes an important tool when planning reversed prostheses implantation.

Handball load and shoulder injury rate: a 31-week cohort study of 679 elite youth handball players.

PubMed

Møller, M; Nielsen, R O; Attermann, J; Wedderkopp, N; Lind, M; Sørensen, H; Myklebust, G

2017-02-01

Knowledge of injury patterns, an essential step towards injury prevention, is lacking in youth handball. To investigate if an increase in handball load is associated with increased shoulder injury rates compared with a minor increase or decrease, and if an association is influenced by scapular control, isometric shoulder strength or glenohumeral range of motion (ROM). 679 players (14-18 years) provided weekly reports on shoulder injury and handball load (training and competition hours) over 31 weeks using the SMS, phone and medical examination system. Handball load in a given week was categorised into (1) <20% increase or decrease (reference), (2) increase between 20% and 60% and (3) increase >60% relative to the weekly average amount of handball load the preceding 4 weeks. Assessment of shoulder isometric rotational and abduction strength, ROM and scapular control was performed at baseline and midseason. An increase in handball load by >60% was associated with greater shoulder injury rate (HR 1.91; 95% CI 1.00 to 3.70, p=0.05) compared with the reference group. The effect of an increase in handball load between 20% and 60% was exacerbated among players with reduced external rotational strength (HR 4.0; 95% CI 1.1 to 15.2, p=0.04) or scapular dyskinesis (HR 4.8; 95% CI 1.3 to 18.3, p=0.02). Reduced external rotational strength exacerbated the effect of an increase above 60% (HR 4.2; 95% CI 1.4 to 12.8, p=0.01). A large increase in weekly handball load increases the shoulder injury rate in elite youth handball players; particularly, in the presence of reduced external rotational strength or scapular dyskinesis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Cutaneous distribution and circadian rhythm of Onchocerca lupi microfilariae in dogs.

PubMed

Otranto, Domenico; Dantas-Torres, Filipe; Giannelli, Alessio; Abramo, Francesca; Ignjatović Ćupina, Aleksandra; Petrić, Dušan; Cardoso, Luís; Mutafchiev, Yasen; Cortes, Helder

2013-01-01

Among the arthropod-borne nematodes infesting dogs, Onchocerca lupi (Spirurida: Onchocercidae) is of increasing zoonotic concern, with new human cases of infection diagnosed in Turkey, Tunisia, Iran and the USA. Knowledge of the biology of this nematode is meagre. This study aimed at assessing the distribution and periodicity of O. lupi microfilariae from different body regions in naturally infested dogs. Skin samples were collected from six dogs infested with O. lupi but without apparent clinical signs. Two skin samples were collected from 18 anatomical regions of dog 1 at necropsy. In addition, single skin biopsies were performed from the forehead, inter-scapular and lumbar regions of dogs 2-6, in the morning, afternoon, and at night. Two aliquots of the sediment of each sample were microscopically observed, microfilariae counted and morphologically and molecularly identified. Most of the 1,667 microfilariae retrieved from dog 1 were in the right ear (59.6%), nose (26.5%), left ear (6.7%), forehead (3.0%), and inter-scapular (2.9%) regions. In dogs 2-6, the overall mean number of microfilariae was larger on the head (n = 122.8), followed by the inter-scapular (n = 119.0) and lumbar (n = 12.8) regions. The overall mean number of microfilariae was larger in the afternoon (153.4), followed by night (75.4) and morning (25.8). Onchocerca lupi microfilariae were more common in the head (i.e., ears and nose) than in the remaining part of the dog's body, indicating they tend to aggregate in specific body regions, which are the best sites to collect skin samples for diagnostic purposes. The periodicity pattern of microfilariae of O. lupi and their concentration in specific body regions is most likely a result of the co-evolution with their as-yet-unknown vector. The detection of skin microfilariae in asymptomatic animals, suggests the potential role of these animals as carriers and reservoirs of O. lupi.

Return to play after treatment of superior labral tears in professional baseball players.

PubMed

Fedoriw, Wasyl W; Ramkumar, Prem; McCulloch, Patrick C; Lintner, David M

2014-05-01

The published return-to-play (RTP) rates for athletes who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of nonsurgical treatment for this group is unknown. Nonsurgical treatment of SLAP tears in professional baseball players leads to RTP before consideration of surgical treatment. Incorporating performance statistics and level of competition will result in lower calculated RTP rates than have been previously reported. Case series; Level of evidence, 4. A retrospective review of 119 consecutive patients in a single professional baseball organization with persistent shoulder pain that limited the ability to compete was performed. Sixty-eight patients had magnetic resonance imaging-documented SLAP lesions. All patients had failed 1 attempt at rehabilitation but had continued with supervised physical therapy. Treatment was according to an algorithm focusing on the correction of scapular dyskinesia and posterior capsular contracture with glenohumeral internal rotation deficit (GIRD), followed by pain-free return to throwing. Those who failed 2 cycles of nonsurgical treatment were treated surgically. Success was defined by 2 different standards: (1) RTP, in accordance with previous studies; and (2) a more stringent standard of return to the same level/quality of professional competition (A, AA, AAA, etc) with the incorporation of a return to preinjury individual performance statistics (earned run average, walks plus hits per inning pitched), termed "return to prior performance" (RPP). Sixty-eight athletes were identified with SLAP lesions. Twenty-one pitchers successfully completed the nonsurgical algorithm and attempted a return. Their RTP rate was 40%, and their RPP rate was 22%. The RTP rate for 27 pitchers who underwent 30 procedures was 48%, and the RPP rate was 7%. For 10 position players treated nonsurgically, the RTP rate was 39%, and the RPP rate was 26%. The RTP rate for 13 position players who underwent 15 procedures was 85%, with an RPP rate of 54%. Nonsurgical treatment correcting scapular dyskinesia and GIRD had a reasonable success rate in professional baseball players with painful shoulders and documented SLAP lesions. The rate of return after surgical treatment of SLAP lesions was low for pitchers. The RTP and RPP rates were higher for position players than for pitchers. Nonsurgical treatment should be considered for professional baseball players with documented SLAP lesions, as it can lead to acceptable RTP and RPP rates.

Measuring Three-Dimensional Thorax Motion Via Biplane Radiographic Imaging: Technique and Preliminary Results.

PubMed

Baumer, Timothy G; Giles, Joshua W; Drake, Anne; Zauel, Roger; Bey, Michael J

2016-01-01

Measures of scapulothoracic motion are dependent on accurate imaging of the scapula and thorax. Advanced radiographic techniques can provide accurate measures of scapular motion, but the limited 3D imaging volume of these techniques often precludes measurement of thorax motion. To overcome this, a thorax coordinate system was defined based on the position of rib pairs and then compared to a conventional sternum/spine-based thorax coordinate system. Alignment of the rib-based coordinate system was dependent on the rib pairs used, with the rib3:rib4 pairing aligned to within 4.4 ± 2.1 deg of the conventional thorax coordinate system.

Anterior deltoid deficiency in reverse total shoulder replacement: a biomechanical study with cadavers.

PubMed

Gulotta, L V; Choi, D; Marinello, P; Wright, T; Cordasco, F A; Craig, E V; Warren, R F

2012-12-01

Reverse total shoulder replacement (RTSR) depends on adequate deltoid function for a successful outcome. However, the anterior deltoid and/or axillary nerve may be damaged due to prior procedures or injury. The purpose of this study was to determine the compensatory muscle forces required for scapular plane elevation following RTSR when the anterior deltoid is deficient. The soft tissues were removed from six cadaver shoulders, except for tendon attachments. After implantation of the RTSR, the shoulders were mounted on a custom-made shoulder simulator to determine the mean force in each muscle required to achieve 30° and 60° of scapular plane elevation. Two conditions were tested: 1) Control with an absent supraspinatus and infraspinatus; and 2) Control with anterior deltoid deficiency. Anterior deltoid deficiency resulted in a mean increase of 195% in subscapularis force at 30° when compared with the control (p = 0.02). At 60°, the subscapularis force increased a mean of 82% (p < 0.001) and the middle deltoid force increased a mean of 26% (p = 0.04). Scapular plane elevation may still be possible following an RTSR in the setting of anterior deltoid deficiency. When the anterior deltoid is deficient, there is a compensatory increase in the force required by the subscapularis and middle deltoid. Attempts to preserve the subscapularis, if present, might maximise post-operative function.

Physical therapy as conservative management for cervical pain and headaches in an adolescent with neurofibromatosis type 1: a case study.

PubMed

Helmers, Kristin M; Irwin, Kent E

2009-12-01

: Neurofibromatosis is a group of genetic disorders that affect the development and growth of nerve cell tissues. These disorders include tumors of myelin-producing supportive cells that grow on nerves and can cause changes in bone formation, skin integrity, and nerve transmission. Common musculoskeletal impairments associated with neurofibromatosis type 1 (NF 1) include cervical pain, muscle weakness, muscle stiffness, headaches, and postural deviations. : This case study describes successful physical therapy management and outcomes for cervical pain and headaches in a 17-year-old girl with a 16-year history of NF 1. Difficulties in driving, studying, lifting, and participating in recreational activities were all associated with the patient's pain, decreased cervical range of motion, decreased scapular strength, and postural deviations. : Physical therapy interventions included posture training, dynamic shoulder/scapular strengthening, cervical stabilization, stretching, ultrasound, interferential current, and a progressive home exercise program. : By the end of 13 weeks (20 sessions) of physical therapy, the patient was completely pain free, demonstrated increased cervical range of motion, and had improvements in scapular strength. She returned to full and unrestricted recreational activities, driving, studying, and household chores. Furthermore, scores on the Neck Disability Index improved from 44 of 50 (complete disability) to 2 of 50 (no disability). : Physical therapy may be a viable option for conservative management of musculoskeletal dysfunction and functional limitations resulting from NF 1.

3D reconstructions of quail-chick chimeras provide a new fate map of the avian scapula.

PubMed

Shearman, Rebecca M; Tulenko, Frank J; Burke, Ann C

2011-07-01

Limbed vertebrates have functionally integrated postcranial axial and appendicular systems derived from two distinct populations of embryonic mesoderm. The axial skeletal elements arise from the paraxial somites, the appendicular skeleton and sternum arise from the somatic lateral plate mesoderm, and all of the muscles for both systems arise from the somites. Recent studies in amniotes demonstrate that the scapula has a mixed mesodermal origin. Here we determine the relative contribution of somitic and lateral plate mesoderm to the avian scapula from quail-chick chimeras. We generate 3D reconstructions of the grafted tissue in the host revealing a very different distribution of somitic cells in the scapula than previously reported. This novel 3D visualization of the cryptic border between somitic and lateral plate populations reveals the dynamics of musculoskeletal morphogenesis and demonstrates the importance of 3D visualization of chimera data. Reconstructions of chimeras make clear three significant contrasts with existing models of scapular development. First, the majority of the avian scapula is lateral plate derived and the somitic contribution to the scapular blade is significantly smaller than in previous models. Second, the segmentation of the somitic component of the blade is partially lost; and third, there are striking differences in growth rates between different tissues derived from the same somites that contribute to the structures of the cervical thoracic transition, including the scapula. These data call for the reassessment of theories on the development, homology, and evolution of the vertebrate scapula. Copyright © 2011 Elsevier Inc. All rights reserved.

Scapular flap for maxillectomy defect reconstruction and preliminary results using three-dimensional modeling.

PubMed

Modest, Mara C; Moore, Eric J; Abel, Kathryn M Van; Janus, Jeffrey R; Sims, John R; Price, Daniel L; Olsen, Kerry D

2017-01-01

Discuss current techniques utilizing the scapular tip and subscapular system for free tissue reconstruction of maxillary defects and highlight the impact of medical modeling on these techniques with a case series. Case review series at an academic hospital of patients undergoing maxillectomy + thoracodorsal scapula composite free flap (TSCF) reconstruction. Three-dimensional (3D) models were used in the last five cases. 3D modeling, surgical, functional, and aesthetic outcomes were reviewed. Nine patients underwent TSCF reconstruction for maxillectomy defects (median age = 43 years; range, 19-66 years). Five patients (55%) had a total maxillectomy (TM) ± orbital exenteration, whereas four patients (44%) underwent subtotal palatal maxillectomy. For TM, the contralateral scapula tip was positioned with its natural concavity recreating facial contour. The laterally based vascular pedicle was ideally positioned for facial vessel anastomosis. For subtotal-palatal defect, an ipsilateral flap was harvested, but inset with the convex surface facing superiorly. Once 3D models were available from our anatomic modeling lab, they were used for intraoperative planning of the last five patients. Use of the model intraoperatively improved efficiency and allowed for better contouring/plating of the TSCF. At last follow-up, all patients had good functional outcomes. Aesthetic outcomes were more successful in patients where 3D-modeling was used (100% vs. 50%). There were no flap failures. Median follow-up >1 month was 5.2 months (range, 1-32.7 months). Reconstruction of maxillectomy defects is complex. Successful aesthetic and functional outcomes are critical to patient satisfaction. The TSCF is a versatile flap. Based on defect type, choosing laterality is crucial for proper vessel orientation and outcomes. The use of internally produced 3D models has helped refine intraoperative contouring and flap inset, leading to more successful outcomes. 4. Laryngoscope, 127:E8-E14, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Electromyographical Comparison of Four Common Shoulder Exercises in Unstable and Stable Shoulders

PubMed Central

Sciascia, Aaron; Kuschinsky, Nina; Nitz, Arthur J.; Mair, Scott D.; Uhl, Tim L.

2012-01-01

This study examines if electromyographic (EMG) amplitude differences exist between patients with shoulder instability and healthy controls performing scaption, prone horizontal abduction, prone external rotation, and push-up plus shoulder rehabilitation exercises. Thirty nine subjects were categorized by a single orthopedic surgeon as having multidirectional instability (n = 10), anterior instability (n = 9), generalized laxity (n = 10), or a healthy shoulder (n = 10). Indwelling and surface electrodes were utilized to measure EMG activity (reported as a % of maximum voluntary isometric contraction (MVIC)) in various shoulder muscles during 4 common shoulder exercises. The exercises studied effectively activated the primary musculature targeted in each exercise equally among all groups. The serratus anterior generated high activity (50–80% MVIC) during a push-up plus, while the infraspinatus and teres major generated moderate-to-high activity (30–80% MVIC) during both the prone horizontal and prone external rotation exercises. Scaption exercise generated moderate activity (20–50% MVIC) in both rotator cuff and scapular musculature. Clinicians should feel confident in prescribing these shoulder-strengthening exercises in patients with shoulder instability as the activation levels are comparable to previous findings regarding EMG amplitudes and should improve the dynamic stabilization capability of both rotator cuff and scapular muscles using exercises designed to address glenohumeral joint instability. PMID:22919499

Shoulder Impingement Treatment

MedlinePlus

... imbalance in the rotator cuff or scapular muscles, postural abnormalities, shoulder joint instability, or improper training or ... and corrected. Phase Goals Methods Comments I Pain control Limit overhead activity or anything that causes pain. ...

Biomechanical comparison of reverse total shoulder arthroplasty systems in soft tissue-constrained shoulders.

PubMed

Henninger, Heath B; King, Frank K; Tashjian, Robert Z; Burks, Robert T

2014-05-01

Numerous studies have examined the biomechanics of isolated variables in reverse total shoulder arthroplasty. This study directly compared the composite performance of two reverse total shoulder arthroplasty systems; each system was designed around either a medialized or a lateralized glenohumeral center of rotation. Seven pairs of shoulders were tested on a biomechanical simulator. Center of rotation, position of the humerus, passive and active range of motion, and force to abduct the arm were quantified. Native arms were tested, implanted with a Tornier Aequalis or DJO Surgical Reverse Shoulder Prosthesis (RSP), and then retested. Differences from the native state were then documented. Both systems shifted the center of rotation medially and inferiorly relative to native. Medial shifts were greater in the Aequalis implant (P < .037). All humeri shifted inferior compared with native but moved medially with the Aequalis (P < .001). Peak passive abduction, internal rotation, and external rotation did not differ between systems (P > .05). Both reverse total shoulder arthroplasty systems exhibited adduction deficits, but the RSP implant deficit was smaller (P = .046 between implants). Both systems reduced forces to abduct the arm compared with native, although the Aequalis required more force to initiate motion from the resting position (P = .022). Given the differences in system designs and configurations, outcome variables were generally comparable. The RSP implant allowed slightly more adduction, had a more lateralized humeral position, and required less force to initiate elevation. These factors may play roles in limiting scapular notching, improving active external rotation by normalizing the residual rotator cuff length, and limiting excessive stress on the deltoid. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Structural and biomechanical changes in shoulders of junior javelin throwers: a comprehensive evaluation as a proof of concept for a preventive exercise protocol.

PubMed

Beitzel, Knut; Zandt, Julia F; Buchmann, Stefan; Beitzel, Kirsten I; Schwirtz, Ansgar; Imhoff, Andreas B; Brucker, Peter U

2016-06-01

The purpose of this study was to develop a preventive exercise protocol based on structural and functional changes present in shoulder joints of young throwing athletes. As a proof of concept, these changes were previously evaluated in a cross-section of high-performance junior javelin throwers. Thirteen members of the German and Bavarian junior javelin squad (mean age 17.5 ± 0.8 years) completed a systematic clinical examination, shoulder range of motion (ROM) measurement, and were scored with standardized clinical tools. 3.0 tesla magnetic resonance imaging (MRI) was conducted on both shoulders. Bilateral three-dimensional analysis of the scapulothoracic motion during multiplanar humeral elevation and isokinetic strength testing of the shoulder internal and external rotators was accomplished. Based on the findings, a preventive exercise protocol was confirmed. Dominant internal ROM was significantly decreased (dominant 48° ± 20° vs. non-dominant 57° ± 19°; P = 0.006) and dominant external ROM increased (dominant 117° ± 15° vs. non-dominant 107° ± 10°; P = 0.008). MRI revealed posterosuperior intraosseous cysts of the humeral head with a size larger than >3 mm in 69 % of the dominant shoulders and only in 15 % in the non-dominant shoulders. Motion analysis of the static scapular resting position was significantly different between dominant and non-dominant sides regarding anterior tilt (dominant > non-dominant, mean difference 4.2°, P = 0.010) and retraction (dominant > non-dominant, mean difference 2.4°, P = 0.038). Dominant scapular anterior tilt during flexion and abduction was significantly increased (-4.3°, P = 0.006; -3.4°, P = 0.046). Dominant retraction was significantly increased during abduction (-2.3°, P = 0.040). Isokinetic outcome parameters presented nonsignificant bilateral differences. Elite junior javelin throwers already present structural (humeral intraosseous cysts) and biomechanical changes (ROM deficits and asymmetric scapulothoracic motion patterns), even if they have no history of major shoulder pain or injury. A novel exercise protocol was developed in order to address the complex of alterations in a comprehensive way. Preventive diagnostics in combination with a systematic all-year preventive exercise intervention might be one option to detect and control risk factors of a symptomatic throwing shoulder at an early stage. IV.

Elevated β-hCG associated with aggressive Osteoblastoma.

PubMed

Morris, Carol D; Hameed, Meera R; Agaram, Narasimhan P; Hwang, Sinchun

2017-09-01

We present a unique case of an aggressive scapular osteoblastoma that produced β-hCG as a paraneoplastic manifestation in a 20-year-old woman. Serum β-hCG was found to be elevated during presurgical workup and consequently delayed surgical resection of the increasingly painful tumor because of suspected pregnancy. The paraneoplastic production of β-hCG was later proven by positive immunohistochemical stain of β-hCG in a curettage specimen and normalization of β-hCG levels after surgical resection of the aggressive osteoblastoma. Production of beta-human chorionic gonadotropin (β-hCG) has been reported in several carcinomas and sarcomas but, to our knowledge, it has not been reported in osteoblastoma in the English-language literature.

Open Anterior Release of the Superior Transverse Scapular Ligament for Decompression of the Suprascapular Nerve During Brachial Plexus Surgery.

PubMed

Elzinga, Kate E; Curran, Matthew W T; Morhart, Michael J; Chan, K Ming; Olson, Jaret L

2016-07-01

Reconstruction of the suprascapular nerve (SSN) after brachial plexus injury often involves nerve grafting or a nerve transfer. To restore shoulder abduction and external rotation, a branch of the spinal accessory nerve is commonly transferred to the SSN. To allow reinnervation of the SSN, any potential compression points should be released to prevent a possible double crush syndrome. For that reason, the authors perform a release of the superior transverse scapular ligament at the suprascapular notch in all patients undergoing reconstruction of the upper trunk of the brachial plexus. Performing the release through a standard anterior open supraclavicular approach to the brachial plexus avoids the need for an additional posterior incision or arthroscopic procedure. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The spinoglenoid ligament. Anatomy, morphology, and histological findings.

PubMed

Plancher, Kevin D; Peterson, Robert K; Johnston, Jack C; Luke, Timothy A

2005-02-01

Dysfunction of the distal branch of the suprascapular nerve has been reported in athletes involved in throwing or overhead sports. The consistent presence of a dynamic anatomic structure, the spinoglenoid ligament, overlying the nerve in the spinoglenoid notch may be a contributing factor to the dysfunction of this nerve. The purpose of this study was to report the anatomy, morphology, and histological characteristics of the spinoglenoid ligament. The spinoglenoid ligaments of fifty-eight fresh-frozen cadaver shoulders were dissected to evaluate their anatomic dimensions, histological characteristics, and relationship to the suprascapular nerve, the posterior part of the capsule, and the glenoid rim. The spinoglenoid ligament was harvested, with its insertions on the scapular spine and on the capsule and glenoid left intact, for the histological analysis. Dissection revealed that a spinoglenoid ligament was present in all specimens. The ligament was found to form an irregular quadrangular shape. On gross examination, the deep fibers of the ligament extended from the lateral aspect of the scapular spine to the posterior part of the glenoid and the superficial fibers blended with the posterior aspect of the shoulder capsule. Histological sections demonstrated Sharpey fibers inserting into bone at the scapular spine and blending with the posterior aspect of the shoulder capsule to insert into the posterior surface of the glenoid, findings that confirmed the ligamentous nature of this structure. This study revealed the presence of the spinoglenoid ligament in all of the shoulders that were examined, with some variation in the size of the ligament.

Body Temperature Measurements for Metabolic Phenotyping in Mice.

PubMed

Meyer, Carola W; Ootsuka, Youichirou; Romanovsky, Andrej A

2017-01-01

Key Points Rectal probing is subject to procedural bias. This method is suitable for first-line phenotyping, provided probe depth and measurement duration are standardized. It is also useful for detecting individuals with out-of-range body temperatures (during hypothermia, torpor).The colonic temperature attained by inserting the probe >2 cm deep is a measure of deep (core) body temperature.IR imaging of the skin is useful for detecting heat leaks and autonomous thermoregulatory alterations, but it does not measure body temperature.Temperature of the hairy or shaved skin covering the inter-scapular brown adipose tissue can be used as a measure of BAT thermogenesis. However, obtaining such measurements of sufficient quality is very difficult, and interpreting them can be tricky. Temperature differences between the inter-scapular and lumbar areas can be a better measure of the thermogenic activity of inter-scapular brown adipose tissue.Implanted probes for precise determination of BAT temperature (changes) should be fixed close to the Sulzer's vein. For measurement of BAT thermogenesis, core body temperature and BAT temperature should be recorded simultaneously.Tail temperature is suitable to compare the presence or absence of vasoconstriction or vasodilation.Continuous, longitudinal monitoring of core body temperature is preferred over single probing, as the readings are taken in a non-invasive, physiological context.Combining core body temperature measurements with metabolic rate measurements yields insights into the interplay between heat production and heat loss (thermal conductance), potentially revealing novel thermoregulatory phenotypes. Endothermic organisms rely on tightly balanced energy budgets to maintain a regulated body temperature and body mass. Metabolic phenotyping of mice, therefore, often includes the recording of body temperature. Thermometry in mice is conducted at various sites, using various devices and measurement practices, ranging from single-time probing to continuous temperature imaging. Whilst there is broad agreement that body temperature data is of value, procedural considerations of body temperature measurements in the context of metabolic phenotyping are missing. Here, we provide an overview of the various methods currently available for gathering body temperature data from mice. We explore the scope and limitations of thermometry in mice, with the hope of assisting researchers in the selection of appropriate approaches, and conditions, for comprehensive mouse phenotypic analyses.

Serratus anterior and lower trapezius muscle activities during multi-joint isotonic scapular exercises and isometric contractions.

PubMed

Tsuruike, Masaaki; Ellenbecker, Todd S

2015-02-01

Proper scapular function during humeral elevation, such as upward rotation, external rotation, and posterior tilting of the scapula, is necessary to prevent shoulder injury. However, the appropriate intensity of rehabilitation exercise for the periscapular muscles has yet to be clarified. To identify the serratus anterior, lower trapezius, infraspinatus, and posterior deltoid muscle activities during 2 free-motion exercises using 3 intensities and to compare these muscle activities with isometric contractions during quadruped shoulder flexion and external rotation and abduction of the glenohumeral joint. Cross-sectional study. Health Science Laboratory. A total of 16 uninjured, healthy, active, male college students (age = 19.5 ± 1.2 years, height = 173.1 ± 6.5 cm, weight = 68.8 ± 6.6 kg). Mean electromyographic activity normalized by the maximal voluntary isometric contraction was analyzed across 3 intensities and 5 exercises. Intraclass correlation coefficients were calculated for electromyographic activity of the 4 muscles in each free-motion exercise. Significant interactions in electromyographic activity were observed between intensities and exercises (P < .05). The quadruped shoulder-flexion exercise activated all 4 muscles compared with other exercises. Also, the modified robbery free-motion exercise activated the serratus anterior, lower trapezius, and infraspinatus compared with the lawn-mower free-motion exercise. However, neither exercise showed a difference in posterior deltoid electromyographic activity. Three intensities exposed the nature of the periscapular muscle activities across the different exercises. The free-motion exercise in periscapular muscle rehabilitation may not modify serratus anterior, lower trapezius, and infraspinatus muscle activities unless knee-joint extension is limited.

Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systematic review.

PubMed

Wright, Alexis A; Wassinger, Craig A; Frank, Mason; Michener, Lori A; Hegedus, Eric J

2013-09-01

To systematically review and critique the evidence regarding the diagnostic accuracy of physical examination tests for the scapula in patients with shoulder disorders. A systematic, computerised literature search of PubMED, EMBASE, CINAHL and the Cochrane Library databases (from database inception through January 2012) using keywords related to diagnostic accuracy of physical examination tests of the scapula. The Quality Assessment of Diagnostic Accuracy Studies tool was used to critique the quality of each paper. Eight articles met the inclusion criteria; three were considered to be of high quality. Of the three high-quality studies, two were in reference to a 'diagnosis' of shoulder pain. Only one high-quality article referenced specific shoulder pathology of acromioclavicular dislocation with reported sensitivity of 71% and 41% for the scapular dyskinesis and SICK scapula test, respectively. Overall, no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder.

Acromiohumeral Distance During Neuromuscular Electrical Stimulation of the Lower Trapezius and Serratus Anterior Muscles in Healthy Participants.

PubMed

Bdaiwi, Alya H; Mackenzie, Tanya Anne; Herrington, Lee; Horsley, Ian; Cools, Ann M

2015-07-01

Compromise to the acromiohumeral distance has been reported in participants with subacromial impingement syndrome compared with healthy participants. In clinical practice, patients with subacromial shoulder impingement are given strengthening programs targeting the lower trapezius (LT) and serratus anterior (SA) muscles to increase scapular posterior tilt and upward rotation. We are the first to use neuromuscular electrical stimulation to stimulate these muscle groups and evaluate how the muscle contraction affects the acromiohumeral distance. To investigate if electrical muscle stimulation of the LT and SA muscles, both separately and simultaneously, increases the acromiohumeral distance and to identify which muscle-group contraction or combination most influences the acromiohumeral distance. Controlled laboratory study. Human performance laboratory. Twenty participants (10 men and 10 women, age = 26.9 ± 8.0 years, body mass index = 23.8) were screened. Neuromuscular electrical stimulation of the LT and SA. Ultrasound measurement of the acromiohumeral distance. Acromiohumeral distance increased during contraction via neuromuscular electrical stimulation of the LT muscle (t(19) = -3.89, P = .004), SA muscle (t(19) = -7.67, P = .001), and combined LT and SA muscles (t(19) = -5.09, P = .001). We observed no differences in the increased acromiohumeral distance among the 3 procedures (F(2,57) = 3.109, P = .08). Our results supported the hypothesis that the muscle force couple around the scapula is important in rehabilitation and scapular control and influences acromiohumeral distance.

Three new Batillipes species (Arthrotardigrada: Batillipedidae) from the Brazilian coast.

PubMed

Santos, Erika; Rocha, Clélia M C DA; Gomes, Edivaldo Jr; Fontoura, Paulo

2017-03-16

Three new tardigrade species, Batillipes brasiliensis sp. nov., Batillipes dandarae sp. nov. and Batillipes potiguarensis sp. nov., are described from shallow subtidal sediments of the Brazilian coast. B. brasiliensis sp. nov. and B. dandarae sp. nov. have toes 3 and 4 on leg IV different in length, so they can be included in the D group of species, while B. potiguarensis sp. nov., with toes 3 and 4 on leg IV equal in length belong to the A group. Batillipes brasiliensis sp. nov. is characterized by having an ala-like caudal expansion; cuticular projections on the coxal region of legs I-III, and lateral projections. The lateral projection located between the third and fourth legs is fringed with digit-shaped expansions. Batillipes dandarae sp. nov. has a dorsal blunt enlargement in the scapular region; a pointed triangular caudal appendage, and no lateral projections. The new species exhibits a sensorial spine on legs I inserted posteriorly and turning forward, and anus surrounded by a peculiar cuticular structure constituted by six platelets. Batillipes potiguarensis sp. nov. is characterized by a unique combination of characters: scapular region well developed, protruding laterally at the level of the first pair of legs; lateral blunt processes between legs, and prominent roundish caudal protrusion. In addition, the new species exhibits cephalic appendages with swollen tips, evident secondary clavae, and very short sense organs on the legs IV.

Evaluation of a Shoulder Injury Prevention Program in Wheelchair Basketball.

PubMed

Wilroy, Jereme; Hibberd, Elizabeth

2017-11-15

Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics. To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury. Pre and post-test. Home-based and controlled laboratory. Seven collegiate wheelchair athletes. Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a post-intervention screening was performed. Internal/external rotation ROM, retraction strength, and internal/external rotation strength. Participants experienced a significant improvement in dominant limb shoulder internal rotation ROM (t6=3.56,p=0.012) with an average increase of 11.4° of IR ROM, and a significant improvement in dominant limb shoulder external rotation (ER) ROM (t6=2.79,p=0.032) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (p>0.05). Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair athletics.

On-the-Field Resistance-Tubing Exercises for Throwers: An Electromyographic Analysis

PubMed Central

Myers, Joseph B; Pasquale, Maria R; Laudner, Kevin G; Sell, Timothy C; Bradley, James P; Lephart, Scott M

2005-01-01

Context: Athletes who throw commonly use rubber-tubing resistance exercises in the field setting to assist with warm-up before throwing. Yet no researchers have described which muscles are being activated or which exercises are most effective during rubber-tubing exercises used by throwers for warm-up. Objective: To describe the effectiveness of 12 rubber-tubing resistance exercises commonly used by throwers in activating the shoulder muscles important for throwing. Design: Descriptive research design. Setting: An applied biomechanics research laboratory. Patients or Other Participants: Fifteen physically active male subjects with no history of shoulder injury. Main Outcome Measure(s): Subjects randomly performed 12 rubber-tubing resistance exercises while we assessed muscle activation of the subscapularis, supraspinatus, teres minor, and rhomboid major by indwelling electromyography. Activation of the sternal portion of the pectoralis major, anterior deltoid, middle deltoid, latissimus dorsi, serratus anterior, biceps brachii, triceps brachii, lower trapezius, and infraspinatus muscles was assessed by surface electromyography. Results: Performance of 7 exercises (external rotation at 90° of abduction, throwing deceleration, humeral flexion, humeral extension, low scapular rows, throwing acceleration, and scapular punch) resulted in the highest level of muscle activation of all muscles tested. Conclusions: These 7 exercises exhibited moderate activation (>20% maximal voluntary isometric contraction) in each muscle of the rotator cuff, the primary humeral movers, and the scapular stabilizer muscles. The results suggest that these exercises are most effective in activating the muscles important to the throwing motion and may be beneficial for throwers during their prethrowing warm-up routine. PMID:15902319

Return to Throwing after Shoulder or Elbow Injury.

PubMed

Sgroi, Terrance A; Zajac, John M

2018-03-01

Throwing places high demands on the human body, and specific characteristics are developed over time unique to these athletes. When returning to throw after injury, it is important to follow a criterion-based progression that allows the body to be prepared appropriately for the stresses that throwing will require. There is currently a void in the literature for criteria-based progression that helps these athletes return to the highest level of play. As injury rates continue to rise in baseball, there is increased evidence showing contributions of the core and lower extremity to the baseball pitch. There is also additional data showing pitcher specific characteristics such as range of motion and scapular position in this unique population. The rehab professional should take into account every phase of the pitch starting from balance through ball release when designing a comprehensive return-to-throwing program. Returning an athlete back to a throwing sport can be an overwhelming task. The rehabilitation specialist must have a sound understanding of the throwing motion as well as any biomechanical implications on the body, contributions throughout the kinetic chain, range of motion, and strength characteristics specific to the thrower as well as proper tissue loading principles. It is important that these athletes are not progressed too quickly through their programs and that a criteria-based progression is followed. They should have normalized range of motion, strength, and scapular mechanics, followed by a sound plyometric progression. Once this is achieved, they are advanced to an interval throwing program with increasing distance, effort, and volume which should be tracked for workload, making sure they do not throw more than their body is prepared for.

Intra-articular kinematics of the upper limb joints: a six degrees of freedom study of coupled motions.

PubMed

Cattrysse, Erik; Baeyens, Jean-Pierre; Van Roy, Peter; Van de Wiele, Olivier; Roosens, Tom; Clarys, Jan-Pieter

In sport, leisure and certain occupational activities, joint lesions of the upper limb are very common. To understand their aetiology in order to prevent and treat these pathologies on a scientific basis, a comprehensive knowledge of the involved stress and kinematics is imperative. For many years intra-articular joint kinematics have been described hypothetically in terms of the convex-concave principle. This principle, however, has not been validated. The in vitro research on the acromioclavicular, glenohumeral and elbow joints was performed using an electromagnetic tracking device (Flock of Birds). By recalculating the positions of the trackers to an embedded coordinate system on the joint surface, the intra-articular joint movements can be analysed. Therefore, the bony configurations and articular surface features were registered with a 3D drawing stylus (Microscribe). Thirteen acromioclavicular joints, six glenohumeral joints and seven elbows were studied. The coupled intra-articular movements were analysed using the Euler angles and finite helical axis approaches. The results of the acromioclavicular joint analysis indicate that during movements in the scapular plane a superior rotation of the clavicle was coupled with an inferior translation and vice versa, whilst during movements in the plane perpendicular to the scapular plane the anterior rotation was coupled with an anterior translation and vice versa. In the glenohumeral joint, the abduction-elevation was coupled with an external rotation. In the humero-ulnar joint, the extension was coupled with an external rotation and varus movement. This intra-articular behaviour was in contradiction to currently accepted convex-concave concepts in arthrokinematics and manual therapy. The results may have major implications for manual therapy and orthopaedic medical practice.

Does scapula stabilizing t-shirt help over-head athletes in shoulder discomfort? A randomized control study.

PubMed

Pellegrini, Andrea; Pogliacomi, Francesco; Costantino, Cosimo; Desimoni, Stefano; Giovanelli, Margherita; Golz, Andrew; Tonino, Pietro; Ceccarelli, Francesco

2016-04-15

Scapular dyskinesis in pitchers can potentially lead to impairments in the optimal performance of muscles of the shoulder complex. The purpose of this prospective study was to evaluate whether the use of a scapula stabilizing t-shirt can decrease stress and discomfort in over-head baseball pitchers. Thirty-two semi-professional baseball pitchers were divided into 2 groups. Group A dressed the scapula stabilizing t-shirt during the weekly practice while group B (control group) continued to follow their training program without the t-shirt. All pitchers underwent a clinical examination at the beginning of the study (T0), 4 weeks (T1) and 8 weeks after (T2). Data collected showed a better clinical outcome at T1 which increased in T2 for pitchers in Group A, while in Group B athletes these positive results were not observed. This study underlines that scapula-stabilizing t-shirt can have positive effects on shoulder discomfort in over-head athletes.

Sunscreen Use and Sweat Production in Men and Women

PubMed Central

Aburto-Corona, Jorge; Aragón-Vargas, Luis

2016-01-01

Context: Sunscreen lotions are important to protect the skin during outdoor exercise, but they may interfere with sweating. Objective: To measure the effect of 2 water-resistant sunscreens on local sweat production in men and women exercising in the heat and to compare those effects with the expected inhibition resulting from the use of an antiperspirant. Design: Randomized crossover study. Setting: Exercise in the heat (ambient temperature = 30.2°C ± 0.4°C dry bulb and 58% ± 4.3% relative humidity) in a controlled-environment laboratory. Patients or Other Participants: Twenty physically active, apparently healthy college students, 10 men (age = 22.5 ± 2.8 years, height = 1.771 ± 0.069 m, mass = 70.2 ± 11.0 kg) and 10 women (age = 22.2 ± 3.2 years, height = 1.625 ± 0.075 m, mass = 57.7 ± 7.9 kg). Intervention(s): With sweat-collection patches applied to their right and left scapular regions, the participants performed 2 exercise sessions on consecutive days. We assigned skin treatments (antiperspirant; organic chemical sun filter, sunscreen A; inorganic physical sun block, sunscreen B; no lotion) randomly to side and session. Participants pedaled at 79% ± 1% of maximum heart rate for 20 minutes in the heat. Main Outcome Measure(s): Scapular localized sweat rate. Results: No baseline, environmental, or exercise condition was different among skin treatments. Scapular localized sweat rate was lower for the antiperspirant treatment (88.3 μL/min·dm2; 95% confidence interval [CI] = 82.0, 94.7 μL/min·dm2) and the inorganic physical sun block (sunscreen B) treatment (99.3 μL/min·dm2; 95% CI = 93.1, 105.5 μL/min·dm2) than for the organic chemical sun filter (sunscreen A) treatment (114.8 μL/min·dm2; 95% CI = 108.8, 120.6 μL/min·dm2) or the no-lotion treatment (122.6 μL/min·dm2; 95% CI = 116.2, 129.0 μL/min·dm2; P < .01). Conclusions: The inorganic physical sun block, sunscreen B, hindered effective sweating to the same extent as the antiperspirant, whereas the treatment with the organic chemical sun filter, sunscreen A, was not different from the control treatment. At this stage, it is not possible to identify the specific ingredient responsible for the effect. PMID:27740850

Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: a cadaver study.

PubMed

Berhouet, J; Garaud, P; Favard, L

2013-12-01

A common disadvantage of reverse shoulder arthroplasty is limitation of the range of arm rotation. Several changes to the prosthesis design and implantation technique have been suggested to improve rotation range of motion (ROM). Glenoid component design and degree of humeral component retroversion influence rotation ROM after reverse shoulder arthroplasty. The Aequalis Reversed™ shoulder prosthesis (Tornier Inc., Edina, MN, USA) was implanted into 40 cadaver shoulders. Eight glenoid component combinations were tested, five with the 36-mm sphere (centred seating, eccentric seating, inferior tilt, centred with a 5-mm thick lateralised spacer, and centred with a 7-mm thick lateralised spacer) and three with the 42-mm sphere (centred with no spacer or with a 7-mm or 10-mm spacer). Humeral component position was evaluated with 0°, 10°, 20°, 30°, and 40° of retroversion. External and internal rotation ROMs to posterior and anterior impingement on the scapular neck were measured with the arm in 20° of abduction. The large glenosphere (42 mm) was associated with significantly (P<0.05) greater rotation ROMs, particularly when combined with a lateralised spacer (46° internal and 66° external rotation). Rotation ROMs were smallest with the 36-mm sphere. Greater humeral component retroversion was associated with a decrease in internal rotation and a significant increase (P<0.05) in external rotation. The best balance between rotation ROMs was obtained with the native retroversion, which was estimated at 17.5° on average in this study. Our anatomic study in a large number of cadavers involved a detailed and reproducible experimental protocol. However, we did not evaluate the variability in scapular anatomy. Earlier studies of the influence of technical parameters did not take humeral component retroversion into account. In addition, no previous studies assessed rotation ROMs. Rotation ROM should be improved by the use of a large-diameter glenosphere with a spacer to lateralise the centre of rotation of the gleno-humeral joint, as well as by positioning the humeral component at the patient's native retroversion value. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Quantitative and qualitative analyses of subacromial impingement by kinematic open MRI.

PubMed

Tasaki, Atsushi; Nimura, Akimoto; Nozaki, Taiki; Yamakawa, Akira; Niitsu, Mamoru; Morita, Wataru; Hoshikawa, Yoshimitsu; Akita, Keiichi

2015-05-01

Quantitative and qualitative kinematic analyses of subacromial impingement by 1.2T open MRI were performed to determine the location of impingement and the involvement of the acromioclavicular joint. In 20 healthy shoulders, 10 sequential images in the scapular plane were taken in a 10-s pause at equal intervals from 30° to maximum abduction in neutral and internal rotation. The distances between the rotator cuff (RC) and the acromion and the acromioclavicular joint were measured. To comprehend the positional relationships, cadaveric specimens were also observed. Although asymptomatic, the RC came into contact with the acromion and the acromioclavicular joint in six and five cases, respectively. The superior RC acted as a depressor for the humeral head against the acromion as the shoulder elevated. The mean elevation angle and distance at the closest position between the RC and the acromion in neutral rotation were 93.5° and 1.6 mm, respectively, while those between the RC and the acromioclavicular joint were 86.7° and 2.0 mm. When comparing this distance and angle, there was no significant difference between the RC to the acromion and to the acromioclavicular joint. The minimum distance between the RC and the acromion was significantly shorter than that between the greater tuberosity and the acromion. The location of RC closest to the acromion and the acromioclavicular joint differed significantly. Although asymptomatic, contact was found between the RC and the acromion and the acromioclavicular joint. The important role of the RC to prevent impingement was observed, and hence, dysfunction of the RC could lead to impingement that could result in a RC lesion. The RC lesions may differ when they are caused by impingement from either the acromion or the acromioclavicular joint.

Biomechanical loading test on reconstructed mandibles with fibular, iliac crest or scapula graft: a comparative study.

PubMed

Grohmann, Isabella; Raith, Stefan; Mücke, Thomas; Stimmer, Herbert; Rohleder, Nils; Kesting, Marco R; Hölzle, Frank; Steiner, Timm

2015-10-01

Advantages and disadavantages of the three most commonly-used bone grafts for mandibular reconstruction are widely known, but biomechanical experimental studies are rare. We have done loading tests on cadaveric mandibles reconstructed with fibular, iliac crest, and scapular grafts using 3 different osteosynthesis systems to detect and compare their primary stability. Loading tests were done on mandibles with grafts from the fibula and iliac crest and published previously. A 4.5cm paramedian L-type defect was reconstructed with scapula using 2 monocortical non-locking plates, 2 monocortical locking plates, or a single bicortical locking plate/fracture gap in 18 human cadaveric mandibles. These were loaded on to the "Mandibulator" test bench and the movement of fragments in 3 dimensions was assessed and quantified by a PONTOS® optical measurement system. Comparison of the osteosynthesis groups showed that the miniplate was significantly superior to the 6-hole TriLock® plate for both fibular and iliac crest grafts. The fibular graft gave greater stability than the iliac crest and scapular grafts for all 3 osteosynthesis systems. All bony specimens offered sufficient resistance to mechanical stress within the recognised range of biting forces after mandibular reconstruction, independently of the choice of bone graft and osteosynthesis system used. Anatomical and surgical advantages need to be taken into account when choosing a graft. Stability can be maximised with a fibular graft, and further optimised by enlarging the binding area by using the "double barrel" method. Computer simulated experiments could segregate factors that biased results, such as morphological differences among cadavers. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Serratus Anterior and Lower Trapezius Muscle Activities During Multi-Joint Isotonic Scapular Exercises and Isometric Contractions.

PubMed

Tsuruike, Masaaki; Ellenbecker, Todd

2014-11-14

Context :  Proper scapular function during humeral elevation, such as upward rotation, external rotation, and posterior tilting of the scapula, is necessary to prevent shoulder injury. However, the appropriate intensity of rehabilitation exercise for the periscapular muscles has yet to be clarified. Objective :  To identify the serratus anterior, lower trapezius, infraspinatus, and posterior deltoid muscle activities during 2 free-motion exercises using 3 intensities and to compare these muscle activities with isometric contractions during quadruped shoulder flexion and external rotation and abduction of the glenohumeral joint. Design :  Cross-sectional study. Setting :  Health Science Laboratory. Patients or Other Participants :  A total of 16 uninjured, healthy, active, male college students (age = 19.5 ± 1.2 years, height = 173.1 ± 6.5 cm, weight = 68.8 ± 6.6 kg). Main Outcome Measure(s) :  Mean electromyographic activity normalized by the maximal voluntary isometric contraction was analyzed across 3 intensities and 5 exercises. Intraclass correlation coefficients were calculated for electromyographic activity of the 4 muscles in each free-motion exercise. Results :  Significant interactions in electromyographic activity were observed between intensities and exercises (P < .05). The quadruped shoulder-flexion exercise activated all 4 muscles compared with other exercises. Also, the modified robbery free-motion exercise activated the serratus anterior, lower trapezius, and infraspinatus compared with the lawn-mower free-motion exercise. However, neither exercise showed a difference in posterior deltoid electromyographic activity. Conclusions :  Three intensities exposed the nature of the periscapular muscle activities across the different exercises. The free-motion exercise in periscapular muscle rehabilitation may not modify serratus anterior, lower trapezius, and infraspinatus muscle activities unless knee-joint extension is limited.

Serratus Anterior and Lower Trapezius Muscle Activities During Multi-Joint Isotonic Scapular Exercises and Isometric Contractions

PubMed Central

Tsuruike, Masaaki; Ellenbecker, Todd S.

2015-01-01

Context: Proper scapular function during humeral elevation, such as upward rotation, external rotation, and posterior tilting of the scapula, is necessary to prevent shoulder injury. However, the appropriate intensity of rehabilitation exercise for the periscapular muscles has yet to be clarified. Objective: To identify the serratus anterior, lower trapezius, infraspinatus, and posterior deltoid muscle activities during 2 free-motion exercises using 3 intensities and to compare these muscle activities with isometric contractions during quadruped shoulder flexion and external rotation and abduction of the glenohumeral joint. Design: Cross-sectional study. Setting: Health Science Laboratory. Patients or Other Participants: A total of 16 uninjured, healthy, active, male college students (age = 19.5 ± 1.2 years, height = 173.1 ± 6.5 cm, weight = 68.8 ± 6.6 kg). Main Outcome Measure(s): Mean electromyographic activity normalized by the maximal voluntary isometric contraction was analyzed across 3 intensities and 5 exercises. Intraclass correlation coefficients were calculated for electromyographic activity of the 4 muscles in each free-motion exercise. Results: Significant interactions in electromyographic activity were observed between intensities and exercises (P < .05). The quadruped shoulder-flexion exercise activated all 4 muscles compared with other exercises. Also, the modified robbery free-motion exercise activated the serratus anterior, lower trapezius, and infraspinatus compared with the lawn-mower free-motion exercise. However, neither exercise showed a difference in posterior deltoid electromyographic activity. Conclusions: Three intensities exposed the nature of the periscapular muscle activities across the different exercises. The free-motion exercise in periscapular muscle rehabilitation may not modify serratus anterior, lower trapezius, and infraspinatus muscle activities unless knee-joint extension is limited. PMID:25689561

A Biomechanical Model of the Scapulothoracic Joint to Accurately Capture Scapular Kinematics during Shoulder Movements

PubMed Central

Seth, Ajay; Matias, Ricardo; Veloso, António P.; Delp, Scott L.

2016-01-01

The complexity of shoulder mechanics combined with the movement of skin relative to the scapula makes it difficult to measure shoulder kinematics with sufficient accuracy to distinguish between symptomatic and asymptomatic individuals. Multibody skeletal models can improve motion capture accuracy by reducing the space of possible joint movements, and models are used widely to improve measurement of lower limb kinematics. In this study, we developed a rigid-body model of a scapulothoracic joint to describe the kinematics of the scapula relative to the thorax. This model describes scapular kinematics with four degrees of freedom: 1) elevation and 2) abduction of the scapula on an ellipsoidal thoracic surface, 3) upward rotation of the scapula normal to the thoracic surface, and 4) internal rotation of the scapula to lift the medial border of the scapula off the surface of the thorax. The surface dimensions and joint axes can be customized to match an individual’s anthropometry. We compared the model to “gold standard” bone-pin kinematics collected during three shoulder tasks and found modeled scapular kinematics to be accurate to within 2mm root-mean-squared error for individual bone-pin markers across all markers and movement tasks. As an additional test, we added random and systematic noise to the bone-pin marker data and found that the model reduced kinematic variability due to noise by 65% compared to Euler angles computed without the model. Our scapulothoracic joint model can be used for inverse and forward dynamics analyses and to compute joint reaction loads. The computational performance of the scapulothoracic joint model is well suited for real-time applications; it is freely available for use with OpenSim 3.2, and is customizable and usable with other OpenSim models. PMID:26734761

A Biomechanical Model of the Scapulothoracic Joint to Accurately Capture Scapular Kinematics during Shoulder Movements.

PubMed

Seth, Ajay; Matias, Ricardo; Veloso, António P; Delp, Scott L

2016-01-01

The complexity of shoulder mechanics combined with the movement of skin relative to the scapula makes it difficult to measure shoulder kinematics with sufficient accuracy to distinguish between symptomatic and asymptomatic individuals. Multibody skeletal models can improve motion capture accuracy by reducing the space of possible joint movements, and models are used widely to improve measurement of lower limb kinematics. In this study, we developed a rigid-body model of a scapulothoracic joint to describe the kinematics of the scapula relative to the thorax. This model describes scapular kinematics with four degrees of freedom: 1) elevation and 2) abduction of the scapula on an ellipsoidal thoracic surface, 3) upward rotation of the scapula normal to the thoracic surface, and 4) internal rotation of the scapula to lift the medial border of the scapula off the surface of the thorax. The surface dimensions and joint axes can be customized to match an individual's anthropometry. We compared the model to "gold standard" bone-pin kinematics collected during three shoulder tasks and found modeled scapular kinematics to be accurate to within 2 mm root-mean-squared error for individual bone-pin markers across all markers and movement tasks. As an additional test, we added random and systematic noise to the bone-pin marker data and found that the model reduced kinematic variability due to noise by 65% compared to Euler angles computed without the model. Our scapulothoracic joint model can be used for inverse and forward dynamics analyses and to compute joint reaction loads. The computational performance of the scapulothoracic joint model is well suited for real-time applications; it is freely available for use with OpenSim 3.2, and is customizable and usable with other OpenSim models.

Suprascapular nerve anatomy during shoulder motion: a cadaveric proof of concept study with implications for neurogenic shoulder pain.

PubMed

Massimini, Daniel F; Singh, Anshu; Wells, Jessica H; Li, Guoan; Warner, Jon J P

2013-04-01

The suprascapular nerve (SSN) carries sensory fibers which may contribute to shoulder pain. Prior anatomic study demonstrated that alteration in SSN course with simulated rotator cuff tendon (RCT) tears cause tethering and potential traction injury to the nerve at the suprascapular notch. Because the SSN has been implicated as a major source of pain with RCT tearing, it is critical to understand nerve anatomy during shoulder motion. We hypothesized that we could evaluate the SSN course with a novel technique to evaluate effects of simulated RCT tears, repair, and/or release of the nerve. The course of the SSN was tracked with a dual fluoroscopic imaging system in a cadaveric model with simulated rotator cuff muscle forces during dynamic shoulder motion. After a simulated full-thickness supraspinatus/infraspinatus tendon tear, the SSN translated medially 3.5 mm at the spinoglenoid notch compared to the anatomic SSN course. Anatomic footprint repair of these tendons restored the SSN course to normal. Open release of the transverse scapular ligament caused the SSN to move 2.5 mm superior-posterior out of the suprascapular notch. This pilot study demonstrated that the dynamic SSN course can be evaluated and may be altered by a RCT tear. Preliminary results suggest release of the transverse scapular ligament allowed the SSN to move upward out of the notch. This provides a biomechanical proof of concept that SSN traction neuropathy may occur with RCT tears and that release of the transverse scapular ligament may alleviate this by altering the course of the nerve. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Scapular deformity in obstetric brachial plexus palsy and the Hueter-Volkmann law; a retrospective study

PubMed Central

2013-01-01

Background The Hueter-Volkmann law describes growth principles around joints and joint deformation. It states that decreased stress leads to increased growth and that excessive stress leads to growth retardation. Aim of this study was to test the possible results of this principle by measuring the effect of dorsal humeral head subluxation on scapular growth in children with Obstetrical Brachial Plexus Lesions (OBPL). According to the Hueter-Volkmann law, subluxation should result in decrease of growth of the dorsal length of the scapula (by increased dorsal pressure) and increase of the ventral length (decreased pressure). Methods 58 children (mean age 20 months, range 1-88 month) with unilateral OBPL and good quality MRI of both shoulders were included. On MRI, humeral head subluxation, joint deformation, and ventral and dorsal scapular lengths were measured. Data were expressed as a ratio of the normal side. Results In affected scapulas both ventral and dorsal side were smaller compared to the normal side. Reduction of growth on the affected side was more marked on the dorsal side than on the ventral side (6.5 mm respectively 4.5 mm, p < 0.001). The balance of growth reduction as expressed by the ratio of ventral and dorsal length was strongly related to subluxation (R2 = 0.33, p < 0.001) and age (R2 = 0.19, p < 0.001). Conclusions The Hueter-Volkmann law is incompletely active in subluxated shoulders in OBPL. Dorsal subluxation indeed leads to decrease of growth of the dorsal length of the scapula. However, decreased stress did not lead to increased growth of the ventral length of the scapula. PMID:23522350

Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement.

PubMed

Mihata, Teruhisa; McGarry, Michelle H; Kinoshita, Mitsuo; Lee, Thay Q

2010-02-01

The objective of this study was to determine the effects of increased horizontal abduction with maximum external rotation, as occurs during the late cocking phase of throwing motion, on shoulder internal impingement. An increase in glenohumeral horizontal abduction will cause overlap of the rotator cuff insertion with respect to the glenoid and increase pressure between the supraspinatus and infraspinatus tendon insertions on the greater tuberosity and the glenoid. Controlled laboratory study. Eight cadaveric shoulders were tested with a custom shoulder testing system with the specimens in 60 degrees of glenohumeral abduction and maximum external rotation. The amount of internal impingement was evaluated by assessing the location of the supraspinatus and infraspinatus articular insertions on the greater tuberosity relative to the glenoid using a MicroScribe 3DLX. Pressure in the posterior-superior quadrant of the glenoid was measured using Fuji prescale film. Data were obtained with the humerus in the scapular plane and 15 degrees , 30 degrees , and 45 degrees of horizontal abduction from the scapular plane. At 30 degrees and 45 degrees of horizontal abduction, the articular margin of the supraspinatus and infraspinatus tendons was anterior to the posterior edge of the glenoid and less than 2 mm from the glenoid rim in the lateral direction; the contact pressure was also greater than that found in the scapular plane and 15 degrees of horizontal abduction. Conclusion Horizontal abduction beyond the coronal plane increased the amount of overlap and contact pressure between the supraspinatus and infraspinatus tendons and glenoid. Excessive glenohumeral horizontal abduction beyond the coronal plane may cause internal impingement, which may lead to rotator cuff tears and superior labral anterior to posterior (SLAP) lesions.

Rehabilitation Exercises to Induce Balanced Scapular Muscle Activity in an Anti-gravity Posture

PubMed Central

Ishigaki, Tomonobu; Yamanaka, Masanori; Hirokawa, Motoki; Tai, Keita; Ezawa, Yuya; Samukawa, Mina; Tohyama, Harukazu; Sugawara, Makoto

2014-01-01

[Purpose] The purpose of this study was to compare the intramuscular balance ratios of the upper trapezius muscle (UT) and the lower trapezius muscle (LT), and the intermuscular balance ratios of the UT and the serratus anterior muscle (SA) among prone extension (ProExt), prone horizontal abduction with external rotation (ProHAbd), forward flexion in the side-lying position (SideFlex), side-lying external rotation (SideEr), shoulder flexion with glenohumeral horizontal abduction load (FlexBand), and shoulder flexion with glenohumeral horizontal adduction load (FlexBall) in the standing posture. [Methods] The electromyographic (EMG) activities of the UT, LT and SA were measured during the tasks. The percentage of maximum voluntary isometric contraction (%MVIC) was calculated for each muscle, and the UT/LT ratios and the UT/SA ratios were compared among the tasks. [Results] The UT/LT ratio with the FlexBand was not significantly different from those of the four exercises in the side-lying and prone postures. The UT/SA ratio with the FlexBall demonstrated appropriate balanced activity. [Conclusion] In an anti-gravity posture, we recommend the FlexBand and the FlexBall for inducing balanced UT/LT and UT/SA ratios, respectively. PMID:25540485

Rehabilitation Exercises to Induce Balanced Scapular Muscle Activity in an Anti-gravity Posture.

PubMed

Ishigaki, Tomonobu; Yamanaka, Masanori; Hirokawa, Motoki; Tai, Keita; Ezawa, Yuya; Samukawa, Mina; Tohyama, Harukazu; Sugawara, Makoto

2014-12-01

[Purpose] The purpose of this study was to compare the intramuscular balance ratios of the upper trapezius muscle (UT) and the lower trapezius muscle (LT), and the intermuscular balance ratios of the UT and the serratus anterior muscle (SA) among prone extension (ProExt), prone horizontal abduction with external rotation (ProHAbd), forward flexion in the side-lying position (SideFlex), side-lying external rotation (SideEr), shoulder flexion with glenohumeral horizontal abduction load (FlexBand), and shoulder flexion with glenohumeral horizontal adduction load (FlexBall) in the standing posture. [Methods] The electromyographic (EMG) activities of the UT, LT and SA were measured during the tasks. The percentage of maximum voluntary isometric contraction (%MVIC) was calculated for each muscle, and the UT/LT ratios and the UT/SA ratios were compared among the tasks. [Results] The UT/LT ratio with the FlexBand was not significantly different from those of the four exercises in the side-lying and prone postures. The UT/SA ratio with the FlexBall demonstrated appropriate balanced activity. [Conclusion] In an anti-gravity posture, we recommend the FlexBand and the FlexBall for inducing balanced UT/LT and UT/SA ratios, respectively.

Long-term trend of bone development in the contemporary teenagers of Chinese Han nationality.

PubMed

Wang, Ya-Hui; Ying, Chong-Liang; Wan, Lei; Zhu, Guang-You

2012-08-01

To further improve the accuracy of bone age identification using the time of secondary ossification center appearance and epiphyseal fusion of 7 joints to estimate the age of living individuals. DR films were taken from 7 parts including sternal end of clavical and the left side of shoulder, elbow, carpal, hip, knee and ankle joints of 1 709 individuals who came from eastern China, central China and southern China, whose ages were between 11.0 and 20.0 years. From those 7 joints 24 osteal loci were selected as bone age indexes, which could better reflect age growth of teenagers. The characteristics of secondary ossification center appearance and epiphyseal fusion were observed, and the mean and age range of secondary ossification center appearance and epiphyseal fusion were calculated. The fusion time of the 24 epiphyses were advanced at different degrees, the most obvious epiphyses the sternal end of clavicle, scapular acromial end, distal end of the radius, distal end of the ulna, iliac crest, ischial tuberosity, the upper and lower end of tibia and fibula. The appearance time of sternal end of clavicle, scapular acromial end, iliac crest and ischial tuberosity epiphyses were all found to be after the age of 12, and the female's age, approximately 1 year ahead of schedule in comparison with the male's. The relevant forensic information and data for bone age identification should be updated every 10-15 years so as to provide accurate and objective evidence for court testimony, conviction and sentencing.

Effects of 4-week self cross body stretching with scapular stabilization on shoulder motions and horizontal adductor strength in subjects with limited shoulder horizontal adduction.

PubMed

Joung, Ha-Na; Yi, Chung-Hwi; Jeon, Hye-Seon; Hwang, Ui-Jae; Kwon, Oh-Yun

2018-05-29

Posterior shoulder tightness (PST) is related to shoulder conditions such as shoulder impingement and limited shoulder horizontal adduction (SHA). The purpose of this study was to compare the effects of self cross body stretching (CBS) with and without scapular stabilization (SS) on SHA and shoulder internal rotation (SIR) range of motion (ROM) and shoulder horizontal adductor strength (SHAS) in subjects with limited SHA. Twenty-six subjects (14 males, 12 females) with limited SHA was participated in this study. The SS group and without stabilization (WS) group were assigned randomly. The SS group performed self CBS with SS by applying belt just under the subject's axilla. The subjects were asked to perform self CBS in 4 times a week for 4 weeks. SHA and SIR RM were measured by Clinometer smartphone application, and SHAS by hand-held dynamometer (HHD) before and after 4-week self CBS. 2 × 2 mixed analysis of variance (ANOVA) was used to identify the significance. If there was an interaction effect, t-test was used to confirm the simple effect. There was a significant interaction in SHA ROM and SHAS. The post-test value of SHA ROM was significantly greater in SS group than WS group (p < 0.0125). In SHAS, there was no significant difference between groups (p > 0.0125). SS during self CBS could enhance to improve SHA, SIR ROM, and SHAS in individuals with limited SHA.

Scapular instability associated with brachial plexus irritation: a proposed causative relationship with treatment implications.

PubMed

Langley, P

1997-01-01

Brachial plexus irritation and other compression neuropathies can be diverse in their presentations and can cause a myriad of signs and symptoms. The purpose of this paper is to review the pertinent anatomy, kinesiology, and neurophysiology and to outline one possible cascade of events that may contribute to more diffuse upper extremity symptoms. Scapular instability and local myofascial trigger points resulting in possible secondary muscle imbalances are described. Their possible relationship to brachial plexus irritation in addition to the implications of the irritation are also discussed. The author postulates that proximal nerve irritation in the region of the thoracic outlet and shoulder may help to account for diffuse or unrelieved symptoms following conventional treatment of distal extremity problems in patients with occupational or cumulative trauma disorders. This paper outlines specific examination procedures for the therapist, which include upper limb tension testing, extensibility testing of the pectoralis minor, and gross manual muscle testing of the lower trapezius.

Maximizing shoulder function after accessory nerve injury and neck dissection surgery: A multicenter randomized controlled trial.

PubMed

McGarvey, Aoife C; Hoffman, Gary R; Osmotherly, Peter G; Chiarelli, Pauline E

2015-07-01

Shoulder pain and dysfunction after neck dissection may result from injury to the accessory nerve. The effect of early physical therapy in the form of intensive scapular strengthening exercises is unknown. A total of 59 neck dissection participants were prospectively recruited for this study. Participants were randomly assigned to either the intervention group (n = 32), consisting of progressive scapular strengthening exercises for 12 weeks, or the control group (n = 29). Blinded assessment occurred at baseline, and at 3, 6, and 12 months. Three-month data were collected on 52 participants/53 shoulders. Per-protocol analysis demonstrated that the intervention group had statistically significantly higher active shoulder abduction at 3 months compared to the control group (+26.6°; 95% confidence interval [CI] 7.28-45.95; p = .007). The intervention is a favorable treatment for maximizing shoulder abduction in the short term. The effect of the intervention compared to usual care is uncertain in the longer term. © 2014 Wiley Periodicals, Inc.

Scapular thickness--implications for fracture fixation.

PubMed

Burke, Charity S; Roberts, Craig S; Nyland, John A; Radmacher, Paula G; Acland, Robert D; Voor, Michael J

2006-01-01

The purpose of this study was to measure and map scapula osseous thickness to identify the optimal areas for internal fixation. Eighteen (9 pairs) scapulae from 2 female and 7 male cadavers were used. After harvest and removal of all soft tissues, standardized measurement lines were made based on anatomic landmarks. For consistency among scapulae, measurements were taken at standard percentage intervals along each line approximating the distance between two consecutive reconstruction plate screw holes. Two-mm-diameter drill holes were made at each point, and a standard depth gauge was used to measure thickness. The glenoid fossa (25 mm) displayed the greatest mean osseous thickness, followed by the lateral scapular border (9.7 mm), the scapula spine (8.3 mm), and the central portion of the body of the scapula (3.0 mm). To optimize screw purchase and internal fixation strength, the lateral border, the lateral aspect of the base of the scapula spine, and the scapula spine itself should be used for anatomic sites of internal fixation of scapula fractures.

Effects of stabilization exercises with a Swiss ball on neck-shoulder pain and mobility of adults with prolonged exposure to VDTs.

PubMed

Ahn, Jeoung-Ah; Kim, Joong-Hwi; Bendik, Anthony L; Shin, Ju-Yong

2015-04-01

[Purpose] This study compared the effects on neck-shoulder pain and mobility of strengthening exercises for the neck flexors and scapular retractors performed on a Swiss ball and a mat. [Subjects] Twenty student volunteers were the subjects. [Methods] The students were randomly assigned to two groups: Mat group (n=10), and Swiss ball group (n=10). At pre-test, post-test, and 1-week follow-up pain was assessed using the visual analogue scale (VAS), the pain pressure threshold (PPT) of the shoulder was measured with an algometer, and neck mobility was measured with a Zebris. [Results] The data analysis revealed that there was a significant decrease in pain and significant increase in neck flexion in both groups, and the Swiss ball group showed better results. [Conclusion] Strengthening the neck flexors and scapular retractors for stabilization of the neck using exercises on a Swiss ball was more effective at reducing the pain and stabilizing the neck than mat exercises.

Three-dimensional photogrammetry for surgical planning of tissue expansion in hemifacial microsomia.

PubMed

Jayaratne, Yasas S N; Lo, John; Zwahlen, Roger A; Cheung, Lim K

2010-12-01

We aim to illustrate the applications of 3-dimensional (3-D) photogrammetry for surgical planning and longitudinal assessment of the volumetric changes in hemifacial microsomia. A 3-D photogrammetric system was employed for planning soft tissue expansion and transplantation of a vascularized scapular flap for a patient with hemifacial microsomia. The facial deficiency was calculated by superimposing a mirror of the normal side on the preoperative image. Postsurgical volumetric changes were monitored by serial superimposition of 3-D images. A total of 31 cm(3) of tissue expansion was achieved within a period of 4 weeks. A scapular free flap measuring 8 cm × 5 cm was transplanted to augment the facial deficiency. Postsurgical shrinkage of the flap was observed mainly in the first 3 months and it was minimal thereafter. 3-D photogrammetry can be used as a noninvasive objective tool for assessing facial deformity, planning, and postoperative follow-up of surgical correction of facial asymmetry.

Massive trapezial metastasis from gastric adenocarcinoma resected and reconstructed with a vascularized scapular bone graft

PubMed Central

Okamoto, Masanori; Yamazaki, Hiroshi; Yoshimura, Yasuo; Aoki, Kaoru; Tanaka, Atsushi; Kato, Hiroyuki

2017-01-01

Abstract Rationale: Isolated metastasis to the hand bones is very rare. Only seven cases of metastasis to the trapezium have been reported. To the best of our knowledge, this is the first report of a single metastasis to the trapezium from a gastric adenocarcinoma. Patient concerns: A 62-year-old man presented with pain and massive swelling in the right carpometacarpal joint of the thumb. Diagnoses: The patient was diagnosed with trapezial metastasis of advanced gastric adenocarcinoma. Interventions: The patient underwent systemic chemotherapy with cisplatin and S-1, radiotherapy to the metastatic bone, and treatment with denosumab. One year later, the huge metastatic tumor was resected, and the hand was reconstructed using vascularized scapular bone. Outcomes: Eighteen months postoperatively, the patient was satisfied with the appearance of the reconstructed hand and was able to use his right thumb in activities of daily living. Lessons: Although rare, metastasis to the trapezium should be considered in patients with persistent and progressive thumb CMC joint pain. PMID:29390390

Malignant pilomatricoma in a dog with local and distant metastases treated with chemotherapy and bisphosphonates

PubMed Central

Treggiari, Elisabetta; Elliott, James W.

2017-01-01

A ten-year-old male neutered cross breed dog presented for evaluation of a mass associated with the left scapular bone, identified as a carcinoma. The dog had a malignant pilomatricoma removed from the left lateral thigh 6 months earlier. Histopathology review of the cutaneous and scapular mass identified the same tumour type, confirming metastatic disease; additional metastases to the inguinal lymph node, liver and lungs were identified. Chemotherapy resulted in partial responses/stable disease of very short duration. Bisphosphonates were administered due to lack of a measurable response and worsening of the associated lameness. The patient ultimately developed a symptomatic vertebral metastasis and was euthanased. The dog survived 255 days since medical treatment was started and 455 days since surgical removal of the primary tumour. This case report suggests that medical treatment with the addition of analgesia may be able to palliate clinical signs and possibly extend survival in dogs with metastatic epithelial cancer. PMID:28795016

Comparing trapezius muscle activity in the different planes of shoulder elevation

PubMed Central

Ishigaki, Tomonobu; Ishida, Tomoya; Samukawa, Mina; Saito, Hiroshi; Hirokawa, Motoki; Ezawa, Yuya; Sugawara, Makoto; Tohyama, Harukazu; Yamanaka, Masanori

2015-01-01

[Purpose] The purpose of this study was to compare the upper, middle, and lower trapezius muscles’ activity in the different planes of shoulder elevation. [Subjects] Twenty male subjects volunteered for this study. [Methods] Surface electromyographic (EMG) activity for each of the three regions of the trapezius muscles in the three different planes of elevation were collected while the participants maintained 30, 60, and 90 degrees of elevation in each plane. The EMG data were normalized with maximum voluntary isometric contraction (%MVIC), and compared among the planes at each angle of elevation. [Results] There were significantly different muscle activities among the elevation planes at each angle. [Conclusion] This study found that the three regions of the trapezius muscles changed their activity depending on the planes of shoulder elevation. These changes in the trapezius muscles could induce appropriate scapular motion to face the glenoid cavity in the correct directions in different planes of shoulder elevation. PMID:26157248

Comparing trapezius muscle activity in the different planes of shoulder elevation.

PubMed

Ishigaki, Tomonobu; Ishida, Tomoya; Samukawa, Mina; Saito, Hiroshi; Hirokawa, Motoki; Ezawa, Yuya; Sugawara, Makoto; Tohyama, Harukazu; Yamanaka, Masanori

2015-05-01

[Purpose] The purpose of this study was to compare the upper, middle, and lower trapezius muscles' activity in the different planes of shoulder elevation. [Subjects] Twenty male subjects volunteered for this study. [Methods] Surface electromyographic (EMG) activity for each of the three regions of the trapezius muscles in the three different planes of elevation were collected while the participants maintained 30, 60, and 90 degrees of elevation in each plane. The EMG data were normalized with maximum voluntary isometric contraction (%MVIC), and compared among the planes at each angle of elevation. [Results] There were significantly different muscle activities among the elevation planes at each angle. [Conclusion] This study found that the three regions of the trapezius muscles changed their activity depending on the planes of shoulder elevation. These changes in the trapezius muscles could induce appropriate scapular motion to face the glenoid cavity in the correct directions in different planes of shoulder elevation.

Can a Single Sagittal Magnetic Resonance Imaging Slice Represent Whole Fatty Infiltration in Chronic Rotator Cuff Tears at the Supraspinatus?

PubMed

Lee, Yong-Beom; Yang, Cheol-Jung; Li, Cheng Zhen; Zhuan, Zhong; Kwon, Seung-Cheol; Noh, Kyu-Cheol

2018-03-01

This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. This study retrospectively reviewed the MRIs of 106 patients (age 50-79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image. Fat mass and muscle mass seen on this Y-view single slice were recorded as F1 and M1, respectively. Fat mass and muscle mass were also assessed on MRI scans lateral and medial to the Y-view. The means of fat mass and muscle mass on these three slices were recorded as F3 and M3, respectively. Average FI ratios (fat mass/muscle mass) of the three assessment methods (F1/M1, FA/MA, and F3/M3) were compared. Intraclass correlation coefficients (ICCs) were calculated for inter- and intraobserver reliability. ICCs showed higher reliability (> 0.8) for all measurements. F1/M1 values were not statistically different from FA/MA and F3/M3 values ( p > 0.05), except in males with medium and large tears. F3/M3 and FA/MA were not statistically different. The difference between F1/M1 and FA/MA did not exceed 2%. A single sagittal MRI slice can represent the whole FI in chronic rotator cuff tears, except in some patient groups. We recommend measurement of FI using a single sagittal MRI slice, given the effort required for repeated measurements.

Can a Single Sagittal Magnetic Resonance Imaging Slice Represent Whole Fatty Infiltration in Chronic Rotator Cuff Tears at the Supraspinatus?

PubMed Central

Lee, Yong-Beom; Yang, Cheol-Jung; Li, Cheng Zhen; Zhuan, Zhong; Kwon, Seung-Cheol

2018-01-01

Background This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. Methods This study retrospectively reviewed the MRIs of 106 patients (age 50–79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image. Fat mass and muscle mass seen on this Y-view single slice were recorded as F1 and M1, respectively. Fat mass and muscle mass were also assessed on MRI scans lateral and medial to the Y-view. The means of fat mass and muscle mass on these three slices were recorded as F3 and M3, respectively. Average FI ratios (fat mass/muscle mass) of the three assessment methods (F1/M1, FA/MA, and F3/M3) were compared. Intraclass correlation coefficients (ICCs) were calculated for inter- and intraobserver reliability. Results ICCs showed higher reliability (> 0.8) for all measurements. F1/M1 values were not statistically different from FA/MA and F3/M3 values (p > 0.05), except in males with medium and large tears. F3/M3 and FA/MA were not statistically different. The difference between F1/M1 and FA/MA did not exceed 2%. Conclusions A single sagittal MRI slice can represent the whole FI in chronic rotator cuff tears, except in some patient groups. We recommend measurement of FI using a single sagittal MRI slice, given the effort required for repeated measurements. PMID:29564048

[Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching].

PubMed

Hernández-Elena, J; de la Red-Gallego, M Á; Garcés-Zarzalejo, C; Pascual-Carra, M A; Pérez-Aguilar, M D; Rodríguez-López, T; Alfonso-Fernández, A; Pérez-Núñez, M I

2015-01-01

An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Reverse total shoulder arthroplasty

PubMed Central

Familiari, Filippo; Rojas, Jorge; Nedim Doral, Mahmut; Huri, Gazi; McFarland, Edward G.

2018-01-01

Since the introduction of reverse total shoulder arthroplasty (RTSA) in 1987 (in Europe) and 2004 (in the United States), the number of RTSAs performed annually has increased. Although the main indication for RTSA has been rotator cuff tears, indications have expanded to include several shoulder conditions, many of which involve dysfunction of the rotator cuff. RTSA complications have been reported to affect 19% to 68% of patients and include acromial fracture, haematoma, infection, instability, mechanical baseplate failure, neurological injury, periprosthetic fracture and scapular notching. Current controversies in RTSA include optimal baseplate positioning, humeral neck-shaft angle (135° versus 155°), glenosphere placement (medial, lateral or bony increased offset RTSA) and subscapularis repair. Improvements in prosthesis design, surgeon experience and clinical results will need to occur to optimize this treatment for many shoulder conditions. Cite this article: EFORT Open Rev 2018;3:58–69 DOI: 10.1302/2058-5241.3.170044 PMID:29657846

Quantitative estimation of muscle shear elastic modulus of the upper trapezius with supersonic shear imaging during arm positioning.

PubMed

Leong, Hio-Teng; Ng, Gabriel Yin-Fat; Leung, Vivian Yee-Fong; Fu, Siu Ngor

2013-01-01

Pain and tenderness of the upper trapezius are the major complaints among people with chronic neck and shoulder disorders. Hyper-activation and increased muscle tension of the upper trapezius during arm elevation will cause imbalance of the scapular muscle force and contribute to neck and shoulder disorders. Assessing the elasticity of the upper trapezius in different arm positions is therefore important for identifying people at risk so as to give preventive programmes or for monitoring the effectiveness of the intervention programmes for these disorders. This study aimed to establish the reliability of supersonic shear imaging (SSI) in quantifying upper trapezius elasticity/shear elastic modulus and its ability to measure the modulation of muscle elasticity during arm elevation. Twenty-eight healthy adults (15 males, 13 females; mean age = 29.6 years) were recruited to participate in the study. In each participant, the shear elastic modulus of the upper trapezius while the arm was at rest and at 30° abduction was measured by two operators and twice by operator 1 with a time interval between the measurements. The results showed excellent within- and between-session intra-operator (ICC = 0.87-0.97) and inter-observer (ICC = 0.78-0.83) reliability for the upper trapezius elasticity with the arm at rest and at 30° abduction. An increase of 55.23% of shear elastic modulus from resting to 30° abduction was observed. Our findings demonstrate the possibilities for using SSI to quantify muscle elasticity and its potential role in delineating the modulation of upper trapezius elasticity, which is essential for future studies to compare the differences in shear elastic modulus between normal elasticity and that of individuals with neck and shoulder disorders.

Quantitative Estimation of Muscle Shear Elastic Modulus of the Upper Trapezius with Supersonic Shear Imaging during Arm Positioning

PubMed Central

Leong, Hio-Teng; Ng, Gabriel Yin-fat; Leung, Vivian Yee-fong; Fu, Siu Ngor

2013-01-01

Pain and tenderness of the upper trapezius are the major complaints among people with chronic neck and shoulder disorders. Hyper-activation and increased muscle tension of the upper trapezius during arm elevation will cause imbalance of the scapular muscle force and contribute to neck and shoulder disorders. Assessing the elasticity of the upper trapezius in different arm positions is therefore important for identifying people at risk so as to give preventive programmes or for monitoring the effectiveness of the intervention programmes for these disorders. This study aimed to establish the reliability of supersonic shear imaging (SSI) in quantifying upper trapezius elasticity/shear elastic modulus and its ability to measure the modulation of muscle elasticity during arm elevation. Twenty-eight healthy adults (15 males, 13 females; mean age = 29.6 years) were recruited to participate in the study. In each participant, the shear elastic modulus of the upper trapezius while the arm was at rest and at 30° abduction was measured by two operators and twice by operator 1 with a time interval between the measurements. The results showed excellent within- and between-session intra-operator (ICC = 0.87–0.97) and inter-observer (ICC = 0.78–0.83) reliability for the upper trapezius elasticity with the arm at rest and at 30° abduction. An increase of 55.23% of shear elastic modulus from resting to 30° abduction was observed. Our findings demonstrate the possibilities for using SSI to quantify muscle elasticity and its potential role in delineating the modulation of upper trapezius elasticity, which is essential for future studies to compare the differences in shear elastic modulus between normal elasticity and that of individuals with neck and shoulder disorders. PMID:23825641

Acromiohumeral Distance During Neuromuscular Electrical Stimulation of the Lower Trapezius and Serratus Anterior Muscles in Healthy Participants

PubMed Central

Bdaiwi, Alya H.; Mackenzie, Tanya Anne; Herrington, Lee; Horsley, Ian; Cools, Ann M.

2015-01-01

Context Compromise to the acromiohumeral distance has been reported in participants with subacromial impingement syndrome compared with healthy participants. In clinical practice, patients with subacromial shoulder impingement are given strengthening programs targeting the lower trapezius (LT) and serratus anterior (SA) muscles to increase scapular posterior tilt and upward rotation. We are the first to use neuromuscular electrical stimulation to stimulate these muscle groups and evaluate how the muscle contraction affects the acromiohumeral distance. Objective To investigate if electrical muscle stimulation of the LT and SA muscles, both separately and simultaneously, increases the acromiohumeral distance and to identify which muscle-group contraction or combination most influences the acromiohumeral distance. Design Controlled laboratory study. Setting Human performance laboratory. Patients or Other Participants Twenty participants (10 men and 10 women, age = 26.9 ± 8.0 years, body mass index = 23.8) were screened. Intervention(s) Neuromuscular electrical stimulation of the LT and SA. Main Outcome Measure(s) Ultrasound measurement of the acromiohumeral distance. Results Acromiohumeral distance increased during contraction via neuromuscular electrical stimulation of the LT muscle (t19 = −3.89, P = .004), SA muscle (t19 = −7.67, P = .001), and combined LT and SA muscles (t19 = −5.09, P = .001). We observed no differences in the increased acromiohumeral distance among the 3 procedures (F2,57 = 3.109, P = .08). Conclusions Our results supported the hypothesis that the muscle force couple around the scapula is important in rehabilitation and scapular control and influences acromiohumeral distance. PMID:25933249

Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade.

PubMed

Valasek, Petr; Theis, Susanne; Krejci, Eliska; Grim, Milos; Maina, Flavio; Shwartz, Yulia; Otto, Anthony; Huang, Ruijin; Patel, Ketan

2010-04-01

The scapula is the main skeletal element of the pectoral girdle allowing muscular fixation of the forelimb to the axial skeleton. The vertebrate limb skeleton has traditionally been considered to develop from the lateral plate mesoderm, whereas the musculature originates from the axial somites. However, in birds, the scapular blade has been shown to develop from the somites. We investigated whether a somitic contribution was also present in the mammalian scapula. Using genetic lineage-tracing techniques, we show that the medial border of the mammalian scapula develops from somitic cells. The medial scapula border serves as the attachment site of girdle muscles (serratus anterior, rhomboidei and levator scapulae). We show that the development of these muscles is independent of the mechanism that controls the formation of all other limb muscles. We suggest that these muscles be specifically referred to as medial girdle muscles. Our results establish the avian scapular blade and medial border of the mammalian scapula as homologous structures as they share the same developmental origin.

Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade

PubMed Central

Valasek, Petr; Theis, Susanne; Krejci, Eliska; Grim, Milos; Maina, Flavio; Shwartz, Yulia; Otto, Anthony; Huang, Ruijin; Patel, Ketan

2010-01-01

The scapula is the main skeletal element of the pectoral girdle allowing muscular fixation of the forelimb to the axial skeleton. The vertebrate limb skeleton has traditionally been considered to develop from the lateral plate mesoderm, whereas the musculature originates from the axial somites. However, in birds, the scapular blade has been shown to develop from the somites. We investigated whether a somitic contribution was also present in the mammalian scapula. Using genetic lineage-tracing techniques, we show that the medial border of the mammalian scapula develops from somitic cells. The medial scapula border serves as the attachment site of girdle muscles (serratus anterior, rhomboidei and levator scapulae). We show that the development of these muscles is independent of the mechanism that controls the formation of all other limb muscles. We suggest that these muscles be specifically referred to as medial girdle muscles. Our results establish the avian scapular blade and medial border of the mammalian scapula as homologous structures as they share the same developmental origin. PMID:20136669

[Treatment of complex scapular body fractures by locking reconstructive plates].

PubMed

Zhang, Jun-wei; Hou, Jin-yong; Yang, Mao-qing

2011-03-01

To investigate the method and effect of treatment of complex scapular body fractures by locking reconstructive plate through modified posterior approach. From August 2005 to November 2009, 27 patients with complex scapula body fractures were treated by locking reconstruction bone plate fixation,including 19 males and 8 females with an average age of 36 years old ranging from 16 to 64 years. The time after injury was 0.5 hours to 11 days (averaged 3 days). Of all the patients, 9 cases were associated with ipsilateral clavicle fracture, 2 cases were associated with acromioclavicular joint dislocation,16 cases were associated with multiple rib fractures, 1 case were associated with humeral shaft fractures, 5 cases were associated with pleural effusion, atelectasis, lung contusion etc. After operating,shoulder functional recovery were followed up. Twenty-four patients were followed up from 2 to 35 months with an average of 19 months. According to Hardegger shoulder function,the results were excellent in 15 cases, good in 7 cases, general in 2 cases. This method had the advantage of less trauma and clear exposure, firm and reliable fixation, and early activities.

The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: a retrospective analysis of 130 reconstructions performed over a period of 5 years in a single department.

PubMed

Mitsimponas, Konstantinos T; Iliopoulos, Christos; Stockmann, Philipp; Bumiller, Lars; Nkenke, Emeka; Neukam, Friedrich W; Schlegel, Karl-Andreas

2014-07-01

The scapular/parascapular free flap was described by Saijo in 1978 and has since then been widely used in reconstructive procedures. This is a retrospective study, describing our experience with the use of free scapula/parascapular flap in 130 reconstructions over a period of 5 years in the Department of Oral and Maxillofacial Surgery of the University Hospital of Erlangen. Demographical data, data regarding the underlying pathology, flap raising details, microvascular anastomoses, early and late postoperative complications will be presented. The flap was raised without problems and the donor site was primarily closed in all cases. Sixteen flaps required revision. Five transplants were lost (failure rate of 3.85%). Loss of part of the flap was observed in 3 cases (2.3%). The free scapula/parascapular flap is a versatile and reliable flap that can find many applications in the reconstruction of complex head and neck defects. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Massive trapezial metastasis from gastric adenocarcinoma resected and reconstructed with a vascularized scapular bone graft: A case report.

PubMed

Okamoto, Masanori; Yamazaki, Hiroshi; Yoshimura, Yasuo; Aoki, Kaoru; Tanaka, Atsushi; Kato, Hiroyuki

2017-12-01

Isolated metastasis to the hand bones is very rare. Only seven cases of metastasis to the trapezium have been reported. To the best of our knowledge, this is the first report of a single metastasis to the trapezium from a gastric adenocarcinoma. A 62-year-old man presented with pain and massive swelling in the right carpometacarpal joint of the thumb. The patient was diagnosed with trapezial metastasis of advanced gastric adenocarcinoma. The patient underwent systemic chemotherapy with cisplatin and S-1, radiotherapy to the metastatic bone, and treatment with denosumab. One year later, the huge metastatic tumor was resected, and the hand was reconstructed using vascularized scapular bone. Eighteen months postoperatively, the patient was satisfied with the appearance of the reconstructed hand and was able to use his right thumb in activities of daily living. Although rare, metastasis to the trapezium should be considered in patients with persistent and progressive thumb CMC joint pain. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

A new species of Pristimantis from southern Ecuador (Anura, Craugastoridae).

PubMed

Székely, Paul; Cogălniceanu, Dan; Székely, Diana; Páez, Nadia; Ron, Santiago R

2016-01-01

A new species of Pristimantis is described from Reserva Buenaventura, southern Ecuador, at elevations between 878 and 1082 m. A molecular phylogeny based on nuclear and mitochondrial genes shows that the new species is closely related to Pristimantis phoxocephalus, Pristimantis riveti, and Pristimantis versicolor. The new species differs from them and other morphologically similar congeners in having a low W-shaped dermal ridge in the scapular region, a large conical tubercle on the upper eyelid and on the heel, a thin mid dorsal fold, and a longitudinal lateral fold starting behind the tympanic fold and extending along the anterior two thirds of the flank. The new species inhabits cloud forests in the Pacific slopes of the Andes.

Ultrasonographic measurement of the acromiohumeral distance in spinal cord injury: Reliability and effects of shoulder positioning.

PubMed

Lin, Yen-Sheng; Boninger, Michael L; Day, Kevin A; Koontz, Alicia M

2015-11-01

To investigate the reliability of ultrasonographic measurement of acromiohumeral distance (AHD) and the effects of shoulder positioning on AHD among manual wheelchair users (MWUs) with spinal cord injury (SCI) and an able-bodied control group. Ten MWUs with SCI and 10 able-bodied subjects participated in this study. The ultrasonographic measurements of AHD from each subject were obtained by two raters during passive and active scapular plane arm elevation in neutral, 45°, 90° with and without resistance and in a weight relief raise position. The measurements were recorded again by each rater using the same procedures after a 30-minute time interval. All raters were blinded to each other's measurements. University Laboratories and Veteran Affairs Healthcare System. Intra-rater (intraclass correlation coefficient, ICC > 0.83) and inter-rater (ICC > 0.78) reliability was excellent for both the MWUs with SCI and able-bodied groups across all arm positions except for the 45° position in the control group for one of the raters (intra-rater: ICC < 0.40 and inter-rater: ICC < 0.60). AHD significantly reduced when the shoulder was in the 90° arm elevated positions with or without resistance. Findings from our study demonstrated that ultrasonography is a reliable means to evaluate AHD in both able bodied and individuals with SCI, who are known to have significant shoulder pathology. This technique could be used to develop reference measures and to identify changes in AHD caused by interventions.

Effects of functional electrical stimulation assisted rowing on aerobic fitness and shoulder pain in manual wheelchair users with spinal cord injury.

PubMed

Wilbanks, Susan R; Rogers, Rebecca; Pool, Sean; Bickel, C Scott

2016-11-01

Test the effectiveness of a 6-week functional electrical stimulation (FES)-assisted rowing intervention to increase aerobic fitness and decrease shoulder pain in manual wheelchair users with spinal cord injury (SCI) Methods: Ten adults with SCI (47 ± 12 years, 86 ± 19.7 kg, 175.5 ± 13.2 cm) 18 ± 14 years since injury, AIS classification A-C who had pain in one or both shoulders for >6 months took part in a pre-test, post-test experiment in our human performance laboratory. Participants took part in 30 minutes of FES-assisted rowing, 3 days/week × 6 weeks. Participants were evaluated for VO 2 peak (FES-row and arm bike), distance rowed, arm power output, Wheelchair User Shoulder Pain Index (WUSPI), upper extremity isokinetic strength, scapular stabilization, participation (LIFE-H), quality of life (QOL-SCI), qualitative exit interview. Participants increased distance rowed by 257 ± 266 m and increased arm power output by 6.7 ± 7.9 W. An 8% increase in VO 2 peak and 10.5 ± 4.4 point decrease in shoulder pain were observed (all P < 0.05). There were no changes in upper extremity strength, scapular stabilization, or survey-based measures of participation or quality of life. Qualitative interviewing indicated overall enjoyment of the intervention and improvement in perceived quality of life. FES-assisted rowing is effective to increase aerobic fitness and decrease shoulder pain in manual wheelchair users with SCI. Further research is necessary to determine if rowing without FES can provide similar benefits, and to determine mechanisms driving improvements in shoulder pain, as no changes in measures of upper extremity strength or scapular stabilization were observed.

The effect of adenotonsillectomy on the position of head, cervical and thoracic spine and scapular girdle of mouth breathing children.

PubMed

Neiva, Patricia Dayrell; Franco, Letícia Paiva; Kirkwood, Renata Noce; Becker, Helena Gonçalves

2018-04-01

The clinical decision for surgical treatment of children diagnosed with mouth breathing depends on the percentage of mechanical obstruction correlated with exacerbation of upper respiratory tract infections and systemic changes. The benefits of adenotonsillectomy include changes in the nasopharyngeal space, the mandibular plane and myofunctional alterations. Post-adenotonsilectomy postural benefits have not yet been described. To investigate the kinematics of the shoulder girdle, cervical and thoracic spine in children with mouth breathing before and after adenotonsillectomy. Forty-nine mouth breathing children (6.3 ± 1.8 years) of both sexes participated in the study. The measures of thoracic kyphosis, forward head position, shoulders protrusion and abduction, elevation, anterior tilt and internal rotation of the scapula were evaluated before and after surgery. The kinematic data were obtained using the system Qualysis ProReflex ® . There was a significant decrease in forward head position, shoulders protrusion, elevation and anterior tilt of the scapula after surgery compared to the pre-operative. One of adenotonsillectomy results is the improvement of the posture of the head and the shoulder girdle of mouth breathing children. Clinically these findings are important and will contribute to improving the quality of life of mouth breathing children. Copyright © 2018 Elsevier B.V. All rights reserved.

Morphologic Variability of the Shoulder between the Populations of North American and East Asian.

PubMed

Cabezas, Andres F; Krebes, Kristi; Hussey, Michael M; Santoni, Brandon G; Kim, Hyuong Sik; Frankle, Mark A; Oh, Joo Han

2016-09-01

The aim of this study was to determine if there were significant differences in glenohumeral joint morphology between North American and East Asian populations that may influence sizing and selection of shoulder arthroplasty systems. Computed tomography reconstructions of 92 North American and 58 East Asian patients were used to perform 3-dimensional measurements. The proximal humeral position was normalized in all patients by aligning it with the scapular plane utilizing anatomic landmarks. Measurements were performed on the humerus and scapula and included coronal and axial humeral head radius, humeral neck shaft and articular arc angles, glenoid height and width, and critical shoulder angle. Glenohumeral relationships were also measured and included lateral distance to the greater tuberosity and acromion, abduction lever arm, and acromial index. Parametric and nonparametric statistical analyses were used to compare population metrics. East Asian glenohumeral measurements were significantly smaller for all linear metrics (p < 0.05), with the exception of acromial length, which was greater than in the North American cohort (p < 0.001). The increase in acromial length affected all measurements involving the acromion including abduction lever arms. No difference was found between the neck shaft and articular angular measurements. The East Asian population exhibited smaller shoulder morphometrics than their North American cohort, with the exception of an extended acromial overhang. The morphologic data can provide some additional factors to consider when choosing an optimal shoulder implant for the East Asian population, in addition to creating future designs that may better accommodate this population.

The floating shoulder—-clinical and radiological results after intramedullary stabilization of the clavicle in cases with minor displacement of the scapular neck fracture.

PubMed

Izadpanah, Kaywan; Jaeger, Martin; Maier, Dirk; Kubosch, David; Hammer, Thorsten Oliver; Südkamp, Norbert P

2012-02-01

The aim of this study was to compare the clinical and radiologic results of titanium elastic nail (TEN) and plate osteosynthesis for treatment of clavicle fractures in patients with a floating shoulder injury. From 2000 to 2008, 16 patients with a floating shoulder injury (ipsilateral clavicle and minor displaced scapular neck fracture) were treated by isolated stabilization of the clavicle. The patients were treated with open reduction and plate osteosynthesis (group 1[G1]) or TEN osteosynthesis (group 2 [G2]). Both procedures were compared with regard to functional and radiologic outcome. Nine patients were treated with a plate osteosynthesis (G1) and seven with a TEN osteosynthesis (G2). The follow-up time was 35.7 months ± 16 months. There was no difference in functional outcome with regard to the intraindividual Constant score 83.9(G1) versus 86.7 (G2) or the American Shoulder and Elbow Surgeons score 79.1 (G1) versus 85.7 (G2). No significant postoperative dislocation of the glenopolar angle appeared. In the TEN-treated group, a clavicle shortening of 2.4 mm was observed. Subgroup analysis revealed significant greater shortening in type B and C compared with type A (OTA) clavicle fractures(4.7 mm vs. 0.8 mm). No clavicle shortening in the plate-treated group appeared. The treatment of floating shoulder injuries with TEN and plate osteosynthesis of the clavicle and nonoperative treatment of a minimally displaced glenoid neck fracture provide equal functional results. However, in type B and C (but not in type A) fractures of the clavicle, a shortening of 5 mm can be expected after titanium elastic nailing. Copyright ©2012 by Lippincott Williams & Wilkins

Eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy: a randomized, single blinded, clinical trial.

PubMed

Dejaco, Beate; Habets, Bas; van Loon, Corné; van Grinsven, Susan; van Cingel, Robert

2017-07-01

To investigate the effectiveness of isolated eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy. Thirty-six patients with rotator cuff tendinopathy, diagnosed by an orthopaedic surgeon, were included and randomly allocated to an isolated eccentric exercise (EE) group (n = 20, mean age = 50.2 ± 10.8 years) or a conventional exercise (CG) group (n = 16, mean age = 48.6 ± 12.3 years). Both groups fulfilled a 12-week daily home-based exercise programme and received a total amount of nine treatment sessions. The Constant Murley score was used to evaluate both objective (e.g. range of motion and strength) and subjective measures (e.g. pain and activities of daily living). A visual analogue scale (VAS) was used to evaluate pain during daily activities. As secondary outcomes, shoulder range of motion and isometric abduction strength in 45° in the scapular plane were evaluated. All measurements were taken at baseline, at 6, 12 and 26 weeks. After 26 weeks, both groups showed a significant increase in the Constant Murley score and a significant decrease in VAS scores. No difference was found between the groups, for any of the evaluated outcome measures. A 12-week-isolated eccentric training programme of the rotator cuff is beneficial for shoulder function and pain after 26 weeks in patients with rotator cuff tendinopathy. However, it is no more beneficial than a conventional exercise programme for the rotator cuff and scapular muscles. Based on the results, clinicians should take into account that performing two eccentric exercises twice a day is as effective as performing six concentric/eccentric exercises once a day in patients with rotator cuff tendinopathy.

Effects of 6-week sling-based training of the external-rotator muscles on the shoulder profile in elite female high school handball players.

PubMed

Genevois, Cyril; Berthier, Philippe; Guidou, Vincent; Muller, Franck; Thiebault, Boris; Rogowski, Isabelle

2014-11-01

In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength. This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players. Crossover study. National elite handball training center. 25 elite female high school handball players. The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone. Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides. After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017). This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.

A new species of Pristimantis from southern Ecuador (Anura, Craugastoridae)

PubMed Central

Székely, Paul; Cogălniceanu, Dan; Székely, Diana; Páez, Nadia; Ron, Santiago R.

2016-01-01

Abstract A new species of Pristimantis is described from Reserva Buenaventura, southern Ecuador, at elevations between 878 and 1082 m. A molecular phylogeny based on nuclear and mitochondrial genes shows that the new species is closely related to Pristimantis phoxocephalus, Pristimantis riveti, and Pristimantis versicolor. The new species differs from them and other morphologically similar congeners in having a low W-shaped dermal ridge in the scapular region, a large conical tubercle on the upper eyelid and on the heel, a thin mid dorsal fold, and a longitudinal lateral fold starting behind the tympanic fold and extending along the anterior two thirds of the flank. The new species inhabits cloud forests in the Pacific slopes of the Andes. PMID:27551223

Effects of scapula-upward taping using kinesiology tape in a patient with shoulder pain caused by scapular downward rotation

PubMed Central

Kim, Byeong-Jo; Lee, Jung-Hoon

2015-01-01

[Purpose] The aim of this study was to evaluate the effects of scapula-upward taping (SUT) in a patient with shoulder pain caused by scapular downward rotation (SDR). [Subject] A 26-year-old male with SDR experienced severe pain in the left shoulder when he lifted his left upper extremity to hold the handle in a bus and during and after push-up exercise. [Methods] The patient underwent SUT for a period of 1 month, 5 times per week, for an average of 9 h/d. [Results] The patient’s radiographs showed that the degree of SDR had decreased; the left shoulder pain also decreased in the resting state and during and after push-up exercise. The manual muscle strength test grades of the upper trapezius, lower trapezius, and serratus anterior had increased. The patient was able to lift the left upper extremity to hold the handle in a bus and perform the push-up exercise without experiencing any pain. [Conclusion] Repeated SUT application may be a beneficial treatment method for alleviating the degree of SDR and shoulder pain in SDR patients. PMID:25729213

Spinal accessory nerve injury: A potentially missed cause of a painful, droopy shoulder.

PubMed

Macaluso, Steven; Ross, Douglas C; Doherty, Timothy J; Doherty, Christopher D; Miller, Thomas A

2016-11-21

Spinal accessory nerve (SAN) injury can be an overlooked cause of scapular winging and shoulder dysfunction. The most common etiology is iatrogenic injury following surgical procedures at the posterior triangle of the neck. We present three cases of isolated injury to the SAN following trauma. To improve detection of SAN injuries through highlighting the clinical presentation, diagnosis and treatment via three cases in which the injuries were initially missed. Clinical case series and narrative review. Three (3) patients were evaluated by history, physical exam and electrodiagnostic study (EMG). Clinical symptoms included, a painful, droopy shoulder and difficulties with overhead activities. Clinical signs included the observation of scapular winging, and focal atrophy of the trapezius and in some cases the sternocleidomastoid (SCM). Novel clinical signs such as the active elevation lag sign and triangle sign were also helpful clinically to highlight the SAN as the site of pathology. EMG revealed denervation and reduced motor unit recruitment in the trapezius and SCM. Early detection of SAN injuries can be improved through appropriate clinical suspicion, a detailed history and careful physical exam. EMG testing can help guide prognosis, direct conservative and surgical treatment, and reduce patient morbidity.

Sex determination from scapular length measurements by CT scans images in a Caucasian population.

PubMed

Giurazza, F; Schena, E; Del Vescovo, R; Cazzato, R L; Mortato, L; Saccomandi, P; Paternostro, F; Onofri, L; Zobel, B Beomonte

2013-01-01

Together with race, stature and age, sex is a main component of the biological identity. Thanks to its proportional correlation with parts of the human body, sex can be evaluated form the skeleton. The most accurate approach to determine sex by bone size is based on os coxae or skull. After natural disaster their presence can never be guaranteed, therefore the development of methods of sex determination using other skeletal elements can result crucial. Herein, sexual dimorphism in the human scapula is used to develop a two-variable discriminant function for sex estimation. We have enrolled 100 males and 100 females who underwent thoracic CT scan evaluation and we have estimated two scapular diameters. The estimation has been carried out by analyzing images of the scapulae of each patient after three dimensional post-processing reconstructions. The two-variable function allows to obtain an overall accuracy of 88% on the calibration sample. Furthermore, we have employed the mentioned function on a collection of 10 individual test sample from the collection of the "Museo di Anatomia Umana di Firenze" of the Università degli Studi di Firenze; sex has been correctly predicted on 9 skeletons.

Ultrasonographic measurement of the acromiohumeral distance in spinal cord injury: Reliability and effects of shoulder positioning

PubMed Central

Lin, Yen-Sheng; Boninger, Michael L.; Day, Kevin A.

2015-01-01

Objective To investigate the reliability of ultrasonographic measurement of acromiohumeral distance (AHD) and the effects of shoulder positioning on AHD among manual wheelchair users (MWUs) with spinal cord injury (SCI) and an able-bodied control group. Methods Ten MWUs with SCI and 10 able-bodied subjects participated in this study. The ultrasonographic measurements of AHD from each subject were obtained by two raters during passive and active scapular plane arm elevation in neutral, 45°, 90° with and without resistance and in a weight relief raise position. The measurements were recorded again by each rater using the same procedures after a 30-minute time interval. All raters were blinded to each other's measurements. Setting University Laboratories and Veteran Affairs Healthcare System. Results Intra-rater (intraclass correlation coefficient, ICC > 0.83) and inter-rater (ICC > 0.78) reliability was excellent for both the MWUs with SCI and able-bodied groups across all arm positions except for the 45° position in the control group for one of the raters (intra-rater: ICC < 0.40 and inter-rater: ICC < 0.60). AHD significantly reduced when the shoulder was in the 90° arm elevated positions with or without resistance. Conclusion Findings from our study demonstrated that ultrasonography is a reliable means to evaluate AHD in both able bodied and individuals with SCI, who are known to have significant shoulder pathology. This technique could be used to develop reference measures and to identify changes in AHD caused by interventions. PMID:24968117

The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests.

PubMed

Chalmers, Peter N; Cvetanovich, Gregory L; Kupfer, Noam; Wimmer, Markus A; Verma, Nikhil N; Cole, Brian J; Romeo, Anthony A; Nicholson, Gregory P

2016-02-01

While Jobe's test is widely used, it does not isolate supraspinatus activity. Our purpose was to examine the electromyographic (EMG) activity within the supraspinatus and deltoid with resisted abduction to determine the shoulder position that best isolates the activity of the supraspinatus. We performed EMG analysis of the supraspinatus, anterior head of the deltoid, and middle head of the deltoid in 10 normal volunteers. We measured EMG activity during resisted shoulder abduction in the scapular plane to both manual resistance and a standardized load in varying degrees of abduction and rotation. To determine which position best isolates supraspinatus activity, the ratio of supraspinatus to deltoid activity (S:D) was calculated for each position. Results were analyzed with a repeated-measures analysis of variance with Bonferroni correction. The posterior deltoid was excluded as it serves mostly to extend and externally rotate. Our study confirmed Jobe's findings of maximal supraspinatus activity at 90° of abduction. However, decreasing abduction significantly increased S:D for both resisted manual testing and testing against a standardized load (P = .002 and .001, respectively). The greatest S:D ratio (4.6 ± 3.4 for standardized load testing) was seen at the "champagne toast" position, i.e., 30° of abduction, mild external rotation, 30° of flexion, and 90° of elbow flexion. The smallest ratio (0.8 ± 0.6) was seen at Jobe's position. Testing of abduction strength in the champagne toast position, i.e., 30° of abduction, mild external rotation, and 30° of flexion, better isolates the activity of the supraspinatus from the deltoid than Jobe's "empty can" position. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The effect of the remplissage procedure on shoulder range of motion: a cadaveric study.

PubMed

Omi, Rei; Hooke, Alexander W; Zhao, Kristin D; Matsuhashi, Tomoya; Goto, Akira; Yamamoto, Nobuyuki; Sperling, John W; Steinmann, Scott P; Itoi, Eiji; An, Kai-Nan

2014-02-01

The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position. HSLs of 50% and 100% of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°). For standard ROMs, the procedure for the 50% HSL maintained complete ROMs, whereas the procedure for the 100% HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50% HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100% HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle. In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position. The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Dipturus amphispinus sp. nov., a new longsnout skate (Rajoidei: Rajidae) from the Philippines.

PubMed

Last, Peter R; Alava, Moonyeen

2013-01-01

A new long-snouted skate, Dipturus amphispinus sp. nov., is formally described based on material caught in the Sulu Sea and later acquired from fish markets of the central and southern Philippines. It differs from its congeners in the western North Pacific, apart from D. wuhanlingi (East and South China Seas), in having a variably-defined, parallel row of posterolaterally directed lumbar thorns, and well-developed scapular thorns on each side of the disc. However, the paired rows of lumbar thorns are better defined in Dipturus amphispinus sp. nov. than in D. wuhanlingi, and these species also differ in some aspects of their morphometrics, meristics and squamation. Dipturus amphispinus sp. nov. displays marked sexual dimorphism with adult males having a relatively broader mouth, much longer teeth, a relatively shorter snout, head and disc, a taller first dorsal fin, and a proportionally longer posterior pelvic-fin lobe and tail, than adult-sized females.

Corrective Osteotomy for Symptomatic Clavicle Malunion Using Patient-specific Osteotomy and Reduction Guides.

PubMed

Haefeli, Mathias; Schenkel, Matthias; Schumacher, Ralf; Eid, Karim

2017-09-01

Midshaft clavicular fractures are often treated nonoperatively with good reported clinical outcome in a majority of patients. However, malunion with shortening of the affected clavicle is not uncommon. Shortening of the clavicle has been shown to affect shoulder strength and kinematics with alteration of scapular position. Whereas the exact clinical impact of these factors is unknown, the deformity may lead to cosmetic and functional impairment as for example pain with weight-bearing on the shoulder girdle. Other reported complications of clavicular malunion include thoracic outlet syndrome, subclavicular vein thrombosis, and axillary plexus compression. Corrective osteotomy has therefore been recommended for symptomatic clavicular malunions, generally using plain x-rays for planning the necessary elongation. Particularly in malunited multifragmentary fractures it may be difficult to exactly determine the plane of osteotomy intraoperatively to restore the precise anatomic shape of the clavicle. We present a technique for corrective osteotomy using preoperative computer planning and 3-dimensional printed patient-specific intraoperative osteotomy and reduction guides based on the healthy contralateral clavicle.

Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation.

PubMed

Van Straaten, Meegan G; Cloud, Beth A; Morrow, Melissa M; Ludewig, Paula M; Zhao, Kristin D

2014-10-01

To test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized. A pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk). Subjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center. A convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination. A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing. Primary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius. Pain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ(2)2=5.10, P=.014), DASH Index (χ(2)2=5.41, P=.012), and SRQ (χ(2)2=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points. A high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Investigations of Anatomical Variations of the Thorax and Heart, and Anatomical Knowledge for First Year Medical Dental and Podiatry Students

ERIC Educational Resources Information Center

Verenna, Anne-Marie

2013-01-01

The universal presence of anatomy in healthcare professions is undeniable. It is a cornerstone to each of the clinical and basic sciences. Therefore, further expansion of current anatomical knowledge and effective methods to teach anatomy is essential. In this work, the relationship of the dorsal scapular artery with the trunks of the brachial…

76 FR 304 - Endangered and Threatened Wildlife and Plants; 90-Day Finding on a Petition To List the Red Knot...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-04

...). Juveniles resemble non-breeding adults, except that the feathers of the scapulars and wing coverts of... stopover sites are Grays Harbor and Willapa Bay in Washington, and Yukon-Kuskokwim Delta and Copper River Delta in Alaska (Isleib 1979, p. 128; Gill and Handel 1990, p. 712; Page et al. 1999, p. 467). Smaller...

Increased Seat Dump Angle in a Manual Wheelchair Is Associated With Changes in Thoracolumbar Lordosis and Scapular Kinematics During Propulsion.

PubMed

Cloud, Beth A; Zhao, Kristin D; Ellingson, Arin M; Nassr, Ahmad; Windebank, Anthony J; An, Kai-Nan

2017-10-01

To quantify and compare spinal curvature and shoulder kinematics throughout the manual wheelchair (MWC) propulsion cycle for individuals with spinal cord injury (SCI) who were seated at 2 different seat dump angles. Single-group, repeated-measures study. Academic medical center. Individuals (N=28) with SCI or spinal cord disease who used MWCs completed a telephone screening, and 21 of them were eligible and completed the study. Participants' personal MWCs were modified to have seat dump angles of 0° or 14°, with a vertical backrest. Participants completed at least 3 propulsion cycles in each condition, during which spine and shoulder motion data were collected with fiberoptic and electromagnetic sensors, respectively. Thoracolumbar spinal curvature, glenohumeral kinematics, and scapulothoracic kinematics at the start of push (SP), mid-push (MP), end of push (EP), and mid-recovery. Participants had significantly less lordosis in the 14° condition for all propulsion events. Median differences ranged from 2.0° to 4.6°. Lordosis differences were more pronounced in those with low SCI. Scapulothoracic internal rotation was increased in the 14° condition at SP and MP (mean differences, 2.5° and 2.7°, respectively). Relative downward rotation increased in the 14° condition at SP and MP (mean differences, 2.4° and 2.1°, respectively). Scapulothoracic differences were more pronounced in those with high SCI. No glenohumeral rotations were significantly different between the conditions. Scapulothoracic kinematics and spinal curvature differences during propulsion may be associated with the position of other body segments or postural stability. Because no differences were observed at the glenohumeral joint, the risk of subacromial impingement may not be affected by this seat angle change. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

First detection of Onchocerca lupi infection in dogs in southern Spain.

PubMed

Miró, Guadalupe; Montoya, Ana; Checa, Rocío; Gálvez, Rosa; Mínguez, Juan José; Marino, Valentina; Otranto, Domenico

2016-05-18

Onchocerca lupi causes ocular pathology of varying severity in dogs from south-western United States, western Europe and northern Asia. This filarioid has also been recognized as a zoonotic agent in Tunisia, Turkey, Iran and the USA, though the information about the biology and epidemiology of this infection is largely unknown. In Europe, O. lupi has been reported in dogs from Germany, Greece, Hungary, Portugal and Romania and in a cat from Portugal. The present study was designed to establish the occurrence of O. lupi in dogs in southwestern Spain. In the present study a total of 104 dogs of different breed, sex, and age living in a shelter in Huelva (SW Spain) were examined. Skin snip samples were collected using a disposable scalpel in the forehead and inter-scapular regions and stored as aliquots in saline solution (0.5 ml) before light microscopy observation of individual sediments (20 μl) and molecular examination. Of the 104 dogs examined, 5 (4.8 %) were skin snip-positive for O. lupi: two by microscopy and three by PCR. One of the O. lupi infected dogs showed neurological signs but ocular ultrasonography and/or MRI detected no abnormalities. This first report of O. lupi infection in dogs in southern Spain expands the range of geographical distribution of this parasite and sounds an alarm bell for practitioners and physicians working in that area.

Shoulder strength imbalances as injury risk in handball.

PubMed

Edouard, P; Degache, F; Oullion, R; Plessis, J-Y; Gleizes-Cervera, S; Calmels, P

2013-07-01

This study was conducted to analyze whether internal (IR) and external (ER) rotator shoulder muscles weakness and/or imbalance collected through a preseason assessment could be predictors of subsequent shoulder injury during a season in handball players. In preseason, 16 female elite handball players (HPG) and 14 healthy female nonathletes (CG) underwent isokinetic IR and ER strength test with use of a Con-Trex® dynamometer in a seated position with 45° shoulder abduction in scapular plane, at 60, 120 and 240°/s in concentric and at 60°/s in eccentric, for both sides. An imbalanced muscular strength profile was determined using -statistically selected cut-offs from CG values. For HPG, all newly incurred shoulder injuries were reported during the season. There were significant differences between HPG and CG only for dominant eccentric IR strength, ER/IR ratio at 240°/s and for IRecc/ERcon ratio. In HPG, IR and ER strength was higher, and ER/IR ratios lower for dominant than for nondominant side. The relative risk was 2.57 (95%CI: 1.60-3.54; P<0.05) if handball players had an imbalanced muscular strength profile. In youth female handball players IR and ER muscle strength increases on the dominant side without ER/IR imbalances; and higher injury risk was associated with imbalanced muscular strength profile. © Georg Thieme Verlag KG Stuttgart · New York.

Quantification of the Exposure of the Glenohumeral Joint from the Minimally Invasive to More Invasive Subscapularis Approach to the Anterior Shoulder: a Cadaveric Study

DTIC Science & Technology

2014-06-01

dx.doi.org/10.3928/01477447 20101221 14 8. DeFranco MJ, Higgins LD, Warner JJP. Subscapularis management in open shoulder surgery. J Am Acad Orthop Surg...scapular muscle in Latarjet intervention. Rev Chir Orthop Reparatrice Appar Mot 1998;84:217 23. 28. Rokito AS, Gallagher Birdzell M, Cuomo F, Di Paola MJ

Reliability of levator scapulae index in subjects with and without scapular downward rotation syndrome.

PubMed

Lee, Ji-Hyun; Cynn, Heon-Seock; Choi, Woo-Jeong; Jeong, Hyo-Jung; Yoon, Tae-Lim

2016-05-01

The objective of this study was to introduce levator scapulae (LS) measurement using a caliper and the levator scapulae index (LSI) and to investigate intra- and interrater reliability of the LSI in subjects with and without scapular downward rotation syndrome (SDRS). Two raters measured LS length twice in 38 subjects (19 with SDRS and 19 without SDRS). For reliability testing, intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. Intrarater reliability analysis resulted with ICCs ranging from 0.94 to 0.98 in subjects with SDRS and 0.96 to 0.98 in subjects without SDRS. These results represented that intrarater reliability in both groups were excellent for measuring LS length with the LSI. Interrater reliability was good (ICC: 0.82) in subjects with SDRS; however, interrater reliability was moderate (ICC: 0.75) in subjects without SDRS. Additionally, SEM and MDC were 0.13% and 0.36% in subjects with SDRS and 0.35% and 0.97% in subjects without SDRS. In subjects with SDRS, low dispersion of the measurement errors and MDC were shown. This study suggested that the LSI is a reliable method to measure LS length and is more reliable for subjects with SDRS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Association between kyphosis and subacromial impingement syndrome: LOHAS study.

PubMed

Otoshi, Kenichi; Takegami, Misa; Sekiguchi, Miho; Onishi, Yoshihiro; Yamazaki, Shin; Otani, Koji; Shishido, Hiroaki; Kikuchi, Shinichi; Konno, Shinichi

2014-12-01

Kyphosis is a cause of scapular dyskinesis, which can induce various shoulder disorders, including subacromial impingement syndrome (SIS). This study aimed to clarify the impact of kyphosis on SIS with use of cross-sectional data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). The study enrolled 2144 participants who were older than 40 years and participated in health checkups in 2010. Kyphosis was assessed by the wall-occiput test (WOT) for thoracic kyphosis and the rib-pelvic distance test (RPDT) for lumbar kyphosis. The associations between kyphosis, SIS, and reduction in shoulder elevation (RSE) were investigated. Age- and gender-adjusted logistic regression analysis demonstrated significant association between SIS and WOT (odds ratio, 1.65; 95% confidence interval, 1.02, 2.64; P < .05), whereas there was no significant association between SIS and RPDT. Multivariable logistic regression analysis demonstrated no significant association between SIS and both WOT and RPDT, whereas there was significant association between SIS and RSE. RSE plays a key role in the development of SIS, and thoracic kyphosis might influence the development of SIS indirectly by reducing shoulder elevation induced by the restriction of the thoracic spine extension and scapular dyskinesis. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Versatility of Subscapular Chimeric Free Flaps in the Secondary Reconstruction of Composite Posttraumatic Defects of the Upper Face

PubMed Central

Stalder, Mark Winston; Wise, Matthew Whitten; Dupin, Charles L.; St Hilaire, Hugo

2014-01-01

High energy injuries to the upper face present challenging reconstructive problems. In some cases, initial reconstructive efforts result in unfavorable outcomes that require secondary intervention. Chimeric free flaps based on the subscapular system offer the tissue components and volume needed for these complex reconstructions. This is a series of five patients who underwent secondary reconstruction of the middle and upper face following traumatic injury. Mechanism of injury, prior attempts at reconstruction, and characteristics of the tissue defects and the flaps used in their reconstruction are described. Two patients were female and three were male. Three injuries resulted from gunshot wounds, and two from motor vehicle accidents. All patients had multiple prior failed attempts at reconstruction using local/regional tissue. Defects included symptomatic oronasal or oro-orbital fistulas, enophthalmos, and forehead contour deformities. Two of the flaps used included scapular bone and latissimus muscular components, and three included scapular bone and thoracodorsal artery perforator-based skin paddle components. All free tissue transfers were successful, and no patients suffered significant complications. Chimeric free flaps based on the subscapular system offer a valuable secondary strategy for reconstruction of composite defects of the upper face when other options have been exhausted through previous efforts. PMID:25709752

Effect of the inoculation site of bovine purified protein derivative (PPD) on the skin fold thickness increase in cattle from officially tuberculosis free and tuberculosis-infected herds.

PubMed

Casal, Carmen; Alvarez, Julio; Bezos, Javier; Quick, Harrison; Díez-Guerrier, Alberto; Romero, Beatriz; Saez, Jose L; Liandris, Emmanouil; Navarro, Alejandro; Perez, Andrés; Domínguez, Lucas; de Juan, Lucía

2015-09-01

The official technique for diagnosis of bovine tuberculosis (bTB) worldwide is the tuberculin skin test, based on the evaluation of the skin thickness increase after the intradermal inoculation of a purified protein derivative (PPD) in cattle. A number of studies performed on experimentally infected or sensitized cattle have suggested that the relative sensitivity of the cervical test (performed in the neck) may vary depending on the exact location in which the PPD is injected. However, quantitative evidence on the variation of the test accuracy associated to changes in the site of inoculation in naturally infected animals (the population in which performance of the test is most critical for disease eradication) is lacking. Here, the probability of obtaining a positive reaction (>2 or 4 millimeters and/or presence of local clinical signs) after multiple inoculations of bovine PPD in different cervical and scapular locations was assessed in animals from five bTB-infected herds (818 cattle receiving eight inoculations) using a hierarchical Bayesian logistic regression model and adjusting for the potential effect of age and sex. The effect of the inoculation site was also assessed qualitatively in animals from four officially tuberculosis free (OTF) herds (two inoculations in 210 animals and eight inoculations in 38 cattle). Although no differences in the qualitative outcome of the test were observed in cattle from OTF herds, a statistically important association between the test outcome and the inoculation site in animals from infected herds was observed, with higher probabilities of positive results when the test was performed in the neck anterior area. Our results suggest that test sensitivity may be maximized by considering the area of the neck in which the test is applied, although lack of effect of the inoculation site in the specificity of the test should be confirmed in a larger sample. Copyright © 2015 Elsevier B.V. All rights reserved.

Morphologic Variability of the Shoulder between the Populations of North American and East Asian

PubMed Central

Cabezas, Andres F.; Krebes, Kristi; Hussey, Michael M.; Santoni, Brandon G.; Kim, Hyuong Sik

2016-01-01

Background The aim of this study was to determine if there were significant differences in glenohumeral joint morphology between North American and East Asian populations that may influence sizing and selection of shoulder arthroplasty systems. Methods Computed tomography reconstructions of 92 North American and 58 East Asian patients were used to perform 3-dimensional measurements. The proximal humeral position was normalized in all patients by aligning it with the scapular plane utilizing anatomic landmarks. Measurements were performed on the humerus and scapula and included coronal and axial humeral head radius, humeral neck shaft and articular arc angles, glenoid height and width, and critical shoulder angle. Glenohumeral relationships were also measured and included lateral distance to the greater tuberosity and acromion, abduction lever arm, and acromial index. Parametric and nonparametric statistical analyses were used to compare population metrics. Results East Asian glenohumeral measurements were significantly smaller for all linear metrics (p < 0.05), with the exception of acromial length, which was greater than in the North American cohort (p < 0.001). The increase in acromial length affected all measurements involving the acromion including abduction lever arms. No difference was found between the neck shaft and articular angular measurements. Conclusions The East Asian population exhibited smaller shoulder morphometrics than their North American cohort, with the exception of an extended acromial overhang. The morphologic data can provide some additional factors to consider when choosing an optimal shoulder implant for the East Asian population, in addition to creating future designs that may better accommodate this population. PMID:27583111

Collagen-Proteoglycan Relationships in Epiphyseal Cartilage

PubMed Central

Eisenstein, Reuben; Larsson, Sven-Erik; Sorgente, Nino; Kuettner, Klaus E.

1973-01-01

Columnar and hypertrophic zones of calf scapular cartilage were studied before and after extraction with 3 M guanidinium chloride (GuCl) and digestion with enzymes which degrade various components of the extracellular matrix. Morphologic and chemical analysis suggests that there are at least two anatomic pools of proteoglycan in this tissue. One, which resides between collagen fibrils, is extractable with GuCl. Another appears attached to collagen by strong bonds and is apparently not extractable with GuCl. This type of collagen-proteoglycan relationship is possibly restricted to epiphyseal cartilage. The morphology of the lacuna is different in the columnar and hypertrophic zones. Proteoglycans in the distal hypertrophic zone are less resistant to GuCl extraction. ImagesFig 9Fig 10Fig 11Fig 1Fig 2Fig 3Fig 4Fig 5Fig 6Fig 7Fig 8 PMID:4357177

Measurements of three-dimensional glenoid erosion when planning the prosthetic replacement of osteoarthritic shoulders.

PubMed

Terrier, A; Ston, J; Larrea, X; Farron, A

2014-04-01

The three-dimensional (3D) correction of glenoid erosion is critical to the long-term success of total shoulder replacement (TSR). In order to characterise the 3D morphology of eroded glenoid surfaces, we looked for a set of morphological parameters useful for TSR planning. We defined a scapular coordinates system based on non-eroded bony landmarks. The maximum glenoid version was measured and specified in 3D by its orientation angle. Medialisation was considered relative to the spino-glenoid notch. We analysed regular CT scans of 19 normal (N) and 86 osteoarthritic (OA) scapulae. When the maximum version of OA shoulders was higher than 10°, the orientation was not only posterior, but extended in postero-superior (35%), postero-inferior (6%) and anterior sectors (4%). The medialisation of the glenoid was higher in OA than normal shoulders. The orientation angle of maximum version appeared as a critical parameter to specify the glenoid shape in 3D. It will be very useful in planning the best position for the glenoid in TSR.

Effects of augmented trunk stabilization with external compression support on shoulder and scapular muscle activity and maximum strength during isometric shoulder abduction.

PubMed

Jang, Hyun-jeong; Kim, Suhn-yeop; Oh, Duck-won

2015-04-01

The aim of the present study was to investigate the effects of augmented trunk stabilization with external compression support (ECS) on the electromyography (EMG) activity of shoulder and scapular muscles and shoulder abductor strength during isometric shoulder abduction. Twenty-six women volunteered for the study. Surface EMG was used to monitor the activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and middle deltoid (MD), and shoulder abductor strength was measured using a dynamometer during three experimental conditions: (1) no external support (condition-1), (2) pelvic support (condition-2), and (3) pelvic and thoracic supports (condition-3) in an active therapeutic movement device. EMG activities were significantly lower for UT and higher for MD during condition 3 than during condition 1 (p < 0.05). The MD/UT ratio was significantly higher during condition 3 than during conditions 1 and 2, and higher during condition 2 than during condition 1 (p < 0.05). Shoulder abductor strength was significantly higher during condition 3 than during condition 1 (p < 0.05). These findings suggest that augmented trunk stabilization with the ECS may be advantageous with regard to reducing the compensatory muscle effort of the UT during isometric shoulder abduction and increasing shoulder abductor strength. Copyright © 2014 Elsevier Ltd. All rights reserved.

Shoulder reconstruction after tumor resection by pedicled scapular crest graft.

PubMed

Amin, Sherif N; Ebeid, Walid A

2002-04-01

The current authors present and evaluate a technique for reconstructing proximal humeral defects that result after resection of malignant bone tumors. Sixteen patients were included in this study with an average followup of 3 years (range, 12-76 months). Twelve patients had intraarticular resections, two had extraarticular resections, and two had intercalary resections. Reconstruction was done at the lateral border of the scapula (based on the circumflex scapular vessels) that was osteotomized and mobilized to bridge the resultant defect. Shoulder arthrodesis was done in 14 patients and the shoulder was spared in the two patients who had intercalary resections. Function was evaluated according to the Musculoskeletal Tumor Society scoring system. The average time for union of the graft proximally and distally was 6 months after which the graft started to hypertrophy. The average functional score was 22.5 points (75%) with a minimum score of 18 points (60%) and a maximum score of 27 points (90%). Nonunion of the distal host-graft junction occurred in two patients; both patients required iliac crest bone grafting and both achieved clinical and radiographic union without additional intervention. In three patients, the proximal fixation became loose but had no effect on function. The authors conclude that this technique is inexpensive, effective, and a durable reconstructive option for proximal humeral defects that are less than 15 cm. It has a predictable functional outcome (60%-90%) that is comparable with other reconstructive options.

Architectural and biochemical adaptations in skeletal muscle and bone following rotator cuff injury in a rat model.

PubMed

Sato, Eugene J; Killian, Megan L; Choi, Anthony J; Lin, Evie; Choo, Alexander D; Rodriguez-Soto, Ana E; Lim, Chanteak T; Thomopoulos, Stavros; Galatz, Leesa M; Ward, Samuel R

2015-04-01

Injury to the rotator cuff can cause irreversible changes to the structure and function of the associated muscles and bones. The temporal progression and pathomechanisms associated with these adaptations are unclear. The purpose of this study was to investigate the time course of structural muscle and osseous changes in a rat model of a massive rotator cuff tear. Supraspinatus and infraspinatus muscle architecture and biochemistry and humeral and scapular morphological parameters were measured three days, eight weeks, and sixteen weeks after dual tenotomy with and without chemical paralysis via botulinum toxin A (BTX). Muscle mass and physiological cross-sectional area increased over time in the age-matched control animals, decreased over time in the tenotomy+BTX group, and remained nearly the same in the tenotomy-alone group. Tenotomy+BTX led to increased extracellular collagen in the muscle. Changes in scapular bone morphology were observed in both experimental groups, consistent with reductions in load transmission across the joint. These data suggest that tenotomy alone interferes with normal age-related muscle growth. The addition of chemical paralysis yielded profound structural changes to the muscle and bone, potentially leading to impaired muscle function, increased muscle stiffness, and decreased bone strength. Structural musculoskeletal changes occur after tendon injury, and these changes are severely exacerbated with the addition of neuromuscular compromise. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

An anthropometric model to estimate neonatal fat mass using air displacement plethysmography

PubMed Central

2012-01-01

Background Current validated neonatal body composition methods are limited/impractical for use outside of a clinical setting because they are labor intensive, time consuming, and require expensive equipment. The purpose of this study was to develop an anthropometric model to estimate neonatal fat mass (kg) using an air displacement plethysmography (PEA POD® Infant Body Composition System) as the criterion. Methods A total of 128 healthy term infants, 60 females and 68 males, from a multiethnic cohort were included in the analyses. Gender, race/ethnicity, gestational age, age (in days), anthropometric measurements of weight, length, abdominal circumference, skin-fold thicknesses (triceps, biceps, sub scapular, and thigh), and body composition by PEA POD® were collected within 1-3 days of birth. Backward stepwise linear regression was used to determine the model that best predicted neonatal fat mass. Results The statistical model that best predicted neonatal fat mass (kg) was: -0.012 -0.064*gender + 0.024*day of measurement post-delivery -0.150*weight (kg) + 0.055*weight (kg)2 + 0.046*ethnicity + 0.020*sum of three skin-fold thicknesses (triceps, sub scapular, and thigh); R2 = 0.81, MSE = 0.08 kg. Conclusions Our anthropometric model explained 81% of the variance in neonatal fat mass. Future studies with a greater variety of neonatal anthropometric measurements may provide equations that explain more of the variance. PMID:22436534

Humeral elevation reduces the dynamic control ratio of the shoulder muscles during internal rotation.

PubMed

Howard, William; Burgess, Jonathan; Vrhovnik, Borut; Stringer, Christian; Choy, Sherrie T; Marsden, Jonathan F; Gedikoglou, Ingrid A; Shum, Gary L

2017-04-01

To determine the differences in the dynamic control ratio of the glenohumeral joint rotators, during internal rotation at 20° and 60° of humeral elevation in the scapular plan. Dynamic control ratio (DCR) is defined as the ratio between eccentric action of the lateral rotators and the concentric action of the medial rotators. A cross-sectional laboratory study. Thirty asymptomatic participants (men n=14, women n=16, mean age=29.4±8.9years, BMI: 24.1±5.4) were tested. Peak torque generated by the concentric action of the MR and the eccentric action of the LR of the shoulder joint and the DCR were evaluated on the dominant arm using an isokinetic dynamometer at 20° and 60° of humeral elevation at a speed of 20°/s. There was a significant decrease in the DCR at 60° humeral elevation when compared to 20° humeral elevation (p<0.05). This decrease was due to the significant decrease in eccentric peak torques at 60° humeral elevation when compared to 20° (p<0.05). However, there was no significant difference in the concentric peak torques between 20° and 60° (p>0.05). The significant decrease in the DCR as a consequence of a decrease in the eccentric peak torque of the LR when the humerus is in a more elevated position suggests that the introduction of humeral elevation can be used as a progression for improving the eccentric action of the shoulder LR and subsequently the dynamic control of the shoulder. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The greater tuberosity angle: a new predictor for rotator cuff tear.

PubMed

Cunningham, Gregory; Nicodème-Paulin, Emilie; Smith, Margaret M; Holzer, Nicolas; Cass, Benjamin; Young, Allan A

2018-04-24

The implication of scapular morphology in rotator cuff tears has been extensively studied. However, the role of the greater tuberosity (GT) should be of equal importance. The aim of this study was to propose a new radiographic marker, the GT angle (GTA), which measures the position of the GT in relation to the center of rotation of the humeral head. The hypothesis was that a higher angle value would be associated with a higher likelihood in detecting a rotator cuff tear. During 1 year, patients were prospectively recruited from a single institution specialized shoulder clinic in 2 different groups. The patient group consisted of individuals with a degenerative rotator cuff tear involving at least the supraspinatus. The control group consisted of individuals with no rotator cuff pathology. Individuals in both groups with congenital, post-traumatic, or degenerative alterations of the proximal humerus were excluded. The GTA was measured on an anteroposterior shoulder x-ray image with the arm in neutral rotation by 3 observers at 2 different times. The study recruited 71 patients (33 patients, 38 controls). Mean GTA value was 72.5° (range, 67.6°-79.2°) in patients and 65.2° (range, 55.8°-70.5°) for controls (P <.001). A value above 70° resulted in 93-fold higher odds of detecting a rotator cuff tear (P <.001). Interobserver and intraobserver reliability were high. GT morphology is implicated in rotator cuff tears. The GTA is a reliable radiographic marker, with more than 70° being highly predictive in detecting such lesions. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Long thoracic neuropathy from athletic activity.

PubMed

Schultz, J S; Leonard, J A

1992-01-01

Four cases of long thoracic mononeuropathy associated with sports participation are presented. Each patient developed shoulder pain or dysfunction after an acute event or vigorous activity, and demonstrated scapular winging consistent with serratus anterior weakness. The diagnosis was confirmed with electromyography in each case. It is suggested that the athletic activity caused a stretch injury to the long thoracic nerve. Conservative management, consisting of range of motion exercises for the shoulder and strengthening of the serratus anterior muscle, resulted in a favorable outcome in all patients.

Cervical spondylotic amyotrophy.

PubMed

Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang

2011-03-01

Cervical spondylotic amyotrophy is characterized with weakness and wasting of upper limb muscles without sensory or lower limb involvement. Two different mechanisms have been proposed in the pathophysiology of cervical spondylotic amyotrophy. One is selective damage to the ventral root or the anterior horn, and the other is vascular insufficiency to the anterior horn cell. Cervical spondylotic amyotrophy is classified according to the most predominantly affected muscle groups as either proximal-type (scapular, deltoid, and biceps) or distal-type (triceps, forearm, and hand). Although cervical spondylotic amyotrophy always follows a self-limited course, it remains a great challenge for spine surgeons. Treatment of cervical spondylotic amyotrophy includes conservative and operative management. The methods of operative management for cervical spondylotic amyotrophy are still controversial. Anterior decompression and fusion or laminoplasty with or without foraminotomy is undertaken. Surgical outcomes of distal-type patients are inferior to those of proximal-type patients.

Exercise effects on fitness, lipids, glucose tolerance and insulin levels in young adults.

PubMed

Israel, R G; Davidson, P C; Albrink, M J; Krall, J M

1981-07-01

The effect of 3 different physical training programs on cardiorespiratory (cr) fitness, fasting plasma lipids, glucose and insulin levels, and scapular skinfold thickness was assessed in 64 healthy college men. Training sessions were held 4 times a week for 5 weeks. The cr fitness improved significantly and skinfold thickness decreased following the aerobic, the pulse workout (interval training), and the anaerobic training compared to the control group. Skinfold thickness, plasma insulin, and triglyceride concentrations were significantly intercorrelated before and after training. The exercise programs had no significant effect on plasma cholesterol, triglycerides, phospholipids, glucose tolerance, or insulin levels. Change in adipose mass was thus dissociated from change in plasma insulin and triglyceride concentrations. It was concluded that in young men plasma triglycerides, the lipid component mostly readily reduced by exercise, were too low to be reduced further by a physical training program.

Evaluation of two cooling systems under a firefighter coverall.

PubMed

Teunissen, Lennart P J; Wang, Li-Chu; Chou, Shih-Nung; Huang, Chin-Hsien; Jou, Gwo-Tsuen; Daanen, Hein A M

2014-11-01

Firemen often suffer from heat strain. This study investigated two chest cooling systems for use under a firefighting suit. In nine male subjects, a vest with water soaked cooling pads and a vest with water perfused tubes were compared to a control condition. Subjects performed 30 min walking and 10 min recovery in hot conditions, while physiological and perceptual parameters were measured. No differences were observed in heart rate and rectal temperature, but scapular skin temperature and fluid loss were lower using the perfused vest. Thermal sensation was cooler for the perfused vest than for the other conditions, while the cool pad vest felt initially cooler than control. However, comfort and RPE scores were similar. We conclude that the cooling effect of both tested systems, mainly providing a (temporally) cooler thermal sensation, was limited and did not meet the expectations. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Origin of the unique morphology of the shoulder girdle in turtles

PubMed Central

Nagashima, Hiroshi; Hirasawa, Tatsuya; Sugahara, Fumiaki; Takechi, Masaki; Usuda, Ryo; Sato, Noboru; Kuratani, Shigeru

2013-01-01

The shoulder girdle of turtles has a triradiate morphology. Although its dorsal process represents the scapular blade, the skeletal identities of the two ventral processes remain uncertain. To elucidate the question, developmental patterns of the girdles were compared between Chinese soft-shelled turtles, chickens, and mice. Despite the morphological diversity of adults, the initial primordia of the shoulder girdles showed similar morphological patterns. The ventral two processes developed from the anlagen comparable to those of the acromion and the coracoid in other amniotes. The developmental pattern of the acromion is very similar among embryos, whereas that of the coracoid in mammals differs from that in non-mammals, implying that coracoids are not homologous between non-mammals and mammals. Therefore, amniotes have retained the ancestral pattern of the girdle anlage, and the shoulder girdle of turtles has been achieved through a transformation of the pattern in the late ontogenic period. PMID:24117338

Fostering interprofessional teamwork in an academic medical center: Near-peer education for students during gross medical anatomy.

PubMed

Shields, Richard K; Pizzimenti, Marc A; Dudley-Javoroski, Shauna; Schwinn, Debra A

2015-01-01

The purpose of this report is to describe student satisfaction with a near-peer interprofessional education (IPE) session for physical therapy and medical students. Ten senior physical therapy students worked in peer-groups to develop a musculoskeletal anatomy demonstration for first-semester medical students. Together with their classmates, they demonstrated observation, palpation, and musculoskeletal assessment of the shoulder and scapular-thoracic articulation to medical student dissection groups in the Gross Anatomy laboratory. The medical students were encouraged to consider the synergistic function of shoulder structures and the potential impact of a selected pathology: rotator cuff injury. The session provided the medical students with an opportunity to integrate their new anatomical knowledge into a framework for clinical musculoskeletal evaluation. The experience offered senior physical therapy students an opportunity to work in teams with their peers, internalize and adapt to constructive feedback, and seek common ground with members of another profession. Both student groups reported a high degree of satisfaction with the sessions and expressed a desire for further interaction. These positive perceptions by student stakeholders have prompted us to consider additional IPE exchanges for the anatomy course in the upcoming school year. Given the positive outcome of this descriptive study, we now plan to systematically test whether near-peer IPE interactions can enhance the degree that students learn key anatomical concepts. © 2014 American Association of Anatomists.

Measurement of strain and tensile force of the supraspinatus tendon under conditions that simulates low angle isometric elevation of the gleno-humeral joint: Influence of adduction torque and joint positioning.

PubMed

Miyamoto, Hiroki; Aoki, Mitsuhiro; Hidaka, Egi; Fujimiya, Mineko; Uchiyama, Eiichi

2017-12-01

Recently, supraspinatus muscle exercise has been reported to treat rotator cuff disease and to recover shoulder function. However, there have been no report on the direct measurement of strain on the supraspinatus tendon during simulated isometric gleno-humeral joint elevation. Ten fresh-frozen shoulder specimens with the rotator cuff complex left intact were used as experimental models. Isometric gleno-humeral joint elevation in a sitting position was reproduced with low angle of step-by-step elevation in the scapular plane and strain was measured on the surface layer of the supraspinatus tendon. In isometric conditions, applied tensile force of the supraspinatus tendon increased significantly with increases in adduction torque on the gleno-humeral joint. Significant increases in the strain on the layer were observed by increase in adduction torque, which were recorded in isometric elevation at -10° and 0°, but little increase in the strain was observed at 10° or greater gleno-humeral elevation. Increased strain on the surface layer of the supraspinatus tendon was observed during isometric gleno-humeral elevation from -10 to 0°. These findings demonstrate a potential risk of inducing overstretching of the supraspinatus tendon during supraspinatus muscle exercise. Copyright © 2017 Elsevier Ltd. All rights reserved.

Negative Influence of Motor Impairments on Upper Limb Movement Patterns in Children with Unilateral Cerebral Palsy. A Statistical Parametric Mapping Study

PubMed Central

Simon-Martinez, Cristina; Jaspers, Ellen; Mailleux, Lisa; Desloovere, Kaat; Vanrenterghem, Jos; Ortibus, Els; Molenaers, Guy; Feys, Hilde; Klingels, Katrijn

2017-01-01

Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation programs. Although UL-3DMA has been shown to be a useful tool to assess movement patterns, it results in a multitude of data, challenging the clinical interpretation and consequently its implementation. UL-3DMA reports are often reduced to summary metrics, such as average or peak values per joint. However, these metrics do not take into account the continuous nature of the data or the interdependency between UL joints, and do not provide phase-specific information of the movement pattern. Moreover, summary metrics may not be sensitive enough to estimate the impact of motor impairments. Recently, Statistical Parametric Mapping (SPM) was proposed to overcome these problems. We collected UL-3DMA of 60 children with uCP and 60 typically developing children during eight functional tasks and evaluated the impact of spasticity and muscle weakness on UL movement patterns. SPM vector field analysis was used to analyze movement patterns at the level of five joints (wrist, elbow, shoulder, scapula, and trunk). Children with uCP showed deviant movement patterns in all joints during a large percentage of the movement cycle. Spasticity and muscle weakness negatively impacted on UL movement patterns during all tasks, which resulted in increased wrist flexion, elbow pronation and flexion, increased shoulder external rotation, decreased shoulder elevation with a preference for movement in the frontal plane and increased trunk internal rotation. Scapular position was altered during movement initiation, although scapular movements were not affected by muscle weakness or spasticity. In conclusion, we identified pathological movement patterns in children with uCP and additionally mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. Last, we also identified a subset of the most relevant tasks for studying UL movements in children with uCP, which will facilitate the interpretation of UL-3DMA data and undoubtedly contribute to its clinical implementation. PMID:29051729

Performance Demands in Softball Pitching: A Comprehensive Muscle Fatigue Study.

PubMed

Corben, Jeffrey S; Cerrone, Sara A; Soviero, Julie E; Kwiecien, Susan Y; Nicholas, Stephen J; McHugh, Malachy P

2015-08-01

Monitoring pitch count is standard practice in minor league baseball but not in softball because of the perception that fast-pitch softball pitching is a less stressful motion. To examine muscle fatigue after fast-pitch softball performances to provide an assessment of performance demand. Descriptive laboratory study. Bilateral strength measurements (handheld dynamometer) were made on 19 female softball pitchers (mean age [±SD], 15.2 ± 1.2 years) before and after pitching a game (mean number of pitches, 99 ± 21; mean innings pitched, 5 ± 1). A total of 20 tests were performed on the dominant and nondominant sides: forearm (grip, wrist flexion/extension, pronation/supination, elbow flexion/extension), shoulder (flexion, abduction/adduction, external/internal rotation, empty can test), scapula (middle/lower trapezius, rhomboid), and hip (hip flexion/extension, abduction/adduction). Fatigue (percentage strength loss) was categorized based on bilateral versus unilateral presentation using paired t tests: bilateral symmetric (significant on dominant and nondominant and not different between sides), bilateral asymmetric (significant on dominant and nondominant but significantly greater on dominant), unilateral asymmetric (significant on dominant only and significantly greater than nondominant), or unilateral equivocal (significant on dominant only but not different from nondominant). Bilateral symmetric fatigue was evident for all hip (dominant, 19.3%; nondominant, 15.2%) and scapular tests (dominant, 19.2%; nondominant, 19.3%). In general, shoulder tests exhibited bilateral asymmetric fatigue (dominant, 16.9%; nondominant, 11.6%). Forearm tests were more variable, with bilateral symmetric fatigue in the elbow flexors (dominant, 22.5%; nondominant, 19.2%), and wrist flexors (dominant, 21.6%; nondominant, 19.0%), bilateral asymmetric fatigue in the supinators (dominant, 21.8%; nondominant, 15.5%), unilateral asymmetric fatigue in the elbow extensors (dominant, 22.1%; nondominant, 11.3%), and unilateral equivocal fatigue in the pronators (dominant, 18.8%; nondominant, 15.2%) and grip (dominant, 11.4%; nondominant, 6.6%). The mean (±SD) pitch velocity was 49 ± 4 mph, with a small loss of velocity from the first to last inning pitched (3.4% ± 5.0%, P < .01). Fast-pitch softball pitching resulted in profound bilateral fatigue in the hip and scapular muscles, with more selective fatigue in the shoulder and arm muscles. These findings emphasize the importance of strength in the proximal musculature to provide a stable platform for the arm to propel the ball. © 2015 The Author(s).

Dominant vs. non-dominant shoulder morphology in volleyball players and associations with shoulder pain and spike speed.

PubMed

Challoumas, Dimitrios; Artemiou, Andreas; Dimitrakakis, Georgios

2017-01-01

The aims of our study were to compare the dominant (DOM) and non-dominant (NDOM) shoulders of high-level volleyball athletes and identify possible associations of shoulder adaptations with spike speed (SS) and shoulder pathology. A total of 22 male volleyball players from two teams participating in the first division of the Cypriot championship underwent clinical shoulder tests and simple measurements around their shoulder girdle joints bilaterally. SS was measured with the use of a sports speed radar. Compared with the NDOM side, the DOM scapula was more lateralised, the DOM dorsal capsule demonstrated greater laxity, the DOM dorsal muscles stretching ability was compromised, and the DOM pectoralis muscle was more lengthened. Players with present or past DOM shoulder pain demonstrated greater laxity in their DOM dorsal capsule, tightening of their DOM inferior capsule, and lower SS compared with those without shoulder pain. Dorsal capsule measurements bilaterally were significant predictors of SS. None of the shoulder measurements was associated with team roles or infraspinatus atrophy, while scapular lateralisation was more pronounced with increasing years of experience, and scapular antetilting was greater with increasing age. Adaptations of the DOM shoulder may be linked to pathology and performance. We describe simple shoulder measurements that may have the potential to predict chronic shoulder injury and become part of injury prevention programmes. Detailed biomechanical and large prospective studies are warranted to assess the validity of our findings and reach more definitive conclusions.

Scapula fractures: interobserver reliability of classification and treatment.

PubMed

Neuhaus, Valentin; Bot, Arjan G J; Guitton, Thierry G; Ring, David C; Abdel-Ghany, Mahmoud I; Abrams, Jeffrey; Abzug, Joshua M; Adolfsson, Lars E; Balfour, George W; Bamberger, H Brent; Barquet, Antonio; Baskies, Michael; Batson, W Arnold; Baxamusa, Taizoon; Bayne, Grant J; Begue, Thierry; Behrman, Michael; Beingessner, Daphne; Biert, Jan; Bishop, Julius; Alves, Mateus Borges Oliveira; Boyer, Martin; Brilej, Drago; Brink, Peter R G; Brunton, Lance M; Buckley, Richard; Cagnone, Juan Carlos; Calfee, Ryan P; Campinhos, Luiz Augusto B; Cassidy, Charles; Catalano, Louis; Chivers, Karel; Choudhari, Pradeep; Cimerman, Matej; Conflitti, Joseph M; Costanzo, Ralph M; Crist, Brett D; Cross, Brian J; Dantuluri, Phani; Darowish, Michael; de Bedout, Ramon; DeCoster, Thomas; Dennison, David G; DeNoble, Peter H; DeSilva, Gregory; Dienstknecht, Thomas; Duncan, Scott F; Duralde, Xavier A; Durchholz, Holger; Egol, Kenneth; Ekholm, Carl; Elias, Nelson; Erickson, John M; Esparza, J Daniel Espinosa; Fernandes, C H; Fischer, Thomas J; Fischmeister, Martin; Forigua Jaime, E; Getz, Charles L; Gilbert, Richard S; Giordano, Vincenzo; Glaser, David L; Gosens, Taco; Grafe, Michael W; Filho, Jose Eduardo Grandi Ribeiro; Gray, Robert R L; Gulotta, Lawrence V; Gummerson, Nigel William; Hammerberg, Eric Mark; Harvey, Edward; Haverlag, R; Henry, Patrick D G; Hobby, Jonathan L; Hofmeister, Eric P; Hughes, Thomas; Itamura, John; Jebson, Peter; Jenkinson, Richard; Jeray, Kyle; Jones, Christopher M; Jones, Jedediah; Jubel, Axel; Kaar, Scott G; Kabir, K; Kaplan, F Thomas D; Kennedy, Stephen A; Kessler, Michael W; Kimball, Hervey L; Kloen, Peter; Klostermann, Cyrus; Kohut, Georges; Kraan, G A; Kristan, Anze; Loebenberg, Mark I; Malone, Kevin J; Marsh, L; Martineau, Paul A; McAuliffe, John; McGraw, Iain; Mehta, Samir; Merchant, Milind; Metzger, Charles; Meylaerts, S A; Miller, Anna N; Wolf, Jennifer Moriatis; Murachovsky, Joel; Murthi, Anand; Nancollas, Michael; Nolan, Betsy M; Omara, Timothy; Omid, Reza; Ortiz, Jose A; Overbeck, Joachim P; Castillo, Alberto Pérez; Pesantez, Rodrigo; Polatsch, Daniel; Porcellini, G; Prayson, Michael; Quell, M; Ragsdell, Matthew M; Reid, James G; Reuver, J M; Richard, Marc J; Richardson, Martin; Rizzo, Marco; Rowinski, Sergio; Rubio, Jorge; Guerrero, Carlos G Sánchez; Satora, Wojciech; Schandelmaier, Peter; Scheer, Johan H; Schmidt, Andrew; Schubkegel, Todd A; Schulte, Leah M; Schumer, Evan D; Sears, Benjamin W; Shafritz, Adam B; Shortt, Nicholas L; Siff, Todd; Silva, Dario Mejia; Smith, Raymond Malcolm; Spruijt, Sander; Stein, Jason A; Pemovska, Emilija Stojkovska; Streubel, Philipp N; Swigart, Carrie; Swiontkowski, Marc; Thomas, George; Tolo, Eric T; Turina, Matthias; Tyllianakis, Minos; van den Bekerom, Michel P J; van der Heide, Huub; van de Sande, M A J; van Eerten, P V; Verbeek, Diederik O F; Hoffmann, David Victoria; Vochteloo, A J H; Wagenmakers, Robert; Wall, Christopher J; Wallensten, Richard; Wascher, Daniel C; Weiss, Lawrence; Wiater, J Michael; Wills, Brian P D; Wint, Jeffrey; Wright, Thomas; Young, Jason P; Zalavras, Charalampos; Zura, Robert D; Zyto, Karol

2014-03-01

There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. Web-based reliability study. Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. One hundred three orthopaedic surgeons evaluated 35 movies of three-dimensional computerized tomography reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. Fleiss kappa (κ) was used to assess the reliability of agreement between the surgeons. The overall agreement on the OTA/AO classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) and for the 9 groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intraarticular extension of the fracture (Fossa (F), κ = 0.79) was substantial and the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53); however, PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA. The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions.

Evaluation of transradial body-powered prostheses using a robotic simulator.

PubMed

Ayub, Rafi; Villarreal, Dario; Gregg, Robert D; Gao, Fan

2017-04-01

Transradial body-powered prostheses are extensively used by upper-limb amputees. This prosthesis requires large muscle forces and great concentration by the patient, often leading to discomfort, muscle fatigue, and skin breakdown, limiting the capacity of the amputee to conduct daily activities. Since body-powered prostheses are commonplace, understanding their optimal operation to mitigate these drawbacks would be clinically meaningful. To find the optimal operation of the prosthesis where the activation force is minimized and the grip force is maximized. Experimental design. A computer-controlled robotic amputee simulator capable of rapidly testing multiple elbow, shoulder, and scapular combinations of the residual human arm was constructed. It was fitted with a transradial prosthesis and used to systematically test multiple configurations. We found that increased shoulder flexion, scapular abduction, elbow extension, and the placement of the ring harness near the vertebra C7 correlate with higher gripper operation efficiency, defined as the ratio of grip force to cable tension. We conclude that force transmission efficiency is closely related to body posture configuration. These results could help guide practitioners in clinical practice as well as motivate future studies in optimizing the operation of a body-powered prosthesis. Clinical relevance The results from this study suggest that clinicians ought to place the ring harness inferior and to the sound side of the vertebra prominens in order to maximize grip efficiency. The results will also help clinicians better instruct patients in body posture during prosthesis operation to minimize strain.

Evidence-based guideline summary: Evaluation, diagnosis, and management of facioscapulohumeral muscular dystrophy

PubMed Central

Tawil, Rabi; Kissel, John T.; Heatwole, Chad; Pandya, Shree; Gronseth, Gary; Benatar, Michael

2015-01-01

Objective: To develop recommendations for the evaluation, diagnosis, prognostication, and treatment of facioscapulohumeral muscular dystrophy (FSHD) from a systematic review and analysis of the evidence. Methods: Relevant articles were analyzed in accordance with the American Academy of Neurology classification of evidence schemes for diagnostic, prognostic, and treatment studies. Recommendations were linked to the strength of the evidence and other factors. Results and recommendations: Available genetic testing for FSHD type 1 is highly sensitive and specific. Although respiratory insufficiency occurs rarely in FSHD, patients with severe FSHD should have routine pulmonary function testing. Routine cardiac screening is not necessary in patients with FSHD without cardiac symptoms. Symptomatic retinal vascular disease is very rare in FSHD. Exudative retinopathy, however, is potentially preventable, and patients with large deletions should be screened through dilated indirect ophthalmoscopy. The prevalence of clinically relevant hearing loss is not clear. In clinical practice, patients with childhood-onset FSHD may have significant hearing loss. Because undetected hearing loss may impair language development, screening through audiometry is recommended for such patients. Musculoskeletal pain is common in FSHD and treating physicians should routinely inquire about pain. There is at present no effective pharmacologic intervention in FSHD. Available studies suggest that scapular fixation is safe and effective. Surgical scapular fixation might be cautiously offered to selected patients. Aerobic exercise in FSHD appears to be safe and potentially beneficial. On the basis of the evidence, patients with FSHD might be encouraged to engage in low-intensity aerobic exercises. PMID:26215877

Molt chronology of northern pintails in California

USGS Publications Warehouse

Miller, M.R.

1986-01-01

Intensity and chronology of molt in 10 feather groups (head, neck, breast, belly, back, rump, side, scapular, tertial, and tail) were measured using percentages of developing feathers (pinfeathers) converted to molt scores (0-100) in samples plucked monthly from northern pintails (Anas acuta) collected by shooting from August through March 1980-82 in the Sacramento Valley, California. Data to supplement sample size of immatures were obtained from October 1982 through January 1983. Molt scores of the prealternate molt peaked (30-40% pinfeathers) in immature and adult females and adult males in October when nearly all feather groups were molting. The prealternate molt in immature males did not peak until November. Adult males nearly completed this molt by December; no new feather growth occurred after January. Immature males were still growing new neck, side, rump, scapular, and tertial feathers in December. Molt scores of the prebasic molt among adult and immature females peaked (30-40% new growth) in February in both years. The prealternate molt of breast and belly feathers (both sexes) peaked earlier (Sep) than molt of most other feathers (Oct). Increased molt scores in peak months were a function of a disproportionate increase of molt activity within each feather group and the number of feather groups with molt. Molt scores of the prebasic molt in adult females were less during December and January of the dry (1980-81) than the wet (1981-82) winter. Restriction or delay of molt may conserve energy or other nutrients during poor habitat conditions.

Gender differences between muscle activation and onset timing of the four subdivisions of trapezius during humerothoracic elevation.

PubMed

Szucs, Kimberly A; Borstad, John D

2013-12-01

The aim of this study was to provide a description of gender differences of the normal muscle activation patterns of the four subdivisions of the trapezius (clavicular, descending, transverse, ascending) during arm elevation. Surface EMG was collected from these four subdivisions from twenty-two healthy subjects (12 females, 10 males) during arm elevation in the scapular plane. Percent activation (RMS) of each subdivision was compared between genders across arm angles and elevation phase and onset time of each subdivision was compared between genders. Females demonstrated significantly higher % activation levels for each subdivision (p<.05), except transverse trapezius (p=.36). A statistically significant difference for onset time was observed between gender for the descending trapezius, with a slower onset time for females (p<.05). Findings from this study support the theory that subdivisions within descending trapezius are preferentially activated and demonstrate that gender differences are present within the fourth subdivision of trapezius. As subjects were without shoulder pathology, the observed gender differences may be explained by normal motor control variations. However, as coordinated activation of trapezius is required for normal shoulder motion, it is recommended to include all four subdivisions of trapezius and address gender differences in future studies. Copyright © 2013 Elsevier B.V. All rights reserved.

Reliability of Performance-Based Clinical Measurements to Assess Shoulder Girdle Kinematics and Positioning: Systematic Review.

PubMed

D'hondt, Norman E; Kiers, Henri; Pool, Jan J M; Hacquebord, Sijmen T; Terwee, Caroline B; Veeger, Dirkjan H E J

2017-01-01

Deviant shoulder girdle movement is suggested as an eminent factor in the etiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies. The purpose of this study was to evaluate the reliability, measurement error, and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain. The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception to August 2015. Articles published in Dutch, English, or German were included if they involved the evaluation of at least one of the measurement properties of interest. Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating scale of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, extracted data, and assessed the adequacy of the measurement properties. Forty studies comprising more than 30 clinical tests were included. Actual reported measurements of the tests were categorized into: (1) positional measurement methods, (2) measurement methods to determine dynamic characteristics, and (3) tests to diagnose impairments of shoulder girdle function. Best evidence synthesis of the tests was performed per measurement for each measurement property. All studies had significant limitations, including incongruence between test description and actual reported measurements and a lack of reporting on minimal important change. In general, the methodological quality of the selected studies was fair to poor. High-quality evidence indicates that measurements obtained with the Modified Scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies, diversity in description, performance, and interpretation of similar tests was present, and different criteria were used to establish similar diagnoses, mostly without taking into account a clinically meaningful context. Consequently, these tests lack face validity, which hampers their clinical use. Further research on validity and how to integrate a clinically meaningful context of movement into clinical tests is warranted. © 2017 American Physical Therapy Association

The effects of plane and arc of elevation on electromyography of shoulder musculature in patients with rotator cuff tears.

PubMed

Alenabi, Talia; Dal Maso, Fabien; Tétreault, Patrice; Begon, Mickaël

2016-02-01

Arm elevations in different planes are commonly assessed in clinics and are included in rehabilitation protocols for patients with rotator cuff pathology. The aim of this study was to quantify the effect of plane and angle of elevation on shoulder muscles activity in patients with symptomatic rotator cuff tear to be used for rehabilitation purposes. Eight symptomatic patients with rotator cuff tears were assessed by using EMG (11 surface and 2 fine wire electrodes) synchronized with a motion analysis. The subjects completed five elevations in full can position (arm externally rotated and thumb up) in frontal, scapular and sagittal planes. Muscle activity in three elevation arcs of 20° (from 0° to 60°) was presented as the percentage of mean activity. Data were analyzed by mixed linear models (α=0.003), and Tuckey Post-hoc comparisons for significant effects (α=0.05). The effect of plane was significant for supraspinatus, middle trapezius, anterior, middle, and posterior deltoid, triceps, and pectoralis major (P<0.001). Supraspinatus was more active during abduction than scaption and flexion (P<0.05), and its activity did not increase significantly after 40° of elevation (P>0.05). Infraspinatus had similar activity pattern in the three planes of elevation (P>0.003) with increasing trend in accordance with the elevation angle. In any rehabilitation protocol, if less activity of supraspinatus is desired, active arm elevation should be directed toward flexion and scaption and postponed abduction to prevent high level of activity in this muscle. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Stereovideographic evaluation of the postural geometry of healthy and scoliotic patients].

PubMed

De la Huerta, F; Leroux, M A; Zabjek, K F; Coillard, C; Rivard, C H

1998-01-01

Idiopathic scoliosis principally characterised by a deformation of the vertebral column can also be associated to postural abnormalities. The validity and reliability of current quantitative postural evaluations has not been thoroughly documented, frequently limited by a two dimensional view of the patient, and do not include the whole posture of the patient. The purpose of this study is to 1) quantify within and between-session reliability of a stereovideographic Postural Geometry (PG) evaluation and 2) to investigate the sensitivity of this technique for the postural evaluation of scoliosis patients. The PG of 14 control subjects and 9 untreated scoliosis patients were evaluated with 5 repeat trials, on two occasions. Postural geometry parameters that describe the position and orientation of the pelvis, trunk, scapular girdle and head were calculated based on the 3-dimensional co-ordinates of anatomical landmarks. The mean between and within-session variability across all parameters were 12.5 mm, 2.8 degrees and 5.4 mm and 1.4 degrees respectively. The patient group was heterogeneous with some noted pathological characteristics. This global stereovideographic postural geometry evaluation appears to demonstrate sufficient reliability and sensitivity to follow-up on the posture of scoliosis patients.

The biomechanical demands of manual scaling on the shoulders & neck of dental hygienists.

PubMed

La Delfa, Nicholas J; Grondin, Diane E; Cox, Jocelyn; Potvin, Jim R; Howarth, Samuel J

2017-01-01

The purpose of this study was to evaluate the postural and muscular demands placed on the shoulders and neck of dental hygienists when performing a simulated manual scaling task. Nineteen healthy female dental hygienists performed 30-min of simulated manual scaling on a manikin head in a laboratory setting. Surface electromyography was used to monitor muscle activity from several neck and shoulder muscles, and neck and arm elevation kinematics were evaluated using motion capture. The simulated scaling task resulted in a large range of neck and arm elevation angles and excessive low-level muscular demands in the neck extensor and scapular stabilising muscles. The physical demands varied depending on the working position of the hygienists relative to the manikin head. These findings are valuable in guiding future ergonomics interventions aimed at reducing the physical exposures of dental hygiene work. Practitioner Summary: Given that this study evaluates the physical demands of manual scaling, a procedure that is fundamental to dental hygiene work, the findings are valuable to identify ergonomics interventions to reduce the prevalence of work-related injuries, disability and the potential for early retirement among this occupational group.

Analysis of a retrieved delta III total shoulder prosthesis.

PubMed

Nyffeler, R W; Werner, C M L; Simmen, B R; Gerber, C

2004-11-01

A reversed Delta III total shoulder prosthesis was retrieved post-mortem, eight months after implantation. A significant notch was evident at the inferior pole of the scapular neck which extended beyond the inferior fixation screw. This bone loss was associated with a corresponding, erosive defect of the polyethylene cup. Histological examination revealed a chronic foreign-body reaction in the joint capsule. There were, however, no histological signs of loosening of the glenoid base plate and the stability of the prosthetic articulation was only slightly reduced by the eroded rim of the cup.

Rehabilitative ultrasound measurement of trapezius muscle contractile states in people with mild shoulder pain.

PubMed

O'Sullivan, Cliona; McCarthy Persson, Ulrik; Blake, Catherine; Stokes, Maria

2012-04-01

The utility of rehabilitative ultrasound imaging (RUSI) for assessing trapezius muscle contractile characteristics was investigated by examining whether muscle thickness changes during contraction (CT) differed between people with and without mild shoulder pain. In 18 subjects with mild shoulder pain (aged 28±8 years) and 18 matched controls, trapezius muscle thickness change was measured in prone at rest at 0° and during isometric CTs at 90° and 120° of shoulder abduction. Images were taken at four sites using a real-time ultrasound scanner (7-MHz linear transducer, 40 mm footprint). Percentage change in muscle thickness from rest was calculated. Differences between painful and non-painful shoulders and participant groups were examined by analysis of variance (ANOVA) and t-tests. There were no significant differences between groups or sides in trapezius muscle thickness change during CT. There was no significant difference in trapezius muscle resting thickness (RT) between painful and non-painful shoulders in the same subjects. Contractile ability of the trapezius muscle, assessed using RUSI was not impaired in subjects with mild shoulder pain during the test manoeuvres used. Further research is warranted involving patients with different severity of symptoms, using other test manoeuvres before RUSI can be advocated for assessing scapular muscle dysfunction. Copyright © 2011 Elsevier Ltd. All rights reserved.

A systematic comparison of the closed shoulder reduction techniques.

PubMed

Alkaduhimi, H; van der Linde, J A; Willigenburg, N W; van Deurzen, D F P; van den Bekerom, M P J

2017-05-01

To identify the optimal technique for closed reduction for shoulder instability, based on success rates, reduction time, complication risks, and pain level. A PubMed and EMBASE query was performed, screening all relevant literature of closed reduction techniques mentioning the success rate written in English, Dutch, German, and Arabic. Studies with a fracture dislocation or lacking information on success rates for closed reduction techniques were excluded. We used the modified Coleman Methodology Score (CMS) to assess the quality of included studies and excluded studies with a poor methodological quality (CMS < 50). Finally, a meta-analysis was performed on the data from all studies combined. 2099 studies were screened for their title and abstract, of which 217 studies were screened full-text and finally 13 studies were included. These studies included 9 randomized controlled trials, 2 retrospective comparative studies, and 2 prospective non-randomized comparative studies. A combined analysis revealed that the scapular manipulation is the most successful (97%), fastest (1.75 min), and least painful reduction technique (VAS 1,47); the "Fast, Reliable, and Safe" (FARES) method also scores high in terms of successful reduction (92%), reduction time (2.24 min), and intra-reduction pain (VAS 1.59); the traction-countertraction technique is highly successful (95%), but slower (6.05 min) and more painful (VAS 4.75). For closed reduction of anterior shoulder dislocations, the combined data from the selected studies indicate that scapular manipulation is the most successful and fastest technique, with the shortest mean hospital stay and least pain during reduction. The FARES method seems the best alternative.

Clusterin expression in elastofibroma dorsi.

PubMed

Aigelsreiter, Ariane; Pichler, Martin; Pixner, Thomas; Janig, Elke; Schuller, Monika; Lackner, Carolin; Scheipl, Susanne; Beham, Alfred; Regauer, Sigrid

2013-05-01

Elastofibroma dorsi is a benign soft tissue lesion composed of abnormal elastic fibers. Degenerated elastic fibers in skin and liver are associated with clusterin, an apoprotein that shares functional properties with small heat shock proteins. We evaluated the staining pattern and possible role of clusterin in elastofibroma dorsi. Twenty-one subcutaneous elastofibromas from the scapular region were evaluated with Elastica van Gieson and Orcein stains, immunohistochemically with antibodies to clusterin, smooth muscle actin, S-100, vimentin and CD34 and correlated with clinical data with respect to physical trauma. Clusterin correlated with the staining pattern of Elastica van Gieson and labelled abnormal broad coarse fibrillar and globular elastic fibers in all elastofibromas. Orcein stains additionally identified fine oxytalan fibers which were not stained by clusterin. Clusterin staining was observed only on the outside of the elastin fibers, while the cores of fibers and globules were unstained. 4/21 elastofibromas showed cellular nodules with a myxoid/collagenous stroma. The round to oval cells showed cytoplasmic staining with vimentin and clusterin; CD34 labelled mostly cell membranes. The cells lacked SMA and S-100 expression. The central areas of the nodules were devoid of elastic fibers, but the periphery contained coarse fibers and globules. 9/ 11 patients, for whom clinical data were available, reported trauma to the scapular region. Many investigated ED were associated with trauma, which supports a reactive/degenerative etiology of ED. The abnormal large elastic fibers in all ED were enveloped by clusterin. Clusterin deposition may protect elastic fibers from degradation and thus contribute indirectly to the tumor-like presentation of ED.

Glenoid bone grafting in primary reverse total shoulder arthroplasty.

PubMed

Ernstbrunner, Lukas; Werthel, Jean-David; Wagner, Eric; Hatta, Taku; Sperling, John W; Cofield, Robert H

2017-08-01

Severe glenoid bone loss remains a challenge in patients requiring shoulder arthroplasty and may necessitate glenoid bone grafting. The purpose of this study was to determine results, complications, and rates of failure of glenoid bone grafting in primary reverse shoulder arthroplasty. Forty-one shoulders that underwent primary reverse arthroplasty between 2006 and 2013 with a minimum follow-up of 2 years (mean, 2.8 years; range, 2-6 years) were reviewed. Thirty-four (83%) received corticocancellous grafts and 7 (17%) structural grafts. Active range of motion and pain levels were significantly improved (P < .001), with mean American Shoulder and Elbow Surgeons score of 77, Simple Shoulder Test score of 9, and patient satisfaction of 93% at the most recent follow-up. Preoperative severe glenoid erosion and increasing body mass index were significantly associated with worse American Shoulder and Elbow Surgeons scores (P = .04). On radiographic evaluation, 7 patients (18%) had grade 1 or grade 2 glenoid lucency. Glenoid bone graft incorporation was observed in 31 patients (78%). Twelve patients (30%) suffered from grade 1 or grade 2 scapular notching. All of the patients with structural grafts showed graft incorporation and no signs of glenoid lucency. Although glenoid lucency, glenoid graft resorption, and scapular notching were present at short-term to midterm follow-up, none of the patients needed revision surgery. Primary reverse shoulder arthroplasty with glenoid reconstruction using bone graft relieved pain and restored shoulder function and stability. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula.

PubMed

Pizzari, Tania; Wickham, James; Balster, Simon; Ganderton, Charlotte; Watson, Lyn

2014-02-01

Scapular dyskinesis, characterised by drooping scapulae and reduced upward rotation, has been implicated in the presentation of a number of shoulder disorders. Traditionally, in shoulder rehabilitation programmes, the shrug exercise has been prescribed to facilitate upward rotation of the scapula by strengthening the upper trapezius muscle. The aim of this research was to compare muscle activation levels during the standard shrug and the upward rotation shrug in a normal and pathological population. Surface electrodes recorded electromyographical activity from upper trapezius, middle trapezius, lower trapezius and serratus anterior muscles in 23 normal participants and 14 participants with multi-directional shoulder instability. Participants completed 10 trials of the standard shrug exercise at 0° of shoulder abduction and the upward rotation shrug exercise at 30° of shoulder abduction in the coronal plane. Muscle activity was expressed as a percentage of maximum voluntary isometric contraction. The four muscles tested performed at a higher intensity during the modified shrug than the standard shrug. Upper trapezius and lower trapezius activity was significantly greater (P < 0.05) in both populations. Though for middle trapezius and serratus anterior muscles, the modified shrug was statistically significant only in the normal population, P = 0.031 and P = <0.001 respectively. The upward rotation shrug is a more effective exercise for eliciting muscle activity of the upper and lower trapezius than the standard shrug in a normal and multi-directional instability population. Clinically, the upward rotation shrug might be useful to address scapular dyskinesis involving drooping shoulders and reduced scapula upward rotation. Copyright © 2013 Elsevier Ltd. All rights reserved.

The trapezius perforator flap: an underused but versatile option in the reconstruction of local and distant soft-tissue defects.

PubMed

Sadigh, Parviz L; Chang, Li-Ren; Hsieh, Ching-Hua; Feng, Wen-Jui; Jeng, Seng-Feng

2014-09-01

The trapezius myocutaneous flap is an established reconstructive option in head and neck cases The authors present their experience with 10 trapezius perforator flaps, all raised using a freestyle technique of perforator dissection, to successfully reconstruct both local and distant soft-tissue defects. Ten patients underwent soft-tissue reconstruction using trapezius perforator flaps. After mapping the perforator with a handheld Doppler device at the intersection of a horizontal line drawn 6 to 8 cm inferior to the scapular spine and a vertical line drawn 8 to 9 cm lateral to the midline of the back, perforator flaps were raised in a freestyle fashion, with complete preservation of the trapezius muscle. The flap can be pedicled into local defects or transferred as a free flap. Six flaps were elevated as pedicled flaps and four were transferred as free flaps. Flap size ranged from 6 × 4 cm to 25 × 15 cm. The pedicle length ranged from 4 to 14 cm. The pedicle originated from the dorsal scapular artery. In one case, the authors converted from a pedicled flap to a free flap secondary to insufficient pedicle length. All donor sites were closed directly. The follow-up period ranged from 4 months to 4 years. All of the flaps survived completely with no major complications, and no patients developed any shoulder dysfunction. The trapezius perforator flap is a reliable and versatile reconstructive option that can be used to repair both local and distant soft-tissue defects. The donor-site morbidity is minimal. Therapeutic, IV.

Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures.

PubMed

Anavian, Jack; Gauger, Erich M; Schroder, Lisa K; Wijdicks, Coen A; Cole, Peter A

2012-04-04

Operative treatment is indicated for displaced fractures of the glenoid fossa. However, little is known regarding functional outcomes in these patients. This study assesses surgical and functional results after treatment of displaced, high-energy, complex, intra-articular glenoid fractures. Thirty-three patients with displaced intra-articular fractures of the glenoid were treated surgically between 2002 and 2009. The indications for operative treatment included articular fracture gap or step-off of ≥ 4 mm. Twenty-five patients also had extra-articular scapular involvement. A posterior approach was utilized in twenty-one patients, an anterior approach in seven, and a combined approach in five. Functional outcomes, including Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) scores, shoulder motion and strength, and return to work and/or activities, were obtained for thirty patients (91%). At a mean follow-up of twenty-seven months (range, twelve to seventy-three months), all patients had radiographic union of the fracture. The mean DASH score was 10.8 (range, 0 to 42). All mean SF-36 subscores were comparable with those of the normal population. Twenty-six patients (87%) were pain-free at the time of follow-up, and four had mild pain with prolonged activity. Twenty-seven (90%) of thirty patients returned to their preinjury level of work and/or activities. Our data suggest that surgical treatment for complex, displaced intra-articular glenoid fractures with or without involvement of the scapular neck and body can be associated with good functional outcomes and a low complication rate.

Sexual dimorphism of the suprascapular notch – morphometric study

PubMed Central

Jędrzejewski, Kazimierz S.; Topol, Mirosław

2013-01-01

Introduction The concept of the study was to compare the morphometry of the suprascapular notch (SSN) in females and males because its size and shape may be a factor in suprascapular nerve entrapment. Material and methods The measurements of 81 scapulae included morphological length and width, maximal width and length projection of the scapular spine, and width and length of the glenoid cavity. The width-length scapular and glenoid cavity indices were calculated. In addition to standard anthropometric measurements three other dimensions were defined and collected for every SSN: maximal depth (MD), superior (STD) and middle (MTD) transverse diameters. Results The analysis of the measurements allowed us to distinguish five types of SSN. Type I (26%) had longer maximal depth than superior transverse diameter. Type II (3%) had equal MD, STD and MTD. In type III (57.6%) superior transverse diameter was longer than maximal depth. In type IV (7.4%) a bony foramen was present. Type V (6%) was without a discrete notch. Types I and III were divided into two subtypes: A (MTD was longer than STD) and B (MTD < STD). Distribution of the suprascapular notch types in both sexes was similar. However, MD, STD and MTD were significantly higher in males. The superior transverse suprascapular ligament was completely and partially ossified in 7.4% and 24.7% respectively. Conclusions The presented classification of the suprascapular notch is simple, easy to use, and based on specific geometric parameters which allow one to clearly distinguish five types of these structures. All dimensions of SSN were significantly higher in males than in females. PMID:23515320

A new method of morphological comparison for bony reconstructive surgery: maxillary reconstruction using scapular tip bone

NASA Astrophysics Data System (ADS)

Chan, Harley; Gilbert, Ralph W.; Pagedar, Nitin A.; Daly, Michael J.; Irish, Jonathan C.; Siewerdsen, Jeffrey H.

2010-02-01

esthetic appearance is one of the most important factors for reconstructive surgery. The current practice of maxillary reconstruction chooses radial forearm, fibula or iliac rest osteocutaneous to recreate three-dimensional complex structures of the palate and maxilla. However, these bone flaps lack shape similarity to the palate and result in a less satisfactory esthetic. Considering similarity factors and vasculature advantages, reconstructive surgeons recently explored the use of scapular tip myo-osseous free flaps to restore the excised site. We have developed a new method that quantitatively evaluates the morphological similarity of the scapula tip bone and palate based on a diagnostic volumetric computed tomography (CT) image. This quantitative result was further interpreted as a color map that rendered on the surface of a three-dimensional computer model. For surgical planning, this color interpretation could potentially assist the surgeon to maximize the orientation of the bone flaps for best fit of the reconstruction site. With approval from the Research Ethics Board (REB) of the University Health Network, we conducted a retrospective analysis with CT image obtained from 10 patients. Each patient had a CT scans including the maxilla and chest on the same day. Based on this image set, we simulated total, subtotal and hemi palate reconstruction. The procedure of simulation included volume segmentation, conversing the segmented volume to a stereo lithography (STL) model, manual registration, computation of minimum geometric distances and curvature between STL model. Across the 10 patients data, we found the overall root-mean-square (RMS) conformance was 3.71+/- 0.16 mm

Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review.

PubMed

Racicki, Stephanie; Gerwin, Sarah; Diclaudio, Stacy; Reinmann, Samuel; Donaldson, Megan

2013-05-01

The purpose of this systematic review was to assess the effectiveness of conservative physical therapy management of cervicogenic headache (CGH). CGH affects 22-25% of the adult population with females being four times more affected than men. CGHs are thought to arise from musculoskeletal impairments in the neck with symptoms most commonly consisting of suboccipital neck pain, dizziness, and lightheadedness. Currently, both invasive and non-invasive techniques are available to address these symptoms; however, the efficacy of non-invasive treatment techniques has yet to be established. Computerized searches of CINAHL, ProQuest, PubMed, MEDLINE, and SportDiscus, were performed to obtain a qualitative analysis of the literature. Inclusion criteria were: randomized controlled trial design, population diagnosed with CGH using the International Headache Society classification, at least one baseline measurement and one outcomes measure, and assessment of a conservative technique. Physiotherapy evidence-based database scale was utilized for quality assessment. One computerized database search and two hand searches yielded six articles. Of the six included randomized controlled trials, all were considered to be of 'good quality' utilizing the physiotherapy evidence-based database scale. The interventions utilized were: therapist-driven cervical manipulation and mobilization, self-applied cervical mobilization, cervico-scapular strengthening, and therapist-driven cervical and thoracic manipulation. With the exception of one study, all reported reduction in pain and disability, as well as improvement in function. Calculated effect sizes allowed comparison of intervention groups between studies. A combination of therapist-driven cervical manipulation and mobilization with cervico-scapular strengthening was most effective for decreasing pain outcomes in those with CGH.

Polyethylene Wear in Retrieved Reverse Total Shoulder Components

PubMed Central

Day, Judd S; MacDonald, Daniel W; Olsen, Madeline; Getz, Charles; Williams, Gerald R; Kurtz, Steven M

2011-01-01

Background Reverse total shoulder arthroplasty has been used to treat rotator cuff tear arthropathy, proximal humeral fractures and for failed conventional total shoulder prostheses. It has been suggested that polyethylene wear is potentially higher in reverse shoulder replacements than in conventional shoulder replacements. The modes and degree of polyethylene wear have not been completely elucidated. The purpose of this study was to evaluate polyethylene wear patterns in seven specimens retrieved at revision arthroplasty and identify factors that may be associated with increased wear. Methods Reverse total shoulder components were retrieved from 7 patients during revision arthroplasty for loosening and/or pain. Pre-operative glenoid tilt and placement, and scapular notching were evaluated using pre-operative radiographs. Polyethylene wear was evaluated using microCT and optical microscopy. Results Wear on the rim of the polyethylene humeral cup, was identified on all retrieved components. The extent of rim wear varied from a penetration depth of 0.1 to 4.7 mm. We could not demonstrate a correlation between scapular notching and rim wear. However, rim wear was more extensive when the inferior screw had made contact with the liner. Metal on metal wear between the humeral component and the inferior screw of one component was also observed. Wear of the intended bearing surface was minimal. Discussion Rim damage was the predominant cause of polyethylene wear in our retrieved specimens. Direct contact between the humeral component and inferior metaglene screws is concerning because this could lead to accelerated UHMWPE wear and also induce mechanical loosening of the glenoid component. PMID:21724419

The effect of glenosphere diameter and eccentricity on deltoid power in reverse shoulder arthroplasty.

PubMed

Scalise, J; Jaczynski, A; Jacofsky, M

2016-02-01

The eccentric glenosphere was principally introduced into reverse shoulder arthroplasty to reduce the incidence of scapular notching. There is only limited information about the influence of its design on deltoid power and joint reaction forces. The aim of our study was to investigate how the diameter and eccentricity of the glenosphere affect the biomechanics of the deltoid and the resultant joint reaction forces. Different sizes of glenosphere and eccentricity were serially tested in ten cadaveric shoulders using a custom shoulder movement simulator. Increasing the diameter of the glenosphere alone did not alter the deltoid moment arm. However, using an eccentric glenosphere increased the moment arm of the deltoid, lowered the joint reaction force and required less deltoid force to generate movement. Eccentricity is an independent variable which increases deltoid efficiency and lowers joint reaction forces in a reverse shoulder arthroplasty. Cite this article: Bone Joint J 2016;98-B:218-23. ©2016 The British Editorial Society of Bone & Joint Surgery.

Ambulatory measurement of the scapulohumeral rhythm: intra- and inter-operator agreement of a protocol based on inertial and magnetic sensors.

PubMed

Parel, I; Cutti, A G; Fiumana, G; Porcellini, G; Verni, G; Accardo, A P

2012-04-01

To measure the scapulohumeral rhythm (SHR) in outpatient settings, the motion analysis protocol named ISEO (INAIL Shoulder and Elbow Outpatient protocol) was developed, based on inertial and magnetic sensors. To complete the sensor-to-segment calibration, ISEO requires the involvement of an operator for sensor placement and for positioning the patient's arm in a predefined posture. Since this can affect the measure, this study aimed at quantifying ISEO intra- and inter-operator agreement. Forty subjects were considered, together with two operators, A and B. Three measurement sessions were completed for each subject: two by A and one by B. In each session, the humerus and scapula rotations were measured during sagittal and scapular plane elevation movements. ISEO intra- and inter-operator agreement were assessed by computing, between sessions, the: (1) similarity of the scapulohumeral patterns through the Coefficient of Multiple Correlation (CMC(2)), both considering and excluding the difference of the initial value of the scapula rotations between two sessions (inter-session offset); (2) 95% Smallest Detectable Difference (SDD(95)) in scapula range of motion. Results for CMC(2) showed that the intra- and inter-operator agreement is acceptable (median≥0.85, lower-whisker ≥ 0.75) for most of the scapula rotations, independently from the movement and the inter-session offset. The only exception is the agreement for scapula protraction-retraction and for scapula medio-lateral rotation during abduction (inter-operator), which is acceptable only if the inter-session offset is removed. SDD(95) values ranged from 4.4° to 8.6° for the inter-operator and between 4.9° and 8.5° for the intra-operator agreement. In conclusion, ISEO presents a high intra- and inter-operator agreement, particularly with the scapula inter-session offset removed. Copyright © 2011 Elsevier B.V. All rights reserved.

Biomechanical testing of locking and nonlocking plates in the canine scapula.

PubMed

Acquaviva, Anthony E; Miller, Emily I; Eisenmann, David J; Stone, Rick T; Kraus, Karl H

2012-01-01

Locking plates have been shown to offer improved fixation in fractures involving either osteoporotic bone or bone with lesser screw pullout strength, such as thin and flat bones. Fractures of the scapular body are one type of fracture where the screw pullout strength using conventional plate fixation may not be sufficient to overcome physiologic forces. The purpose of this study was to compare the pullout strengths of locking plates to conventional nonlocking plates in the canine scapula. A 2.7 mm string of pearls plate (SOP) and a 2.7 mm limited contact dynamic compression plate (LC-DCP) were applied with similar divergent screws to the supraspinatus fossa of the scapula. Forces perpendicular to the plates were applied and both the loads at failure and modes of failure were recorded. No differences were noted in loads at failure between the two plating systems. Although the modes of failure were not significantly different, the SOP constructs tended to fail more often by bone slicing and coring, whereas the LC-DCP constructs failed primarily by screw stripping. Neither of the plate systems used in this study demonstrated a distinct mechanical advantage. The application and limitations of locking plate systems in various clinical situations require further study.

Bennett lesions in baseball players detected by magnetic resonance imaging: assessment of association factors.

PubMed

Park, Jin-Young; Noh, Young-Min; Chung, Seok-Won; Moon, Sung-Gyn; Ha, Dae-Ho; Lee, Ki-Sun; Chung, Seok Won

2016-05-01

The purpose of this study was to evaluate the characteristics of Bennett lesions in baseball players compared with those without a Bennett lesion and to identify other possible factors associated with Bennett lesions on magnetic resonance imaging (MRI). We investigated 388 male baseball players with a career >1 year. Demographic factors and a routine physical examination, including glenohumeral internal rotation difference, scapular dyskinesis, and various pathologic changes, were reviewed on MRI to identify relative factors for Bennett lesions. Of the 388 patients evaluated, 125 (32.2%) were diagnosed with Bennett lesions of the shoulder. No significant differences were observed between the groups in demographic factors, physical examination results, visual analog scale score, American Shoulder and Elbow Surgeons score, or prevalence of concomitant diseases. However, players with Bennett lesions had played baseball longer than those without the lesions (P < .001). An association was found between Bennett lesions and the length of time that a patient with a Bennett lesion had played baseball. The prevalence of pathologic lesions detected on MRI and the physical examination results were not different between players with and without Bennett lesions. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Muscle activation patterns of the upper and lower extremity during the windmill softball pitch.

PubMed

Oliver, Gretchen D; Plummer, Hillary A; Keeley, David W

2011-06-01

Fast-pitch softball has become an increasingly popular sport for female athletes. There has been little research examining the windmill softball pitch in the literature. The purpose of this study was to describe the muscle activation patterns of 3 upper extremity muscles (biceps, triceps, and rhomboids [scapular stabilizers]) and 2 lower extremity muscles (gluteus maximus and medius) during the 5 phases of the windmill softball pitch. Data describing muscle activation were collected on 7 postpubescent softball pitchers (age 17.7 ± 2.6 years; height 169 ± 5.4 cm; mass 69.1 ± 5.4 kg). Surface electromyographic data were collected using a Myopac Jr 10-channel amplifier (RUN Technologies Scientific Systems, Laguna Hills, CA, USA) synchronized with The MotionMonitor™ motion capture system (Innovative Sports Training Inc, Chicago IL, USA) and presented as a percent of maximum voluntary isometric contraction. Gluteus maximus activity reached (196.3% maximum voluntary isometric contraction [MVIC]), whereas gluteus medius activity was consistent during the single leg support of phase 3 (101.2% MVIC). Biceps brachii activity was greatest during phase 4 of the pitching motion. Triceps brachii activation was consistently >150% MVIC throughout the entire pitching motion, whereas the scapular stabilizers were most active during phase 2 (170.1% MVIC). The results of this study indicate the extent to which muscles are activated during the windmill softball pitch, and this knowledge can lead to the development of proper preventative and rehabilitative muscle strengthening programs. In addition, clinicians will be able to incorporate strengthening exercises that mimic the timing of maximal muscle activation most used during the windmill pitching phases.

Quantifying the competing relationship between adduction range of motion and baseplate micromotion with lateralization of reverse total shoulder arthroplasty.

PubMed

Elwell, Josie; Choi, Joseph; Willing, Ryan

2017-02-08

Lateralizing the center of rotation (COR) of reverse total shoulder arthroplasty (rTSA) could improve functional outcomes and mitigate scapular notching, a commonly occurring complication of the procedure. However, resulting increases in torque at the bone-implant interface may negatively affect initial fixation of the glenoid-side component, especially if only two fixation screws can be placed. Shoulder-specific finite element (FE) models of four fresh-frozen cadaveric shoulders were constructed. Scapular geometry and material property distributions were derived from CT data. Generic baseplates with two and four fixation screws were virtually implanted, after which superiorly-oriented shear loads, accompanied by a compressive load, were applied incrementally further from the glenoid surface to simulate lateralization of the COR. Relationships between lateralization, adduction range of motion (ROM), the number of fixation screws and micromotion of the baseplate (initial implant fixation) were characterized. Lateralization significantly increases micromotion (p=0.015) and adduction ROM (p=0.001). Using two, versus four, baseplate fixation screws significantly increases micromotion (p=0.008). The effect of lateralization and the number of screws on adduction ROM and baseplate fixation is variable on a shoulder-specific basis. Trade-offs exist between functional outcomes, namely adduction ROM, and initial implant fixation and the negative effect of lateralization on implant fixation is amplified when only two fixation screws are used. The possibility of lateralizing the COR in order to improve functional outcomes of the procedure should be considered on a patient-specific basis accounting for factors such as availability and quality of bone stock. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of lateral offset center of rotation in reverse total shoulder arthroplasty: a biomechanical study.

PubMed

Henninger, Heath B; Barg, Alexej; Anderson, Andrew E; Bachus, Kent N; Burks, Robert T; Tashjian, Robert Z

2012-09-01

Lateral offset center of rotation (COR) reduces the incidence of scapular notching and potentially increases external rotation range of motion (ROM) after reverse total shoulder arthroplasty (rTSA). The purpose of this study was to determine the biomechanical effects of changing COR on abduction and external rotation ROM, deltoid abduction force, and joint stability. A biomechanical shoulder simulator tested cadaveric shoulders before and after rTSA. Spacers shifted the COR laterally from baseline rTSA by 5, 10, and 15 mm. Outcome measures of resting abduction and external rotation ROM, and abduction and dislocation (lateral and anterior) forces were recorded. Resting abduction increased 20° vs native shoulders and was unaffected by COR lateralization. External rotation decreased after rTSA and was unaffected by COR lateralization. The deltoid force required for abduction significantly decreased 25% from native to baseline rTSA. COR lateralization progressively eliminated this mechanical advantage. Lateral dislocation required significantly less force than anterior dislocation after rTSA, and both dislocation forces increased with lateralization of the COR. COR lateralization had no influence on ROM (adduction or external rotation) but significantly increased abduction and dislocation forces. This suggests the lower incidence of scapular notching may not be related to the amount of adduction deficit after lateral offset rTSA but may arise from limited impingement of the humeral component on the lateral scapula due to a change in joint geometry. Lateralization provides the benefit of increased joint stability, but at the cost of increasing deltoid abduction forces. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Kinematic analysis of dynamic shoulder motion in patients with reverse total shoulder arthroplasty.

PubMed

Kwon, Young W; Pinto, Vivek J; Yoon, Jangwhon; Frankle, Mark A; Dunning, Page E; Sheikhzadeh, Ali

2012-09-01

Reverse total shoulder arthroplasty (rTSA) has been used to treat patients with irreparable rotator cuff dysfunction. Despite the proven clinical efficacy, there is minimal information regarding the underlying changes to the shoulder kinematics associated with this construct. Therefore, we sought to examine the kinematics of dynamic shoulder motion in patients with well-functioning rTSA. We tested 12 healthy subjects and 17 patients with rTSA. All rTSA patients were able to elevate their arms to at least 90° and received the implant as the primary arthroplasty at least 6 months before testing. On average, the rTSA patients elevated their arms to 112° ± 12° (mean ± SD) and reported an American Shoulder and Elbow Surgeons outcome score of 90.6 ± 6.3. A 3-dimensional electromagnetic motion capture device was used to detect the dynamic motion of the trunk, scapula, and humerus during bilateral active shoulder elevation along the sagittal, scapular, and coronal planes. In both healthy and rTSA shoulders, the majority of the humeral-thoracic motion was provided by the glenohumeral motion. Therefore, the ratio of glenohumeral to scapulothoracic (ST) motion was always greater than 1.62 during elevation along the scapular plane. In comparison to healthy subjects, however, the contribution of ST motion to overall shoulder motion was significantly increased in the rTSA shoulders. This increased contribution was noted in all planes of shoulder elevation and was maintained when weights were attached to the arm. Kinematics of the rTSA shoulders are significantly altered, and more ST motion is used to achieve shoulder elevation. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Evidence-based guideline summary: Evaluation, diagnosis, and management of facioscapulohumeral muscular dystrophy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the Practice Issues Review Panel of the American Association of Neuromuscular & Electrodiagnostic Medicine.

PubMed

Tawil, Rabi; Kissel, John T; Heatwole, Chad; Pandya, Shree; Gronseth, Gary; Benatar, Michael

2015-07-28

To develop recommendations for the evaluation, diagnosis, prognostication, and treatment of facioscapulohumeral muscular dystrophy (FSHD) from a systematic review and analysis of the evidence. Relevant articles were analyzed in accordance with the American Academy of Neurology classification of evidence schemes for diagnostic, prognostic, and treatment studies. Recommendations were linked to the strength of the evidence and other factors. Available genetic testing for FSHD type 1 is highly sensitive and specific. Although respiratory insufficiency occurs rarely in FSHD, patients with severe FSHD should have routine pulmonary function testing. Routine cardiac screening is not necessary in patients with FSHD without cardiac symptoms. Symptomatic retinal vascular disease is very rare in FSHD. Exudative retinopathy, however, is potentially preventable, and patients with large deletions should be screened through dilated indirect ophthalmoscopy. The prevalence of clinically relevant hearing loss is not clear. In clinical practice, patients with childhood-onset FSHD may have significant hearing loss. Because undetected hearing loss may impair language development, screening through audiometry is recommended for such patients. Musculoskeletal pain is common in FSHD and treating physicians should routinely inquire about pain. There is at present no effective pharmacologic intervention in FSHD. Available studies suggest that scapular fixation is safe and effective. Surgical scapular fixation might be cautiously offered to selected patients. Aerobic exercise in FSHD appears to be safe and potentially beneficial. On the basis of the evidence, patients with FSHD might be encouraged to engage in low-intensity aerobic exercises. © 2015 American Academy of Neurology.

A Basal Sauropodomorph (Dinosauria: Saurischia) from the Ischigualasto Formation (Triassic, Carnian) and the Early Evolution of Sauropodomorpha

PubMed Central

Martinez, Ricardo N.; Alcober, Oscar A.

2009-01-01

Background The earliest dinosaurs are from the early Late Triassic (Carnian) of South America. By the Carnian the main clades Saurischia and Ornithischia were already established, and the presence of the most primitive known sauropodomorph Saturnalia suggests also that Saurischia had already diverged into Theropoda and Sauropodomorpha. Knowledge of Carnian sauropodomorphs has been restricted to this single species. Methodology/Principal Findings We describe a new small sauropodomorph dinosaur from the Ischigualsto Formation (Carnian) in northwest Argentina, Panphagia protos gen. et sp. nov., on the basis of a partial skeleton. The genus and species are characterized by an anteroposteriorly elongated fossa on the base of the anteroventral process of the nasal; wide lateral flange on the quadrate with a large foramen; deep groove on the lateral surface of the lower jaw surrounded by prominent dorsal and ventral ridges; bifurcated posteroventral process of the dentary; long retroarticular process transversally wider than the articular area for the quadrate; oval scars on the lateral surface of the posterior border of the centra of cervical vertebrae; distinct prominences on the neural arc of the anterior cervical vertebra; distal end of the scapular blade nearly three times wider than the neck; scapular blade with an expanded posterodistal corner; and medial lamina of brevis fossa twice as wide as the iliac spine. Conclusions/Significance We regard Panphagia as the most basal sauropodomorph, which shares the following apomorphies with Saturnalia and more derived sauropodomorphs: basally constricted crowns; lanceolate crowns; teeth of the anterior quarter of the dentary higher than the others; and short posterolateral flange of distal tibia. The presence of Panphagia at the base of the early Carnian Ischigualasto Formation suggests an earlier origin of Sauropodomorpha during the Middle Triassic. PMID:19209223

Intra- and interrater reliability of the 'lumbar-locked thoracic rotation test' in competitive swimmers ages 10 through 18 years.

PubMed

Feijen, Stef; Kuppens, Kevin; Tate, Angela; Baert, Isabel; Struyf, Thomas; Struyf, Filip

2018-04-17

Measuring thoracic spine mobility can be of interest to competitive swimmers as it has been associated with shoulder girdle function and scapular position in subjects with and without shoulder pain. At present, no reliability data of thoracic spine mobility measurements are available in the swimming population. This study aims to evaluate the within-session intra- and interrater reliability of the "lumbar-locked rotation test" for thoracic spine rotation in competitive swimmers aged 10 to 18 years. This reliability study is part of a larger prospective cohort study investigating potential risk factors for the development of shoulder pain in competitive swimmers. Within-session, intra- and inter-rater reliability. Competitive swimming clubs in Belgium. 21 competitive swimmers. Intra- and inter-rater reliability of the lumbar-locked thoracic rotation test. Intraclass correlation coefficients (ICCs) ranged from 0.91 (95% CI 0.78 to 0.96) to 0.96 (0.89-0.98) for intra-rater reliability. Results for inter-rater reliability ranged from 0.89 (0.72-0.95) to 0.86 (0.65-0.94) respectively for right and left thoracic rotation. Results suggest good to excellent reliability of the lumbar-locked thoracic rotation test, indicating this test can be used reliably in clinical practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

Slot-type fractures of the scapula at New Kingdom Tell El-Amarna, Egypt.

PubMed

Dabbs, Gretchen R; Zabecki, Melissa

2015-12-01

Amarna is the archaeological representation of Akhetaten, the short-lived Egyptian capital city of Akhenaten (reign 1352-1336BCE).Five adult males excavated from the South Tombs Cemetery (STC) (total n>400) at Amarna exhibit slot-type fracture lesions of the scapula, and two of these lesions exhibit evidence of active bone remodeling at the time of death.The lesions in question are described and a full differential diagnosis is considered.The differential diagnosis rules out atrophic perforations, scapular foramina, tumors, and occupational and accidental trauma.Given the location, morphology, and surrounding bony changes, these lesions are consistent with sharp force trauma, specifically stabbing.These lesions most likely represent the consequence of corporal punishment in the form of "strokes" accompanied by "open wounds" known from Egyptian literature for punishment of a wide range of civil and criminal activities.Alternatively, several pigs at Amarna show similar wound morphologies of the cranium and scapulae, which have been interpreted by other authors to represent ritualized punishment of the god Seth, who is often represented as a pig.The lesions described here are consistent in morphology and positioning with the swine examples, and may represent further, cross-species, evidence of ritualized punishment at the ancient capital city. Copyright © 2015 Elsevier Inc. All rights reserved.

Correlation between Trunk Posture and Neck Reposition Sense among Subjects with Forward Head Neck Postures

PubMed Central

Lee, Han Suk; Chung, Hyung Kuk; Park, Sun Wook

2015-01-01

Objective. To assess the correlation of abnormal trunk postures and reposition sense of subjects with forward head neck posture (FHP). Methods. In all, postures of 41 subjects were evaluated and the FHP and trunk posture including shoulder, scapular level, pelvic side, and anterior tilting degrees were analyzed. We used the head repositioning accuracy (HRA) test to evaluate neck position senses of neck flexion, neck extension, neck right and left side flexion, and neck right and left rotation and calculated the root mean square error in trials for each subject. Spearman's rank correlation coefficients and regression analysis were used to assess the degree of correlation between the trunk posture and HRA value, and a significance level of α = 0.05 was considered. Results. There were significant correlations between the HRA value of right side neck flexion and pelvic side tilt angle (p < 0.05). If pelvic side tilting angle increases by 1 degree, right side neck flexion increased by 0.76 degrees (p = 0.026). However, there were no significant correlations between other neck motions and trunk postures. Conclusion. Verifying pelvic postures should be prioritized when movement is limited due to the vitiation of the proprioceptive sense of neck caused by FHP. PMID:26583125

[Arthrodesis of the shoulder. A new and soft-tissue-sparing technique with a deep locking plate in the supraspinatus fossa].

PubMed

Klonz, A; Habermeyer, P

2007-10-01

Arthrodesis of the glenohumeral joint is a difficult intervention that involves a relatively high probability of complications. A stable internal fixation and secure consolidation is required. The operation needs to achieve several conditions: thorough denudation of the cartilage and partial decortication of the subchondral bone; good congruence of the corresponding surfaces; compression of the gap by tension screws and lasting stability. For increased primary stability a neutralizing plate is generally used as well as a compression screw. Up to now, the plate has usually been applied starting from the scapular spine and extending across the acromial corner to the humeral shaft. A wide exposure is needed for this procedure; the plate is difficult to shape during the operation and often causes some discomfort because it protrudes at the acromial corner. We present an alternative position of the plate in the supraspinatus fossa, where we have sited a 4.5 mm LCP locking plate (Synthes). The implant is inserted under the acromion, does not cause any discomfort at the acromial corner, and is far easier to shape. When it is used in association with a transarticular compressive screw, the technique results in a very stable situation, which allows physiotherapy from the first day after surgery onward.

Dual function of the pectoral girdle for feeding and locomotion in white-spotted bamboo sharks.

PubMed

Camp, Ariel L; Scott, Bradley; Brainerd, Elizabeth L; Wilga, Cheryl D

2017-07-26

Positioned at the intersection of the head, body and forelimb, the pectoral girdle has the potential to function in both feeding and locomotor behaviours-although the latter has been studied far more. In ray-finned fishes, the pectoral girdle attaches directly to the skull and is retracted during suction feeding, enabling the ventral body muscles to power rapid mouth expansion. However, in sharks, the pectoral girdle is displaced caudally and entirely separate from the skull (as in tetrapods), raising the question of whether it is mobile during suction feeding and contributing to suction expansion. We measured three-dimensional kinematics of the pectoral girdle in white-spotted bamboo sharks during suction feeding with X-ray reconstruction of moving morphology, and found the pectoral girdle consistently retracted about 11° by rotating caudoventrally about the dorsal scapular processes. This motion occurred mostly after peak gape, so it likely contributed more to accelerating captured prey through the oral cavity and pharynx, than to prey capture as in ray-finned fishes. Our results emphasize the multiple roles of the pectoral girdle in feeding and locomotion, both of which should be considered in studying the functional and evolutionary morphology of this structure. © 2017 The Author(s).

Wearable Textile Platform for Assessing Stroke Patient Treatment in Daily Life Conditions

PubMed Central

Lorussi, Federico; Carbonaro, Nicola; De Rossi, Danilo; Paradiso, Rita; Veltink, Peter; Tognetti, Alessandro

2016-01-01

Monitoring physical activities during post-stroke rehabilitation in daily life may help physicians to optimize and tailor the training program for patients. The European research project INTERACTION (FP7-ICT-2011-7-287351) evaluated motor capabilities in stroke patients during the recovery treatment period. We developed wearable sensing platform based on the sensor fusion among inertial, knitted piezoresistive sensors and textile EMG electrodes. The device was conceived in modular form and consists of a separate shirt, trousers, glove, and shoe. Thanks to the novel fusion approach it has been possible to develop a model for the shoulder taking into account the scapulo-thoracic joint of the scapular girdle, considerably improving the estimation of the hand position in reaching activities. In order to minimize the sensor set used to monitor gait, a single inertial sensor fused with a textile goniometer proved to reconstruct the orientation of all the body segments of the leg. Finally, the sensing glove, endowed with three textile goniometers and three force sensors showed good capabilities in the reconstruction of grasping activities and evaluating the interaction of the hand with the environment, according to the project specifications. This paper reports on the design and the technical evaluation of the performance of the sensing platform, tested on healthy subjects. PMID:27047939

Reduced invasive and muscle-sparing operative approaches to the posterolateral chest wall provide an excellent accessibility for the operative stabilization! : Minimized approaches to the posterolateral chest wall.

PubMed

Langenbach, A; Oppel, Pascal; Grupp, Sina; Krinner, Sebastian; Pachowsky, Milena; Buder, Thomas; Schulz-Drost, Melanie; Hennig, Friedrich F; Schulz-Drost, Stefan

2017-11-09

Stabilizing techniques for flail chest injuries are described through wide surgical approaches to the chest wall, especially in the most affected posterior and lateral regions. Severe morbidity due to these invasive approaches needs to be considered due to dissection of the scapular guiding muscles and the risk of injuries to neurovascular bundles. This study discusses possibilities for minimized approaches to the posterior and lateral regions. Ten fresh-frozen cadavers in lateral decubitus position were observed on both sides. Each surgical arm was kept mobile during the procedure. Approaches were performed following a standard protocol with muscle-sparing incisions starting with 5 cm in length and extending to 10 and 15 cm. The accessible surface comparing the extensions was measured. Visible ribs were counted. In a next step, MatrixRib ® Plates were fixed to those ribs to prove the feasibility of rib stabilization through limited approaches. Combinations of the posterior and lateral minimized approaches allow surgical fixation of 6-9 and 7-11 ribs through 5 and 10 cm incisions, respectively. In the case of an extreme expansion of a rib fracture series, an access extension can be made to 15 cm to be able to adequately supply the entire hemithorax using two approaches. Extensive invasive surgical approaches to the thoracic wall can be replaced by reduced invasive and muscle-sparing access combinations. A free-moving positioning of the arm and an accurate preoperative plan for minimizing approaches are essential. Minimally invasive plate techniques are very helpful adjuncts.

Radiographic follow-up of 84 operatively treated scapula neck and body fractures.

PubMed

Cole, Peter A; Gauger, Erich M; Herrera, Diego A; Anavian, Jack; Tarkin, Ivan S

2012-03-01

Certain scapula fractures may warrant surgical management to restore shoulder anatomy and promote optimal function. The purpose of this study is to determine the early radiographic follow-up of open reduction internal fixation (ORIF) for displaced, scapular fractures involving the glenoid neck and body. Eighty-four patients with a scapula body or neck fracture (with or without articular involvement) underwent ORIF between 2002 and 2010 at a single level I trauma centre. This study represents a retrospective review of data prospectively collected into a dedicated scapula fracture database. All patients met at least one of the following operative criteria: ≥20 mm medial/lateral (M/L) displacement (lateral border offset), ≥45° of angular deformity on a scapular-Y X-ray, the combination of angulation ≥30° plus M/L displacement ≥15 mm, double disruptions of the superior shoulder suspensory complex both displaced ≥10 mm, glenopolar angle (GPA) ≤22° and open fractures. Eighty-eight percent (74/84) had sufficient follow-up defined as at least 6 months. Measured outcomes included rates of scapula union and malunion, as well as surgical complications and re-operations. All fractures were caused by high-energy trauma with 24 (29%) resulting from motor-vehicle collisions. Associated injuries occurred in 94% of patients, most commonly involving the chest (70%) and ipsilateral shoulder girdle (43%). Forty-eight patients had M/L displacement as an operative indication with a mean displacement of 25.7 mm (range=20-40). Thirty-eight (45%) had ≥2 operative indications. A single surgeon performed ORIF in all patients using a posterior approach. Five patients also required an anterior (deltopectoral) approach. The fixation strategy included lateral and vertebral border stabilisation with dynamic compression and reconstruction plates, respectively. Union was achieved in all cases. There were three cases of malunion based on a GPA difference >10° from the uninjured shoulder. Re-operations included removal of hardware (seven patients) and manipulation under anaesthesia (three patients). There were no infections or wound dehiscence. ORIF for displaced scapula fractures is a relatively safe and effective procedure for restoration of anatomy and promotion of union. Therapeutic study, level IV. Copyright © 2011 Elsevier Ltd. All rights reserved.

Evaluation and nonsurgical management of rotator cuff calcific tendinopathy.

PubMed

Greis, Ari C; Derrington, Stephen M; McAuliffe, Matthew

2015-04-01

Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Is there a difference between the effects of single and triple indirect moxibustion stimulations on skin temperature changes of the posterior trunk surface?

PubMed

Mori, Hidetoshi; Kuge, Hiroshi; Tanaka, Tim Hideaki; Taniwaki, Eiichi; Ohsawa, Hideo

2011-06-01

To determine whether any difference exists in responses to indirect moxibustion (IM) relative to thermal stimulation duration. In experiment 1, 9 subjects attended two experimental sessions consisting of single stimulation with IM or triple stimulation with IM, using a crossover design. A K-type thermocouple temperature probe was fixed on the skin surface at the GV14 acupuncture point. IM stimulation was administered to the top of the probe in order to measure the temperature curve. In addition, each subject evaluated his or her subjective feeling of heat on a visual analogue scale after each stimulation. Experiment 2 was conducted on 42 participants, divided into three groups according to the envelope allocation method: single stimulation with IM (n=20), triple stimulation with IM (n=11) and a control group (n=11). A thermograph was used to obtain the skin temperature on the posterior trunk of the participant. To analyse skin temperature, four arbitrary frames (the scapular, interscapular, lumbar and vertebral regions) were made on the posterior trunk. In experiment 1, no significant difference in maximum temperature was found in IM and subjective feeling of heat intensity between single and triple stimulation with IM. In experiment 2, increases in skin temperature occurred on the posterior trunk, but no differences in skin temperature occurred between the groups receiving single and triple stimulation with IM. No difference exists in the skin temperature response to moxibustion between the single and triple stimulation with IM.

Clinical features and predictors for disease natural progression in adults with Pompe disease: a nationwide prospective observational study

PubMed Central

2012-01-01

Background Due partly to physicians’ unawareness, many adults with Pompe disease are diagnosed with great delay. Besides, it is not well known which factors influence the rate of disease progression, and thus disease outcome. We delineated the specific clinical features of Pompe disease in adults, and mapped out the distribution and severity of muscle weakness, and the sequence of involvement of the individual muscle groups. Furthermore, we defined the natural disease course and identified prognostic factors for disease progression. Methods We conducted a single-center, prospective, observational study. Muscle strength (manual muscle testing, and hand-held dynamometry), muscle function (quick motor function test), and pulmonary function (forced vital capacity in sitting and supine positions) were assessed every 3–6 months and analyzed using repeated-measures ANOVA. Results Between October 2004 and August 2009, 94 patients aged between 25 and 75 years were included in the study. Although skeletal muscle weakness was typically distributed in a limb-girdle pattern, many patients had unfamiliar features such as ptosis (23%), bulbar weakness (28%), and scapular winging (33%). During follow-up (average 1.6 years, range 0.5-4.2 years), skeletal muscle strength deteriorated significantly (mean declines of −1.3% point/year for manual muscle testing and of −2.6% points/year for hand-held dynamometry; both p<0.001). Longer disease duration (>15 years) and pulmonary involvement (forced vital capacity in sitting position <80%) at study entry predicted faster decline. On average, forced vital capacity in supine position deteriorated by 1.3% points per year (p=0.02). Decline in pulmonary function was consistent across subgroups. Ten percent of patients declined unexpectedly fast. Conclusions Recognizing patterns of common and less familiar characteristics in adults with Pompe disease facilitates timely diagnosis. Longer disease duration and reduced pulmonary function stand out as predictors of rapid disease progression, and aid in deciding whether to initiate enzyme replacement therapy, or when. PMID:23147228

An ergonomic study of women workers in a woolen textile factory for identification of health-related problems.

PubMed

Metgud, D C; Khatri, Subhash; Mokashi, M G; Saha, P N

2008-04-01

The observational cross-sectional study conducted on a sample of 100 women workers who volunteered, outlines their cardio-respiratory and musculo-skeletal profile before, during and at end of work. In addition, information on their health status in general was collected in advance.Contrary to expectation, there was no significant change in respiratory function. However, the musculo-skeletal problems were found to be abundantly present with pain in 91% of the subjects. Region-wise mapping of pain revealed that postural pain in low back was present in 47% while in neck was 19%. Scapular muscles on the right side were involved in stabilizing shoulder, which never went overhead. On the contrary, left shoulder was raised as high (>90 degrees) in spinning action, while pulling thread. This muscle work involved trapezius, deltoid and triceps action concentrically in lifting and while coming to starting position slowly, eccentrically. There was no pause since the wheel continued to spin the thread continuously, unless a worker opted to stop the work. Accordingly, left wrist and hand were in holding contraction while the right wrist and hand holding the handle were also in a fixed position with wrist in flexion with supinated forearm. Though the overall job was light as per peak HR, there was pain due to fatigue and grip strength weakened by around 10%, at the end of the day's work. In conclusion, pain and fatigue were found to be the main problems for women in the spinning section of the small-scale industry under this study. Women have to take up dual responsibility of a full-time job as well as the domestic work. It was considered that ergonomic factors such as provision of a backrest and frequent rest periods could remediate the musculo-skeletal symptoms.

Lobomycosis in Colombian Amer Indian patients.

PubMed

Rodríguez-Toro, G; Tellez, N

1992-10-01

Several foci of lobomycosis among Colombian Amer Indians population were described in the Casanare region of Colombia, near the Orinoco river on the Colombian-Venezuelan border. This paper reports 16 new patients. The prevalence of Lobo's disease was 8.5% in the Amoruas tribe. Nodular lesions were located on the elbow, scapular and lumbar regions, knees, feet and legs. Leg lesions were especially numerous, were confluent and tended to ulcerate. All cases were confirmed histologically. Two Negro patients were also described. The cases bring the total number of confirmed patients with lobomycosis in Colombia to 41. Twenty-five of these were Amer Indian patients from tribes living in the Orinoco and Amazon basins of the country.

[Tumorous space occupying lesions of the scapula. An analysis of preoperative assessment of invasion].

PubMed

Erlemann, R; Davies, A M; Edel, G; Wuisman, P; Peters, P E; Grundmann, E

1988-02-01

The radiographic and histological morphology of 38 tumors lesions of the scapula are analyzed. Osteochondromas (n = 12), chondrosarcomas (n = 7), plasmacytomas (n = 4) and Ewing's sarcomas (n = 3) were the most frequent neoplasms. The radiographically determined growth rates allowed an estimate of the dignity in all cases. Benign lesions were only observed in the first five decades of life, and were mostly located in the scapular blade. Most tumors found in the acromion and in the glenoid region and all lesions diagnosed in the 6th to the 8th decades of life were malignant. In 63.2% of cases correct diagnosis of the type of lesion present was possible on radiographic examination.

Case Report of Serratus Plane Catheter for Pain Management in a Patient With Multiple Rib Fractures and an Inferior Scapular Fracture.

PubMed

Fu, Peter; Weyker, Paul D; Webb, Christopher A J

2017-03-15

We placed a superficial serratus anterior plane catheter in an elderly woman with dementia and elevated clotting times who presented with multiple rib fractures after a mechanical fall. She was not a surgical candidate, and treatment consisted of conservative management with physical therapy and pain control. She was not a candidate for a patient-controlled analgesia regimen because of her dementia. Given her elevated international normalized ratio, thoracic epidural and paravertebral analgesia was also contraindicated. We placed an ultrasound-guided serratus anterior plane catheter, allowing titratable continuous infusion in a trauma patient, resulting in excellent analgesia without adverse effects.

Recurrent Scapular Metastasis From Hepatoblastoma Shown on FDG PET/CT and F-DOPA PET/CT.

PubMed

Zhang, Bing; He, Qiao; Shi, Xinchong; Wang, Xiaoyan; Zhang, Xiangsong

2017-10-01

We report the case of a 4-year-old girl with a biochemical relapse (plasma α-fetoprotein of 57,987.6 μg/L) after hepatoblastoma and extrahepatic metastases removal and adjuvant chemotherapy. Abdominal ultrasound, CT, and MRI failed to determine the site of recurrence. F-FDG PET/CT showed increased activity in the region of left scapula and adjacent soft tissue, which was incorrectly interpreted as the postoperative repair or inflammatory change. F-DOPA PET/CT showed increased activity and noticeable progressed lesion in the same place. Finally, the left scapula was identified as the site of recurrent metastasis from hepatoblastoma by pathological examination.

The potential role of brain asymmetry in the development of adolescent idiopathic scoliosis: a hypothesis.

PubMed

Niesluchowski, W; Dabrowska, A; Kedzior, K; Zagrajek, T

1999-10-01

The size asymmetry of cerebral hemispheres may predispose to head tilt and asymmetric blocking of the zygapophysial joints, potentially leading to the development of compensatory curvatures in the lower segments of the spine. To analyze the effects of spinal manipulation, maintained by an exercise program, on the progression of idiopathic adolescent scoliosis in 2 children aged 6 and 10. The scoliosis found was 16 and 60 degrees. For diagnosis and monitoring of therapy, we recorded qualitative parameters of shoulder asymmetry, axillary line asymmetry, and scapular angle position. Manual treatment consisted of the examinations of all sliding motion in zygapophysial joints and both sacroiliac joints and removing the limitations of the sliding motions according to the method of Karel Lewit. The treatment procedure consisted of 3 or 4 manipulations within 17 months and an exercise program. The manipulation effects were maintained by the exercise program. The exercises were done in 2 or 3 sessions weekly for a year. In both patients we observed that scoliosis decompensation was successfully stopped and the effects of the correction persisted for 10 years. Brain and head asymmetry may be only a transient state, predisposing to asymmetric blocking at the atlanto-occipital level. Removal of blocking may prevent curve progression in children who had adolescent idiopathic scoliosis. The manipulative therapy may also have a promising effect on retarding curve progression when used in skeletally immature patient.

Outcomes of reverse shoulder arthroplasty using a mini 25-mm glenoid baseplate.

PubMed

Athwal, George S; Faber, Kenneth J

2016-01-01

As worldwide use of reverse shoulder arthroplasty (RSA) increases, a range of implant sizes may be required to match regional and ethnic variation in patients' height and bone size. The purpose of this study was to report the outcomes of RSA using a mini 25-mm-diameter glenoid baseplate in smaller patients with rotator cuff arthropathy. Between 2009 and 2012, 28 patients underwent RSA for cuff-tear arthropathy using a 25-mm circular glenoid baseplate (Aequlais Reversed, Tornier, Bloomington, MN, USA). Twenty-four patients were able to return for comprehensive follow-up. The mean height of the entire cohort was 158 ± 10 cm (5 ft. 2 in.). The indication to use a smaller baseplate was a combination of preoperative templating using computed tomography (CT) and intraoperative measurements of glenoid width. At a mean of 36 ± 8 months' follow-up, there were no revisions or glenoid-sided failures. The mean American Shoulder and Elbow Surgeons (ASES) score was 70 ± 10, the Simple Shoulder Test (SST) was 10 ± 2, the Constant was 60 ± 10 and the Disabilities of the Arm, Shoulder and Hand (DASH) was 18 ± 15. Mean active forward elevation was 140 ± 15°, active external rotation was 21 ± 15° and active internal rotation was to the sacroiliac joint. Mean shoulder strength in flexion was 5.2 ± 1.7 kg, in external rotation was 2.9 ± 1.4 kg and in internal rotation was 4.3 ± 1.2 kg. Radiographs demonstrated no evidence of glenoid loosening. There was, however, a 62 % rate of scapular notching. Short-term outcomes of mini 25-mm baseplate RSA in proportionally smaller patients are good and demonstrate implant safety and effectiveness. Scapular notching rates are worrisome, and additional follow-up is necessary to determine if notching is progressive and becomes symptomatic.

Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.

PubMed

Boneti, Cristiano; Arentz, Candy; Klimberg, V Suzanne

2010-10-01

Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain. An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics. Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases. Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

SUSTAINED ISOMETRIC SHOULDER CONTRACTION ON MUSCULAR STRENGTH AND ENDURANCE: A RANDOMIZED CLINICAL TRIAL.

PubMed

Myers, Natalie L; Toonstra, Jenny L; Smith, Jacob S; Padgett, Cooper A; Uhl, Tim L

2015-12-01

The Advanced Throwers Ten Exercise Program incorporates sustained isometric contractions in conjunction with dynamic shoulder movements. It has been suggested that incorporating isometric holds may facilitate greater increases in muscular strength and endurance. However, no objective evidence currently exists to support this claim. The purpose of this research was to compare the effects of a sustained muscle contraction resistive training program (Advanced Throwers Ten Program) to a more traditional exercise training protocol to determine if increases in shoulder muscular strength and endurance occur in an otherwise healthy population. It was hypothesized that utilizing a sustained isometric hold during a shoulder scaption exercise from the Advanced Throwers Ten would produce greater increases in shoulder strength and endurance as compared to a traditional training program incorporating a isotonic scapular plane abduction (scaption) exercise. Randomized Clinical Trial. Fifty healthy participants were enrolled in this study, of which 25 were randomized into the traditional training group (age: 26 ± 8, height:172 ± 10 cm, weight: 73 ± 13 kg, Marx Activity Scale: 11 ± 4) and 25 were randomized to the Advanced Throwers Ten group (age: 28 ± 9, height: 169 ± 23 cm, weight: 74 ± 16 kg, Marx Activity Scale: 11 ± 5). No pre-intervention differences existed between the groups (P>0.05). Arm endurance and strength data were collected pre and post intervention using a portable load cell (BTE Evaluator, Hanover, MD). Both within and between group analyses were done in order to investigate average torque (strength) and angular impulse (endurance) changes. The traditional and Advanced Throwers Ten groups both significantly improved torque and angular impulse on both the dominant and non-dominant arms by 10-14%. There were no differences in strength or endurance following the interventions between the two training groups (p>0.75). Both training approaches increased strength and endurance as the muscle loads were consistent between protocols indicating that either approach will have positive effects. Level 2.

Clinical concepts for treatment of the elbow in the adolescent overhead athlete.

PubMed

Ellenbecker, Todd S; Reinold, Michael; Nelson, Cory O

2010-10-01

Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the upper extremity kinetic chain during these overhead activities as well as a detailed examination and rehabilitation for the entire upper extremity kinetic chain. Particular emphasis on improving rotator cuff strength and muscular endurance, along with scapular stabilization, is a critical part of elbow rehabilitation in these patients. In addition, the use of a strategic and progressive interval sport return program is necessary to minimize reinjury and return the adolescent overhead athlete to full function. Copyright © 2010 Elsevier Inc. All rights reserved.

Transposition cutaneous flap and split skin mesh graft as combined optimal treatment approach for Giant Neglected multicentric BCC of the Shoulder.

PubMed

Tchernev, Georgi; Pidakev, Ivan

2018-05-31

We report for a 70-year-old cachectic patient - 165 cm, 45 kg, who was admitted for the first time to the dematosurgical unit for a surgical removal of a tumor formation localized in the region of the back from more than 15 years (fig. 1a). In the last few months the lesion has increased significantly in size and causes burning sensation, mild pain and abundant secretion of bloody yellow secretions (fig. 1a). During the dermatological examination a tumor-like formation in the left scapular region was visualized, This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Anticipatory postural adjustments during sitting reach movement in post-stroke subjects.

PubMed

Pereira, Soraia; Silva, Cláudia C; Ferreira, Sílvia; Silva, Cláudia; Oliveira, Nuno; Santos, Rubim; Vilas-Boas, John P; Correia, Miguel V

2014-02-01

The study assessed the effect of velocity of arm movement on anticipatory postural adjustments (APAs) generation in the contralateral and ipsilateral muscles of individuals with stroke in seating. Ten healthy and eight post-stroke subjects were studied in sitting. The task consisted in reaching an object placed at scapular plane and mid-sternum height at self-selected and fast velocities. Electromyography was recorded from anterior deltoid (AD), upper (UT) and lower trapezius (LT) and latissimus dorsi (LD). While kinematic analysis was used to assess peak velocity and trunk displacement. Differences were found between the timing of APAs on ipsi and contralateral LD and LT in both movement speeds and in ipsilateral UT during movement of the non-affected arm at a self-selected velocity. A delay on the contralateral LD to reach movement with the non-affected arm at fast velocity was also observed. The trunk displacement was greater in post-stroke subjects. Individuals with stroke demonstrated a delay of APAs in the muscles on both sides of the body compared to healthy subjects. The delay was observed during performance of the reaching task with the fast and self-selected velocity. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evidence-based rehabilitation of athletes with glenohumeral instability.

PubMed

Cools, Ann M; Borms, Dorien; Castelein, Birgit; Vanderstukken, Fran; Johansson, Fredrik R

2016-02-01

To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. Expert opinion, Level V.

Acromion Index in Korean Population and Its Relationship with Rotator Cuff Tears.

PubMed

Kum, Dong Ho; Kim, Jun Ho; Park, Keun Min; Lee, Eun Su; Park, Yong Bok; Yoo, Jae Chul

2017-06-01

Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations. We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups. The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups ( p <0.001, 95% confidence interval). The AI was not related to tear size. Our study showed that the AI was an effective predictive factor for rotator cuff tears in a Korean population.

Rajella paucispinosa n. sp., a new deep-water skate (Elasmobranchii, Rajidae) from the western Indian Ocean off South Mozambique, and a revised generic diagnosis.

PubMed

Weigmann, Simon; Stehmann, Matthias F W; Thiel, Ralf

2014-08-08

A new species of the widely in temperate and tropical latitudes distributed skate genus Rajella is described based on an almost adult male specimen from the western Indian Ocean off South Mozambique. The holotype of R. paucispinosa n. sp. was caught during cruise 17 of RV 'Vityaz' along the deep western Indian Ocean in 1988/89. It is the northernmost record of a Rajella specimen in the western Indian Ocean. The new species is the 18th valid species of the genus and the fifth species in the western Indian Ocean. It differs from its congeners in the small maximal total length of about 50 cm and only few thorns on the dorsal surface. The new species has only two thorns on each orbit, one nuchal thorn, one right scapular thorn (left one not detectable, abraded), and one median row of tail thorns. Other species of Rajella typically have half rings of thorns on orbital rims, a triangle of thorns on nape-shoulder region, and at least three rows of tail thorns. Another conspicuous feature of the new species is the almost completely white dorsal and ventral coloration. 

Mercury contamination in free-ranging great egret nestlings (Ardea albus) from southern Florida, USA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sepulveda, M.S.; Frederick, P.C.; Spalding, M.G.

1999-05-01

Between March and June of 1994 and 1995, mercury (Hg) concentrations were determined from 393 blood and 164 growing scapular feathers from 252 great egret nestlings (Ardea albus). Nestlings came from eight colonies located in Water Conservation Area 3 in the Everglades region in southern Florida. The ages of these birds ranged from 1 to 44 d (bill length 1.1 to 10.2 cm). Mercury concentrations in blood and feathers of first-hatched great egret nestlings sampled during 1994 averaged 1.2 {micro}g/g (range = 0.07--3.9) wet weight and 16 {micro}g/g (4.5--40) dry weight, respectively. During 1995, first-hatched chicks had blood and feathermore » Hg concentrations that averaged 0.8 {micro}g/g (0.2--1.7) and 9.7 {micro}g/g (2.3--26), respectively. In both years, Hg concentrations in blood and feathers were significantly correlated, and a significant correlation also was found between Hg in blood and age of the chicks. Blood and feather Hg concentrations differed significantly between years, with higher concentrations during 1994. Birds from JW1 and L67 colonies had the highest concentrations of Hg in blood and feathers. Mercury concentrations did not differ between chicks of different hatch order Mercury in feathers of great egret nestlings from southern Florida are approximately six times higher than when compared to feather Hg concentrations of nestlings wading birds sampled elsewhere.« less

Two new species of frogs of the genus Pristimantis from Llanganates National Park in Ecuador with comments on the regional diversity of Ecuadorian Pristimantis (Anura, Craugastoridae).

PubMed

Navarrete, María J; Venegas, Pablo J; Ron, Santiago R

2016-01-01

We describe two new species of frogs of the genus Pristimantis from the eastern slopes of the Ecuadorian Andes, at Parque Nacional Llanganates. The new species are characterized by the spiny appearance typical of several species inhabiting montane forests. Pristimantis yanezi sp. n. is most similar to Pristimantis colonensis and Pristimantis incanus but differs from both in groin coloration and by having smaller tubercles on the upper eyelids, heels, and tarsus. Pristimantis llanganati sp. n. is most similar to Pristimantis eriphus and Pristimantis chloronotus. It can be distinguished from Pristimantis eriphus by the color pattern on the scapular region and by having smaller conical tubercles on the dorsum. Pristimantis chloronotus differs from Pristimantis llanganati sp. n. in having a pair of sinuous paravertebral folds. Both new species occur in a region with few amphibian collections and nothing is known about their abundance and ecology. Therefore, it is recommended to assign them to the Data Deficient Red List category. Updated figures of species richness of Pristimantis among biogeographic regions in Ecuador are also presented. Pristimantis reach their highest diversity in Montane Forests of the eastern versant of the Andes. Its species richness across regions cannot be explained by regional area, elevation, temperature, or precipitation. Political endemism in Pristimantis is higher than that of other terrestrial vertebrates.

Nocturnal activity of nesting shrubland and grassland passerines: Chapter 9

USGS Publications Warehouse

Slay, Christy M.; Ellison, Kevin S.; Ribic, Christine; Smith, Kimberly G.; Schmitz, Carolyn M.

2013-01-01

Nocturnal activity of nesting passerines is largely undocumented in field situations. We used video recordings to quantify sleep patterns of four shrubland and three grassland bird species during the nestling period. All species exhibited “back sleep” (bill tucked under scapular feathers); individuals woke frequently for vigils of their surroundings. Sleep-bout duration varied from 6 minutes (grasshopper sparrow) to 28 minutes (blue-winged warbler, field sparrow). Duration on nest varied from 6.4 hours (field sparrow) to 8.8 hours (indigo bunting). Adults woke 20–30 minutes before sunrise. First morning absence from the nest was short; nestlings were fed within 12 minutes of a parent’s departure. Further research is needed to understand energetic costs of sleep and behavioral adaptations to environmental pressures.

Inflammatory fibrous histiocytoma presenting leukemoid reaction.

PubMed

Takahashi, K; Kimura, Y; Naito, M; Yoshimura, T; Uchida, H; Araki, S

1989-05-01

A case of inflammatory fibrous histiocytoma presenting leukemoid reaction is reported. A tumor had developed at the right scapular region 10 years ago and recurred twice with fever and leukocytosis, and finally with leukemoid reaction. Besides the histopathological features typical of malignant fibrous histiocytoma, this tumor showed prominent and diffuse infiltration of neutrophilic leukocytes. Hematologic examination of the bone marrow aspirates disclosed myeloid hyperplasia. Bacteriological examination revealed no pathogenic microorganisms in the tumor tissue. Chemotactic activity of the neutrophilic leukocytes was demonstrated in the extract obtained from the tumor, and subcutaneous injection of the extract into rats induced myeloid hyperplasia in the bone marrow and neutrophil infiltration in the liver and spleen of the animals. These results suggest the possibility of the case as a colony-stimulating factor-producing tumor.

Kinetic chain abnormalities in the athletic shoulder.

PubMed

Sciascia, Aaron; Thigpen, Charles; Namdari, Surena; Baldwin, Keith

2012-03-01

Overhead activities require the shoulder to be exposed to and sustain repetitive loads. The segmental activation of the body's links, known as the kinetic chain, allows this to occur effectively. Proper muscle activation is achieved through generation of energy from the central segment or core, which then transfers the energy to the terminal links of the shoulder, elbow, and hand. The kinetic chain is best characterized by 3 components: optimized anatomy, reproducible efficient motor patterns, and the sequential generation of forces. However, tissue injury and anatomic deficits such as weakness and/or tightness in the leg, pelvic core, or scapular musculature can lead to overuse shoulder injuries. These injuries can be prevented and maladaptations can be detected with a thorough understanding of biomechanics of the kinetic chain as it relates to overhead activity.

Measurement of muscle thickness of the serratus anterior and lower trapezius using ultrasound imaging in competitive recreational adult swimmers, with and without current shoulder pain.

PubMed

McKenna, Leanda J; de Ronde, Mandy; Le, Minyang; Burke, William; Graves, Anna; Williams, Sian A

2018-02-01

To compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging. A single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers. Muscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm. There was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group. There appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Physical Risk Factors for a Medial Elbow Injury in Junior Baseball Players: A Prospective Cohort Study of 353 Players.

PubMed

Sakata, Jun; Nakamura, Emi; Suzukawa, Makoto; Akaike, Atsushi; Shimizu, Kuniaki

2017-01-01

The physical risk factors for a medial elbow injury in junior baseball players are unknown. To identify the risk factors for an initial medial elbow injury in junior baseball players. Case-control study; Level of evidence, 3. Junior baseball players (aged 6-12 years) without a history of elbow pain underwent a clinical assessment, ultrasonography, and physical function measurements before the baseball season started. Bilateral passive range of motion (ROM) of elbow extension and flexion, external rotation (ER) and internal rotation (IR) of the shoulder, and ER and IR of the hip were measured. IR and ER strength of the shoulder and scapular muscles were measured on both sides. The thoracic kyphosis angle was measured with participants in a relaxed standing position. Before these examinations, every participant completed a questionnaire regarding his or her age, sex, total years of baseball played, position in baseball, number of balls thrown, and episodes of pain during throwing. After the initial test session, each participant was followed up for 12 months to assess for the occurrence of a new injury. Multiple regression analysis was used to identify the risk factors for a medial elbow injury. Seventy-eight players (22.1%) sustained a medial elbow injury. Age ≥9 years (odds ratio [OR], 2.708; 95% CI, 1.224-5.990), pitcher position (OR, 2.620; 95% CI, 1.389-4.941), >100 throws per day (OR, 1.936; 95% CI, 1.072-3.497), thoracic kyphosis angle ≥30° (OR, 2.501; 95% CI, 1.381-4.531), and elbow extension deficit ≥5° (OR, 1.973; 95% CI, 1.022-3.809) were significantly associated with a medial elbow injury. The incidence of an initial medial elbow injury was 22.1%. Age, number of throws per day, thoracic kyphosis angle, and elbow extension deficit are newly discovered risk factors related to physical function. Improvement of the posture and early detection of a silent elbow extension deficit may prevent a medial elbow injury.

Bone Grafting the Glenoid Versus Use of Augmented Glenoid Baseplates with Reverse Shoulder Arthroplasty.

PubMed

Jones, Richard B; Wright, Thomas W; Roche, Christopher P

2015-12-01

Large glenoid defects are a difficult reconstructive problem for surgeons performing reverse shoulder arthroplasty (rTSA). Options to address glenoid defects include eccentric reaming, bone grafting, and augmented glenoid baseplates. Augmented glenoid baseplates may provide a simpler, cost-effective, bone-preserving option compared to other techniques. No studies report the use of augmented baseplates to correct glenoid deformity in rTSA relative to the use of glenoid bone graft. We retrospectively reviewed 80 patients that received a primary rTSA and received either a structural bone graft or an augmented glenoid baseplate to address a significant glenoid defect. There were 39 patients in the augmented baseplate cohort and 41 patients in the bone graft cohort. The augmented baseplate cohort contained 24 8° posterior augment implants and 15 10° superior augment baseplates. The bone graft cohort consisted of 36 autograft humeral heads and 5 allograft femoral heads. The average follow-up for rTSA patients with an augmented baseplate was 28.3 ± 5.7 months, and the average follow-up for rTSA patients with glenoid bone graft was 34.1 ± 15.0 months. Each patient was scored preoperatively and at latest follow-up using the SST, UCLA, ASES, Constant, and SPADI metrics. Range of motion data was obtained as well. All patients demonstrated significant improvements in pain, ROM, and functional scores following treatment with rTSA using either augmented baseplates or glenoid bone graft to correct glenoid defects. The database contained no complications for the augmented glenoid baseplate cohort, and six complications (14.6%) for the glenoid bone graft cohort (including two glenoid loosenings and graft failures). Additionally, the augmented baseplate cohort showed a lower scapular notching rate of 10% as compared to the bone graft cohort which had a notching rate of 18.5%. The results of this study suggest that either augmented glenoid baseplates or glenoid bone graft can be used to address large glenoid defects during rTSA with significant improvement in outcomes. Augmented glenoid baseplates may achieve a lower complication and scapular notching rate, but additional and longer-term clinical follow-up is required to confirm these results.

Healing rates for challenging rotator cuff tears utilizing an acellular human dermal reinforcement graft

PubMed Central

Agrawal, Vivek

2012-01-01

Purpose: This study presents a retrospective case series of the clinical and structural outcomes (1.5 T MRI) of arthroscopic rotator cuff repair with acellular human dermal graft reinforcement performed by a single surgeon in patients with large, massive, and previously repaired rotator cuff tears. Materials and Methods: Fourteen patients with mean anterior to posterior tear size 3.87 ± 0.99 cm (median 4 cm, range 2.5–6 cm) were enrolled in the study and were evaluated for structural integrity using a high-field (1.5 T) MRI at an average of 16.8 months after surgery. The Constant-Murley scores, the Flexilevel Scale of Shoulder Function (Flex SF), scapular plane abduction, and strength were analyzed. Results: MRI results showed that the rotator cuff repair was intact in 85.7% (12/14) of the patients studied. Two patients had a Sugaya Type IV recurrent tear (2 of 14; 14.3%), which were both less than 1 cm. The Constant score increased from a preoperative mean of 49.72 (range 13–74) to a postoperative mean of 81.07 (range 45–92) (P value = 0.009). Flexilevel Scale of Shoulder Function (Flex SF) Score normalized to a 100-point scale improved from a preoperative mean of 53.69 to a postoperative mean of 79.71 (P value = 0.003). The Pain Score improved from a preoperative mean of 7.73 to a postoperative mean of 13.57 (P value = 0.008). Scapular plane abduction improved from a preoperative mean of 113.64° to a postoperative mean of 166.43° (P value = 0.010). The strength subset score improved from a preoperative mean of 1.73 kg to a postoperative mean of 7.52 kg (P value = 0.006). Conclusions: This study presents a safe and effective technique that may help improve the healing rates of large, massive, and revision rotator cuff tears with the use of an acellular human dermal allograft. This technique demonstrated favorable structural healing rates and statistically improved functional outcomes in the near term. Level of Evidence: 4. Retrospective case series. PMID:22787332

Rapamycin and Chloroquine: The In Vitro and In Vivo Effects of Autophagy-Modifying Drugs Show Promising Results in Valosin Containing Protein Multisystem Proteinopathy

PubMed Central

Nalbandian, Angèle; Llewellyn, Katrina J.; Nguyen, Christopher; Yazdi, Puya G.; Kimonis, Virginia E.

2015-01-01

Mutations in the valosin containing protein (VCP) gene cause hereditary Inclusion body myopathy (hIBM) associated with Paget disease of bone (PDB), frontotemporal dementia (FTD), more recently termed multisystem proteinopathy (MSP). Affected individuals exhibit scapular winging and die from progressive muscle weakness, and cardiac and respiratory failure, typically in their 40s to 50s. Histologically, patients show the presence of rimmed vacuoles and TAR DNA-binding protein 43 (TDP-43)-positive large ubiquitinated inclusion bodies in the muscles. We have generated a VCPR155H/+ mouse model which recapitulates the disease phenotype and impaired autophagy typically observed in patients with VCP disease. Autophagy-modifying agents, such as rapamycin and chloroquine, at pharmacological doses have previously shown to alter the autophagic flux. Herein, we report results of administration of rapamycin, a specific inhibitor of the mechanistic target of rapamycin (mTOR) signaling pathway, and chloroquine, a lysosomal inhibitor which reverses autophagy by accumulating in lysosomes, responsible for blocking autophagy in 20-month old VCPR155H/+ mice. Rapamycin-treated mice demonstrated significant improvement in muscle performance, quadriceps histological analysis, and rescue of ubiquitin, and TDP-43 pathology and defective autophagy as indicated by decreased protein expression levels of LC3-I/II, p62/SQSTM1, optineurin and inhibiting the mTORC1 substrates. Conversely, chloroquine-treated VCPR155H/+ mice revealed progressive muscle weakness, cytoplasmic accumulation of TDP-43, ubiquitin-positive inclusion bodies and increased LC3-I/II, p62/SQSTM1, and optineurin expression levels. Our in vitro patient myoblasts studies treated with rapamycin demonstrated an overall improvement in the autophagy markers. Targeting the mTOR pathway ameliorates an increasing list of disorders, and these findings suggest that VCP disease and related neurodegenerative multisystem proteinopathies can now be included as disorders that can potentially be ameliorated by rapalogs. PMID:25884947

An ergonomic study of women workers in a woolen textile factory for identification of health-related problems

PubMed Central

Metgud, D. C.; Khatri, Subhash; Mokashi, M. G.; Saha, P. N.

2008-01-01

The observational cross-sectional study conducted on a sample of 100 women workers who volunteered, outlines their cardio-respiratory and musculo-skeletal profile before, during and at end of work. In addition, information on their health status in general was collected in advance. Contrary to expectation, there was no significant change in respiratory function. However, the musculo-skeletal problems were found to be abundantly present with pain in 91% of the subjects. Region-wise mapping of pain revealed that postural pain in low back was present in 47% while in neck was 19%. Scapular muscles on the right side were involved in stabilizing shoulder, which never went overhead. On the contrary, left shoulder was raised as high (>90 degrees) in spinning action, while pulling thread. This muscle work involved trapezius, deltoid and triceps action concentrically in lifting and while coming to starting position slowly, eccentrically. There was no pause since the wheel continued to spin the thread continuously, unless a worker opted to stop the work. Accordingly, left wrist and hand were in holding contraction while the right wrist and hand holding the handle were also in a fixed position with wrist in flexion with supinated forearm. Though the overall job was light as per peak HR, there was pain due to fatigue and grip strength weakened by around 10%, at the end of the day's work. In conclusion, pain and fatigue were found to be the main problems for women in the spinning section of the small-scale industry under this study. Women have to take up dual responsibility of a full-time job as well as the domestic work. It was considered that ergonomic factors such as provision of a backrest and frequent rest periods could remediate the musculo-skeletal symptoms. PMID:20040992

Analyses of phenotypic differentiations among South Georgian Diving Petrel (Pelecanoides georgicus) populations reveal an undescribed and highly endangered species from New Zealand.

PubMed

Fischer, Johannes H; Debski, Igor; Miskelly, Colin M; Bost, Charles A; Fromant, Aymeric; Tennyson, Alan J D; Tessler, Jake; Cole, Rosalind; Hiscock, Johanna H; Taylor, Graeme A; Wittmer, Heiko U

2018-01-01

Unresolved taxonomy of threatened species is problematic for conservation as the field relies on species being distinct taxonomic units. Differences in breeding habitat and results from a preliminary molecular analysis indicated that the New Zealand population of the South Georgian Diving Petrel (Pelecanoides georgicus) was a distinct, yet undescribed, species. We measured 11 biometric characters and scored eight plumage characters in 143 live birds and 64 study skins originating from most populations of P. georgicus, to assess their taxonomic relationships. We analysed differences with principal component analyses (PCA), factorial ANOVAs, and Kruskal-Wallis rank sum tests. Results show that individuals from New Zealand differ significantly from P. georgicus from all other populations as following: 1) longer wings, 2) longer outer tail feathers, 3) deeper bills, 4) longer heads, 5) longer tarsi, 6) limited collar extent, 7) greater extent of contrasting scapulars, 8) larger contrasting markings on the secondaries, 9) paler ear coverts, 10) paler collars, and 11) paler flanks. Furthermore, we used a species delimitation test with quantitative phenotypic criteria; results reveal that the New Zealand population of P. georgicus indeed merits species status. We hereby name this new species Pelecanoides whenuahouensis sp. nov. Due to severe reductions in its range and the very low number of remaining birds (~150 individuals limited to a single breeding colony on Codfish Island/Whenua Hou) the species warrants listing as 'Critically Endangered'. An abstract in the Māori language/Te Reo Māori can be found in S1 File.

Cut-off of anthropometry measurement and nutritional status among elderly outpatient in Indonesia: multi-centre study.

PubMed

Setiati, Siti; Istanti, Rahmi; Andayani, Rejeki; Kuswardhani, R A Tuty; Aryana, I G P Suka; Putu, I Dewa; Apandi, M; Ichwani, Jusri; Soewoto, Sumarmi; Dinda, Rose; Mustika, Syifa

2010-10-01

To obtain the cut-off value of anthropometric measurements and nutritional status of elderly in Indonesia. A multicentre-cross sectional study was performed at 9 hospitals in Indonesia. The data collected comprises of samples characteristics, anthropometric measurements (weight, height, trisep, bisep, subscapular, suprailiac, and circumference of the hip, waist, arm, calf, and thigh), albumin value, MNA score and ADL Index of Barthel. A total of 702 subjects were collected. The average value of serum albumin is 4.28 g/dl, with 98% subjects had normal serum albumin (> 3.5 g/dl). The mean MNA score and BMI was 23.07 and 22.54 respectively. Most of subjects (56.70%) had risk of malnutrition based on MNA score, and 45.01% had normal nutritional status based on body mass index. Average value of several anthropometric measures (weight, stature, and body mass index; sub-scapular and supra-iliac skinfolds; thigh, calf, mid-arm, and waist circumferences) in various age groups in both groups of women and men were obtained. Cut-off values of various anthropometric indicators were also analyzed in this study with MNA as a gold standard. This study showed age related anthropometric measurement differences in both men and women aged 60 years and older.

The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment.

PubMed

De Carvalho, Diana; Grondin, Diane; Callaghan, Jack

2017-10-01

The purpose of this study was to determine which office chair feature is better at improving spine posture in sitting. Participants (n = 28) were radiographed in standing, maximum flexion and seated in four chair conditions: control, lumbar support, seat pan tilt and backrest with scapular relief. Measures of lumbar lordosis, intervertebral joint angles and sacral tilt were compared between conditions and sex. Sitting consisted of approximately 70% of maximum range of spine flexion. No differences in lumbar flexion were found between the chair features or control. Significantly more anterior pelvic rotation was found with the lumbar support (p = 0.0028) and seat pan tilt (p < 0.0001). Males had significantly more anterior pelvic rotation and extended intervertebral joint angles through L1-L3 in all conditions (p < 0.0001). No one feature was statistically superior with respect to minimising spine flexion, however, seat pan tilt resulted in significantly improved pelvic posture. Practitioner Summary: Seat pan tilt, and to some extent lumbar supports, appear to improve seated postures. However, sitting, regardless of chair features used, still involves near end range flexion of the spine. This will increase stresses to the spine and could be a potential injury generator during prolonged seated exposures.

Shoulder joint abduction motion test bench: a new shoulder test bench for in vitro experiments with active muscle force simulation.

PubMed

Onder, Ursula; Blauth, Michael; Kralinger, Franz; Schmoelz, Werner

2012-05-30

In our society the average age is increasing, as are the number of proximal humeral head fractures. For fixation of these fractures, an increasing number of implants are available. New fixation devices should be compared biomechanically with established methods in a standardized fashion. The test bench that was designed was intended to simulate abduction motion of the humerus actively induced by muscle forces. We used three pneumatic muscles to apply forces to the tendons of the musculus supraspinatus and the bifid musculus deltoideus. Thus, it was possible to create an active abduction in the scapular plane. Two different fracture models (with and without medial support) were stabilised with an angular stable plate in sawbone models to reproduce a known clinical outcome with the newly designed test setup. The resultant force acting on the proximal humerus reached approximately 47% BW (per cent body weight), which amounted to 329.0 N (SD: 21.76). The supraspinatus reached maximum forces of 254.7 N (SD: 20.1) and the deltoid muscle 258.9 N (SD: 16.5). Fracture gap instrumentation with medial support resulted in a significantly reduced per-cycle fracture gap motion. The performance evaluation showed that the simulator produced predicable, reproducible movements with physiological muscle force magnitudes.

Pharmacokinetics of 2 Formulations of Transdermal Fentanyl in Cynomolgus Macaques (Macaca fascicularis)

PubMed Central

Carlson, Amy M; Kelly, Richard; Fetterer, David P; Rico, Pedro J; Bailey, Emily J

2016-01-01

Fentanyl is a μ-opioid agonist that often is used as the analgesic component for balanced anesthesia in both human and veterinary patients. Minimal information has been published regarding appropriate dosing, and the pharmacokinetics of fentanyl are unknown in NHP. The pharmacokinetic properties of 2 transdermal fentanyl delivery methods, a solution (2.6 and 1.95 mg/kg) and a patch (25 µg/h), were determined when applied topically to the dorsal scapular area of cynomolgus macaques (Macaca fascicularis). Serum fentanyl concentrations were analyzed by using liquid chromatography–mass spectrometry. Compared with the patch, the transdermal fentanyl solution generated higher drug concentrations over longer time. Adverse reactions occurred in the macaques that received the transdermal fentanyl solution at 2.6 mg/kg. Both preparations showed significant interanimal variability in the maximal serum drug levels, time to achieve maximal fentanyl levels, elimination half-life, and AUC values. Both the maximal concentration and the time at which this concentration occurred were increased in macaques compared with most other species after application of the transdermal fentanyl patch and compared with dogs after application of the transdermal fentanyl solution. The pharmacokinetic properties of transdermal fentanyl in macaques are markedly different from those in other veterinary species and preclude its use as a long-acting analgesic drug in NHP. PMID:27423151

How do deltoid muscle moment arms change after reverse total shoulder arthroplasty?

PubMed

Walker, David R; Struk, Aimee M; Matsuki, Keisuke; Wright, Thomas W; Banks, Scott A

2016-04-01

Although many advantages of reverse total shoulder arthroplasty (RTSA) have been demonstrated, a variety of complications indicate there is much to learn about how RTSA modifies normal shoulder function. This study used a subject-specific computational model driven by in vivo kinematic data to assess how RTSA affects deltoid muscle moment arms after surgery. A subject-specific 12 degree-of-freedom musculoskeletal model was used to analyze the shoulders of 26 individuals (14 RTSA and 12 normal). The model was modified from the work of Holzbaur to directly input 6 degree-of-freedom humeral and scapular kinematics obtained using fluoroscopy. The moment arms of the anterior, lateral, and posterior aspects of the deltoid were significantly different when RTSA and normal cohorts were compared at different abduction angles. Anterior and lateral deltoid moment arms were significantly larger in the RTSA group at the initial elevation of the arm. The posterior deltoid was significantly larger at maximum elevation. There was large intersubject variability within the RTSA group. Placement of implant components during RTSA can directly affect the geometric relationship between the humerus and scapula and the muscle moment arms in the RTSA shoulder. RTSA shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but show much greater intersubject variation and larger moment-arm magnitudes. These observations provide a basis for determining optimal implant configuration and surgical placement to maximize RTSA function in a patient-specific manner. Published by Elsevier Inc.

Andreas Vesalius' five hundreth anniversary: initiation of the rotator cuff concept.

PubMed

Brinkman, Romy J; Hage, J Joris

2015-12-01

The rotator cuff concept refers to the four scapulohumeral muscles that stabilize and rotate the humerus relative to the scapula. To date, the first description of the rotator cuff remained unidentified. In light of the 500th birthday of Andreas Vesalius (1515-1564) we searched his 1543 masterwork "Fabrica Corporis Humani Libri Septem" for references to the morphology and function of the rotator cuff muscles. Even though he distinguished three rather than four scapulohumeral muscles, Vesalius recognized the need for structures that prevent dislocation of the shoulder inherent to the morphology of the humeral caput and scapular socket. He recorded "three strong ligaments" and the "three muscles that rotate the arm" of which the tendons completely "embrace the ligaments of the joint" as such structures. Vesalius defined the rotator cuff concept avant la lettre.

Halechiniscidae (Heterotardigrada, Arthrotardigrada) of Oura Bay, Okinawajima, Ryukyu Islands, with descriptions of three new species

PubMed Central

Fujimoto, Shinta

2015-01-01

Abstract Marine tardigrades of the family Halechiniscidae (Heterotardigrada: Arthrotardigrada) are reported from Oura Bay, Okinawajima, one of the Ryukyu Islands, Japan, including Dipodarctus sp., Florarctus wunai sp. n., Halechiniscus churakaagii sp. n., Halechiniscus yanakaagii sp. n. and Styraconyx sp. The attributes distinguishing Florarctus wunai sp. n. from its congeners is a combination of two characters, the smooth dorsal cuticle and two small projections of the caudal alae caestus. Halechiniscus churakaagii sp. n. is differentiated from its congeners by the combination of two characters, the robust cephalic cirrophores and the scapular processes with flat oval tips, while Halechiniscus yanakaagii sp. n. can be identified by the laterally protruded arched double processes with acute tips situated dorsally at the level of leg I. A list of marine tardigrades reported from the Ryukyu Islands is provided. PMID:25755627

A rare case of hepatic duct injury from blunt abdominal trauma.

PubMed

Hasaniya, Nahidh W; Premaratne, Shyamal; Premaratne, Ishani D; McNamara, J Judson

2013-01-01

A 25 year-old male was brought to the emergency room following an apparent suicide attempt by jumping from the fourth floor. Patient had a large abdominal laceration in the right upper quadrant (RUQ). CT scan showed a sub-scapular hematoma of the liver. Due to the repeated episodes of hypotension, a laporotomy was performed and the left hepatic artery was ligated while the ductal injury was managed with a Roux-en-Y left hepatic jejunostomy and stent. Bile leakage was resolved post-operatively by day 5 and the patient was discharged home on day 13 after clearance from psychiatry. While non-iatrogenic extrahepatic biliary trauma is rare, a high degree of suspicion is essential, especially in cases like the one discussed in this report. Diagnosis can be difficult in patients undergoing observation.

Application of a quick-freezing and deep-etching method to pathological diagnosis: a case of elastofibroma.

PubMed

Hemmi, Akihiro; Tabata, Masahiko; Homma, Taku; Ohno, Nobuhiko; Terada, Nobuo; Fujii, Yasuhisa; Ohno, Shinichi; Nemoto, Norimichi

2006-04-01

A case of elastofibroma in a middle-aged Japanese woman was examined by the quick-freezing and deep-etching (QF-DE) method, as well as by immunohistochemistry and conventional electron microscopy. The slowly growing tumor developed at the right scapular region and was composed of fibrous connective tissue with unique elastic materials called elastofibroma fibers. A normal elastic fiber consists of a central core and peripheral zone, in which the latter has small aggregates of 10 nm microfibrils. By the QF-DE method, globular structures consisting of numerous fibrils (5-20 nm in width) were observed between the collagen bundles. We could confirm that they were microfibril-rich peripheral zones of elastofibroma fibers by comparing the replica membrane and conventional electron microscopy. One of the characteristics of elastofibroma fibers is that they are assumed to contain numerous microfibrils. Immunohistochemically, spindle tumor cells showed positive immunoreaction for vimentin, whereas alpha-smooth muscle actin, desmin, S-100 protein and CD34 showed negative immunoreaction. By conventional electron microscopy, the tumor cell had thin cytoplasmic processes, pinocytotic vesicles and prominent rough endoplasmic reticulum. Abundant intracytoplasmic filaments were observed in some tumor cells. Thick lamina-like structures along with their inner nuclear membrane were often observed in the tumor cell nuclei. The whole image of the tumor cell was considered to be a periosteal-derived cell, which would produce numerous microfibrils in the peripheral zone of elastofibroma fibers. This study indicated that the QF-DE method could be applied to the pathological diagnosis and analysis of pathomechanism, even for surgical specimens obtained from a patient.

Topographical anatomy of the suprascapular nerve and vessels at the suprascapular notch.

PubMed

Yang, Hee-Jun; Gil, Young-Chun; Jin, Jeong-Doo; Ahn, Song Vogue; Lee, Hye-Yeon

2012-04-01

Suprascapular nerve entrapment caused by the superior transverse scapular ligament (STSL) causes pain, and limitation of motion in the shoulder. To relieve these symptoms, suprascapular nerve decompression is performed through the resection of STSL. To describe and classify the topographic anatomy of the suprascapular notch, 103 cadaveric shoulders were dissected. The mean length and width of STSLs were 11.2 and 3.4 mm, respectively. The bony bridges replacing STSL in four shoulders were 8.2 mm long and 3.5 mm wide on average. The suprascapular nerve always ran through the notch under the STSL. All shoulders had a single suprascapular artery, while multiple suprascapular veins appeared in 21.3%. The arrangement of the suprascapular vessels was classified into three types: in Type I (59.4%), all suprascapular vessels ran over the STSL; in Type II (29.7%), the vessels ran over and under the STSL simultaneously; in Type III (10.9%), all vessels ran under the STSL. In 48.9% of cadavers, these types were bilaterally matched. The omohyoid muscle originated distantly from the STSL in 38.0%, was adjacent to it in 44.0%, and was partially over the STSL in 18.0%. The number of suprascapular vessels running under the STSL was positively correlated with the size of the STSL and the middle diameter of the suprascapular notch. Age was inversely correlated with the length of STSL. The STSL was wider in males than in females. This study provides details of the structural variations in the region of the suprascapular notch. Copyright © 2011 Wiley Periodicals, Inc.

Relationship between extrinsic factors and the acromio-humeral distance.

PubMed

Mackenzie, Tanya Anne; Herrington, Lee; Funk, Lenard; Horsley, Ian; Cools, Ann

2016-06-01

Maintenance of the subacromial space is important in impingement syndromes. Research exploring the correlation between biomechanical factors and the subacromial space would be beneficial. To establish if relationship exists between the independent variables of scapular rotation, shoulder internal rotation, shoulder external rotation, total arc of shoulder rotation, pectoralis minor length, thoracic curve, and shoulder activity level with the dependant variables: AHD in neutral, AHD in 60° arm abduction, and percentage reduction in AHD. Controlled laboratory study. Data from 72 male control shoulders (24.28years STD 6.81 years) and 186 elite sportsmen's shoulders (25.19 STD 5.17 years) were included in the analysis. The independent variables were quantified and real time ultrasound was used to measure the dependant variable acromio-humeral distance. Shoulder internal rotation and pectoralis minor length, explained 8% and 6% respectively of variance in acromio-humeral distance in neutral. Pectoralis minor length accounted for 4% of variance in 60° arm abduction. Total arc of rotation, shoulder external rotation range, and shoulder activity levels explained 9%, 15%, and 16%-29% of variance respectively in percentage reduction in acromio-humeral distance during arm abduction to 60°. Pectorals minor length, shoulder rotation ranges, total arc of shoulder rotation, and shoulder activity levels were found to have weak to moderate relationships with acromio-humeral distance. Existence and strength of relationship was population specific and dependent on arm position. Relationships only accounted for small variances in AHD indicating that in addition to these factors there are other factors involved in determining AHD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Intra-operative localisation of thoracic spine level: a simple "'K'-wire in pedicle" technique.

PubMed

Thambiraj, Sathya; Quraishi, Nasir A

2012-05-01

To describe a simple and reliable method of intra-operative localisation of thoracic spine in a single surgical setting. Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints, such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. There are several methods described in recent literature to address this. Many of them require a separate procedure which was performed often the previous day. We report a technique which addresses the issue of localising thoracic level intra-operatively. After induction of general anaesthesia, the patient was placed prone and the pedicle of interest was identified using fluoroscopy. A K-wire was then inserted percutaneously into this pedicle under image guidance [confirmed in the antero-posterior (AP) and lateral views]. The wire was then cut close to the skin after bending it. The patient was now positioned laterally and the intended procedure performed through an anterior trans-thoracic approach. The 'K' wire was removed at the end of the procedure. We routinely used this technique in all our thoracic discectomies (four cases in 2 years). There were no intra-operative complications. This method is simple, avoids the patient undergoing two procedures and requires no more ability than placing an implant in the pedicle under fluoroscopy. Placing the 'K' wire into a fixed point like the pedicle facilitates rapid intra-operative viewing of the level of interest and is removed easily at the conclusion of surgery.

Adaptive changes in the dominant shoulders of female professional overhead athletes: mutual association and relation to shoulder injury.

PubMed

Tonin, Katarina; Stražar, Klemen; Burger, Helena; Vidmar, Gaj

2013-09-01

The aim of our study was to evaluate adaptive changes in the dominant shoulders of female professional overhead athletes, their mutual association, and relation between adaptive changes and shoulder injury. Thirty-six female professional volleyball and handball players were divided into two groups: 14 athletes were included in the symptomatic group (positive shoulder injury history and specific shoulder tests) and 22 athletes were included in the asymptomatic group (negative shoulder injury history and specific shoulder tests). Clinical examinations with specific shoulder tests, evaluation of rotational mobility, and symptoms of malposition and dyskinesis of the dominant scapula (SICK scapula syndrome) were performed. Glenohumeral rotators were isokinetically tested at 60 and 150°/s, with evaluation of stability ratios and rotator fatigability. On average, the participants had decreased internal rotation (P<0.001) and increased external rotation (P<0.001), lower spiking (P<0.01 at 60 and 150°/s) and conventional ratios (P≤0.01 at 60 and 150°/s), lower eccentric external rotator peak torques (eER) (P≤0.05 at 60 and 150°/s), and marginally lower eccentric internal rotator peak torques at 60°/s (P=0.061) on the dominant side compared with the nondominant side. The symptomatic group showed decreased ER (P=0.021), higher deficit of dominant eER at 60°/s (P=0.049), and higher fatigability of internal (P=0.013) and external rotators (P=0.028). The athletes with increased ER had more scapular lateralization (ρ=0.340, P=0.042), higher spiking ratios at 60°/s (ρ=0.349, P=0.037) and 150°/s (ρ=0.330, P=0.049), and lower cocking ratios at 60°/s (ρ=-0.477, P=0.003). Decreased dominant ER, higher deficit of dominant eccentric ER peak torques, and higher dominant rotator fatigability correlate with previous shoulder pain/injury. Different adaptive changes (rotational mobility, SICK scapula signs, and glenohumeral muscular imbalance) are inter-related. As a form of both prevention and rehabilitation for the athletes at risk, we recommend individually adjusted shoulder training on the basis of clinical and isokinetic testing.

Restoration of shoulder biomechanics according to degree of repair completion in a cadaveric model of massive rotator cuff tear: importance of margin convergence and posterior cuff fixation.

PubMed

Oh, Joo Han; McGarry, Michelle H; Jun, Bong Jae; Gupta, Akash; Chung, Kyung Chil; Hwang, James; Lee, Thay Q

2012-11-01

Complete repair in massive rotator cuff tear may not be possible, allowing for only partial repair. However, the effect of partial repair on glenohumeral biomechanics has not been evaluated. Therefore, the purpose of this study was to compare the rotational range of motion (ROM), glenohumeral kinematics, and gap formation at the repaired tendon edge following massive cuff tear and repair according to the degree of repair completion. Posterior fixation will restore the altered biomechanics of massive rotator cuff tear. Controlled laboratory study. Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane. Muscle loading was applied based on physiological muscle cross-sectional area ratios. Maximum internal (MaxIR) and external rotations (MaxER) were measured. Humeral head apex (HHA) position and gap formation at the repaired tendon edge were measured using a MicroScribe from MaxIR to MaxER in 30° increments. Testing was performed for intact, massive cuff tear, complete repair, and 4 types of partial repair. A repeated-measures analysis of variance was used to determine significant differences. Massive tear significantly increased ROM and shifted HHA superiorly in MaxIR at all abduction angles (P < .05). The complete repair restored ROM to intact (P < .05), while all partial repairs did not. Abnormal HHA elevation due to massive tear was restored by all repairs (P < .05). Release of the anterior single row alone and release of the marginal convergence significantly increased gap formation at the anterior tendon edge (P < .05). This study emphasizes the importance of anterior fixation in massive cuff tear to restore rotational range of motion and decrease gap formation at the repaired tendon edge and of posterior fixation to restore abnormal glenohumeral kinematics due to massive cuff tear. If complete repair of massive cuff tear is not possible, posterior cuff (infraspinatus) repair is necessary to restore abnormal glenohumeral kinematics, and margin convergence anteriorly is recommended to decrease gap formation of the repaired tendon edge, which may provide a better biomechanical environment for healing.

Intracardiac metastasis originated from chondrosarcoma.

PubMed

Maurea, Nicola; Ragone, Gianluca; Coppola, Carmela; Caronna, Antonietta; Tocchetti, Carlo G; Agozzino, Lucio; Apice, Gaetano; Iaffaioli, Rosario V

2017-05-01

Primary cardiac tumors are extremely rare. By comparison, metastatic involvement of the heart is over 20 times more common and has been reported in autopsy series in up to one in five patients dying of cancer. Cardiac metastasis of chondrosarcoma is absolutely not frequent. In the recent literature, a cardiac metastasis from chondrosarcoma has never been described. We report the case of an 18-year-old man with a diagnosis of cardiac metastasis that originated from a left scapular chondrosarcoma. Chondrosarcoma is a skeletal tumor with various grades of malignancy, rapidly evolving, and with a strong tendency to metastasize, with low responsiveness to chemotherapy. The onset of characteristic systemic symptoms in the late stage of the disease led to the diagnosis of a mass localized in the right atrium. Management and differential diagnosis of infective heart lesions were also very complex in a rapidly evolving life-threatening condition.

[Two new species of Phrynopus (Anura: Leptodactylidae) from the Bolivian cloud forests].

PubMed

Aguayo Vedia, C R; Harvey, M B

2001-03-01

We describe two new species of Phrynopus from cloud forests in Cochabamba, Bolivia. The new species are assigned to the P. peruanus group and are characterized by the presence of basal webbing, distinctive coloration, and by having the first finger shorter than the second. The first of these new species was collected near Montepunko in Parque Nacional Carrasco and is known from eight males and six females. Among its distinctive characteristics are round cream-colored glands on its flanks. A second species is known from one male and one female collected near "Zona de Aguirre" near the northwest border of the park. V and X-shaped blotches and a dorsum that is smooth except for dorsolateral and scapular folds characterize this species. Musculature has rarely been described for species of Phrynopus. The species from Montepunko has unusual gular and thigh musculature that is quite unlike other species of the genus.

PubMed Central

Descarreaux, Martin; Blouin, Jean-Sébastien; Normand, Martin C; Hudon, Daniel

2001-01-01

Background: Ankylosing spondylitis (AS) produces gradual ossification in articular components of the sacro-iliac joints, spine, thoracic and scapular region. This pathology features a diminution of range of motion, muscle force and extensibility as well as functional capacities. Actual treatment of ankylosing spondylitis includes exercise program aimed at pain control, restoration of normal muscle force and extensibility and improvement in functional capacities. These programs are designed to adapt to the special characteristics of ankylosing spondylitis population. Case study: We present the case of a 30 years old man suffering from AS who participated in a 10 week exercise program based on his personal characteristics. We evaluated changes in trunk and hip muscle force and extensibility, pain level (visual pain scale) and disability level (Modified Oswerstry questionnaire). Conclusion: He showed improvement of some physical characteristics that were deficient in the initial evaluation. Improvement were noted in trunk range of motion, some muscular group forces and extensibility of certain muscles too.

Musculoskeletal dysfunctions associated with swimmers' shoulder.

PubMed

Struyf, Filip; Tate, Angela; Kuppens, Kevin; Feijen, Stef; Michener, Lori A

2017-05-01

Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called 'swimmers' shoulder' has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers' shoulder can assist clinicians in developing rehabilitation strategies. This literature review aims at providing clinicians insight into the musculoskeletal mechanisms and impairments associated with swimmers' shoulder that could aid them in developing rehabilitation strategies. The following musculoskeletal dysfunctions will be discussed: muscle activity, strength, endurance, muscle control, range of motion, glenohumeral laxity, glenohumeral instability, shoulder posture and scapular dyskinesis. The findings in this review may have implications for swimmers, their coaches, and rehabilitation specialists working with swimmers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Fenestration of axillary vein by a variant axillary artery.

PubMed

Hadimani, S; Desai, S D; Bagoji, I B; Patil, B S

2013-01-01

Variations of venous pattern in the arm are common. In this case report, we present a variation of axillary artery and vein. During routine educational dissections of axillary region, it was observed that a fenestrated axillary vein was perforated by a variant axillary artery in right arm of an old male cadaver. The axillary artery which was fenestrated through axillary vein had only two branches arising from its second part and no branches from its remaining distal parts. The branches are thoraco-acromial (usual) and another large collateral (unusual) branch. This collateral branch is the origin of several important arteries as the subscapular, circumflex scapular, posterior circumflex humeral and lateral thoracic arteries. We propose to name this artery as collateral axillary arterial trunk. The course of this collateral axillary arterial trunk and its branches and also clinical significance of this variation are discussed in the paper.

Parry-romberg syndrome with en coup de sabre.

PubMed

Jun, Jae Hun; Kim, Ho Youn; Jung, Han Jin; Lee, Weon Ju; Lee, Seok-Jong; Kim, Do Won; Kim, Moon Bum; Kim, Byung Soo

2011-08-01

Parry-Romberg syndrome (PRS) is a relatively rare degenerative disorder that is poorly understood. PRS is characterized by slowly progressing atrophy affecting one side of the face, and is frequently associated with localized scleroderma, especially linear scleroderma, which is known as en coup de sabre. This is a report of the author's experiences with PRS accompanying en coup de sabre, and a review of the ongoing considerable debate associated with these two entities. Case 1 was a 37-year-old woman who had right hemifacial atrophy with unilateral en coup de sabre for seven years. Fat grafting to her atrophic lip had been conducted, and steroid injection had been performed on the indurated plaque of the forehead. Case 2 was a 29-year-old woman who had suffered from right hemifacial atrophy and bilateral en coup de sabre for 18 years. Surgical corrections such as scapular osteocutaneous flap and mandible/maxilla distraction showed unsatisfying results.

MR imaging of peripheral nervous system involvement: Parsonage-Turner syndrome.

PubMed

Zara, Gabriella; Gasparotti, Roberto; Manara, Renzo

2012-04-15

A 55-year-old woman complained of right scapular pain, like burning, radiating down his right arm and numbness in the first three fingers of the hand. Neurologic examination showed a slight deficit of the right brachial triceps muscle. Neurophysiological assessment showed a mild involvement of the seventh right spinal root (C7). Conventional MR imaging of the cervical spine showed mild disc protrusion at level C5-C6 without spinal root compression. High resolution MR neurography with multiplanar reconstruction along the course of the right brachial plexus showed a mild increase in signal intensity and thickening of the C7 root, middle trunk and posterior cord, consistent with Parsonage-Turner Syndrome. STIR images showed increased signal intensity in the right infraspinatus muscle innervated by the suprascapular nerve. In our case, sensitivity and specificity of the new MR sequences are higher than the clinical and neurophysiological evaluations. Copyright © 2011 Elsevier B.V. All rights reserved.

Nematocysts of Rhopilema nomadica (Scyphozoa: Rhizostomeae), an immigrant jellyfish in the eastern mediterranean.

PubMed

Avian, M; Spanier, E; Galil, B

1995-05-01

Rhopilema nomadica-a recently discovered scyphomedusa in the eastern Mediterranean-is considered a lessepsian migrant. Its nematocysts were extracted from the scapular and mouth-arm tentacles and examined using light and electron microscopy techniques. The morphometric parameters of the nematocysts were measured before and after complete discharge. Three categories of nematocysts were identified: heterotrichous isorhiza haploneme, holotrichous isorhiza haploneme, and heterotrichous microbasic eurytele. The relative abundance of the nematocysts and their occurrence in tissues of the jellyfish were noted. A brief discussion concerning the classification of certain types of nematocysts is given. A comparison with the available data on other Rhopilema species revealed that the nematocyst categories of R. nomadica are more similar to those of the Atlantic R. verrilli than to those of the Western Pacific R. esculentum. A brief comparison of the injuries caused by these species is given. © 1995 Wiley-Liss, Inc. Copyright © 1995 Wiley-Liss, Inc.

Complications in reverse shoulder arthroplasty

PubMed Central

Barco, Raul; Savvidou, Olga D.; Sperling, John W.; Sanchez-Sotelo, Joaquín; Cofield, Robert H.

2016-01-01

The reported rate of complications of reverse shoulder arthroplasty (RSA) seems to be higher than the complication rate of anatomical total shoulder arthroplasty. The reported overall complication rate of primary RSA is approximately 15%; when RSA is used in the revision setting, the complication rate may approach 40%. The most common complications of RSA include instability, infection, notching, loosening, nerve injury, acromial and scapular spine fractures, intra-operative fractures and component disengagement. Careful attention to implant design and surgical technique, including implantation of components in the correct version and height, selection of the best glenosphere-humeral bearing match, avoidance of impingement, and adequate management of the soft tissues will hopefully translate in a decreasing number of complications in the future. Cite this article: Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev 2016;1:72-80. DOI: 10.1302/2058-5241.1.160003. PMID:28461931

Complications in reverse shoulder arthroplasty.

PubMed

Barco, Raul; Savvidou, Olga D; Sperling, John W; Sanchez-Sotelo, Joaquín; Cofield, Robert H

2016-03-01

The reported rate of complications of reverse shoulder arthroplasty (RSA) seems to be higher than the complication rate of anatomical total shoulder arthroplasty.The reported overall complication rate of primary RSA is approximately 15%; when RSA is used in the revision setting, the complication rate may approach 40%.The most common complications of RSA include instability, infection, notching, loosening, nerve injury, acromial and scapular spine fractures, intra-operative fractures and component disengagement.Careful attention to implant design and surgical technique, including implantation of components in the correct version and height, selection of the best glenosphere-humeral bearing match, avoidance of impingement, and adequate management of the soft tissues will hopefully translate in a decreasing number of complications in the future. Cite this article: Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev 2016;1:72-80. DOI: 10.1302/2058-5241.1.160003.

Contact geometry at the undersurface of the acromion with and without a rotator cuff tear.

PubMed

Lee, S B; Itoi, E; O'Driscoll, S W; An, K N

2001-04-01

The purpose of this study was to investigate the difference in contact geometry at the undersurface of acromion in shoulders with and without a rotator cuff (RC) tear. Case-control study. Forty fresh cadaveric shoulders (average age at death, 61 years) without gross osteoarthritic changes were divided into the intact RC group (n = 20) and the RC tear group (n = 20). Clinical impingement was simulated by compressing the humeral head and the intact portion of the RC against the coracoacromial arch with an axial compressive force of 25 kg while the humerus was held abducted 20 degrees in the scapular plane. The contact pattern between the acromion and the RC was measured with Fuji Prescale super low-pressure-sensitive film (Fuji Photo Film Co, Ltd, Tokyo, Japan). The imprint image was analyzed using Global Lab image software (Automatix, Marlboro, MA). The percentage of the maximum anteroposterior dimension of the imprint on Fuji film to the anteroposterior diameter of the acromial undersurface was 29% +/- 9% in intact RC shoulders, and 39% +/- 13% in shoulders with an RC tear (P >.05). The percentage of the maximum mediolateral dimension of the imprint to the mediolateral diameter of the corresponding part of the acromial undersurface was 27% +/- 12% in intact RC shoulders, and 48% +/- 11% in shoulders with an RC tear. This difference was statistically significant (P <.005). The contact geometry of the acromial undersurface with the underlying RC in the anteroposterior dimension, which might be related to the appearance in supraspinatus outlet view, was not significantly different between shoulders with and without an RC tear. These findings suggest that factors other than acromial shape play a significant role in the pathogenesis of RC tears. The implication regarding the role of acromioplasty remains to be clarified.

Three-dimensional circumferential liposuction of the overweight or obese upper arm.

PubMed

Hong, Yoon Gi; Sim, Hyung Bo; Lee, Mu Young; Seo, Sang Won; Chang, Choong Hyun; Yeo, Kwan Koo; Kim, June-kyu

2012-06-01

Due to recent trends in liposuction, anatomic consideration of the body's fatty layers is essential. Based on this knowledge, a circumferential approach to achieving maximal aesthetic results is highlighted. In the upper arm, aspiration of fat from only the posterolateral region can result in skin flaccidity and disharmony of the overall balance of the upper arm contour. Different suction techniques were applied depending on the degree of fat accumulation. If necessary, the operation area was extended around the axillary and scapular regions to overcome the limitations of the traditional method and to achieve optimal effects. To maximize skin contracture and redraping, the authors developed three-dimensional circumferential liposuction (3D-CL) based on two concepts: circumferential aspiration of the upper arm, to which was applied different fluid infiltration and liposuction techniques in three anatomic compartments (anteromedial, anterolateral, and posterolateral), and extension of liposuction to the periaxillar and parascarpular areas. A total of 57 female patients underwent liposuction of their excess arm fat using this technique. The authors achieved their aesthetic goals of a straightened inferior brachial border and a more slender body contour. Complications occurred for five patients including irregularity, incision-site scar, and transient pigmentation. Through 3D-CL, the limitations of traditional upper arm liposuction were overcome, and a slender arm contour with a straightened inferior brachial border was produced. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at http://www.springer.com/00266.

Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors.

PubMed

Gutiérrez, Sergio; Comiskey, Charles A; Luo, Zong-Ping; Pupello, Derek R; Frankle, Mark A

2008-12-01

Evaluations of functional outcomes of reverse shoulder arthroplasty have revealed variable improvements in the range of motion and high rates of scapular notching. The purpose of this study was to systematically examine the impact of surgical factors (location of the glenosphere on the glenoid and tilt angle of the glenosphere on the glenoid) and implant-related factors (implant size, center-of-rotation offset, and humeral neck-shaft angle) on impingement-free abduction motion. A computer model was developed to virtually simulate abduction/adduction motion and its dependence on five surgical and implant-related factors. Three conditions were tested for each factor, resulting in a total of 243 simulated combinations. The overall motion was determined from 0 degrees of abduction until maximum abduction, which would be limited by impingement of the humerosocket on the scapula. In those combinations in which 0 degrees of abduction could not be achieved, the adduction deficit was recorded. The largest average increase in the range of impingement-free abduction motion resulted from a more lateral center-of-rotation offset: the average increase was 31.9 degrees with a change in the center-of-rotation offset from 0 to 10 mm, and this change resulted in an increase in abduction motion in eighty of the eighty-one combinations. The position of the glenosphere on the glenoid was associated with the second largest average increase in abduction motion (28.1 degrees when the glenosphere position was changed from superior to inferior, with the change resulting in an increase in seventy-one of the eighty-one combinations). These factors were followed by glenosphere tilt, humeral neck-shaft angle, and prosthetic size in terms of their effects on abduction motion. The largest effect in terms of avoiding an adduction deficit was provided by a humeral neck-shaft angle of 130 degrees (the deficit was avoided in forty-nine of the eighty-one combinations in which this angle was used), followed by an inferior glenosphere position on the glenoid (deficit avoided in forty-one combinations), a 10-mm lateral offset of the center of rotation, inferior tilt of the glenosphere, and a 42-mm-diameter prosthetic size. An understanding of a hierarchy of prosthetic design and implantation factors may be important to maximize impingement-free abduction motion as well as to avoid inferior impingement.

Improving anterior deltoid activity in a musculoskeletal shoulder model - an analysis of the torque-feasible space at the sternoclavicular joint.

PubMed

Ingram, David; Engelhardt, Christoph; Farron, Alain; Terrier, Alexandre; Müllhaupt, Philippe

2016-01-01

Modelling the shoulder's musculature is challenging given its mechanical and geometric complexity. The use of the ideal fibre model to represent a muscle's line of action cannot always faithfully represent the mechanical effect of each muscle, leading to considerable differences between model-estimated and in vivo measured muscle activity. While the musculo-tendon force coordination problem has been extensively analysed in terms of the cost function, only few works have investigated the existence and sensitivity of solutions to fibre topology. The goal of this paper is to present an analysis of the solution set using the concepts of torque-feasible space (TFS) and wrench-feasible space (WFS) from cable-driven robotics. A shoulder model is presented and a simple musculo-tendon force coordination problem is defined. The ideal fibre model for representing muscles is reviewed and the TFS and WFS are defined, leading to the necessary and sufficient conditions for the existence of a solution. The shoulder model's TFS is analysed to explain the lack of anterior deltoid (DLTa) activity. Based on the analysis, a modification of the model's muscle fibre geometry is proposed. The performance with and without the modification is assessed by solving the musculo-tendon force coordination problem for quasi-static abduction in the scapular plane. After the proposed modification, the DLTa reaches 20% of activation.

Reference standards to assess physical fitness of children and adolescents of Brazil: an approach to the students of the Lake Itaipú region-Brazil.

PubMed

Hobold, Edilson; Pires-Lopes, Vitor; Gómez-Campos, Rossana; de Arruda, Miguel; Andruske, Cynthia Lee; Pacheco-Carrillo, Jaime; Cossio-Bolaños, Marco Antonio

2017-01-01

The importance of assessing body fat variables and physical fitness tests plays an important role in monitoring the level of activity and physical fitness of the general population. The objective of this study was to develop reference norms to evaluate the physical fitness aptitudes of children and adolescents based on age and sex from the lake region of Itaipú, Brazil. A descriptive cross-sectional study was carried out with 5,962 students (2,938 males and 3,024 females) with an age range of 6.0 and 17.9 years. Weight (kg), height (cm), and triceps (mm), and sub-scapular skinfolds (mm) were measured. Body Mass Index (BMI kg/m 2 ) was calculated. To evaluate the four physical fitness aptitude dimensions (morphological, muscular strength, flexibility, and cardio-respiratory), the following physical education tests were given to the students: sit-and-reach (cm), push-ups (rep), standing long jump (cm), and 20-m shuttle run (m). Females showed greater flexibility in the sit-and-reach test and greater body fat than the males. No differences were found in BMI. Percentiles were created for the four components for the physical fitness aptitudes, BMI, and skinfolds by using the LMS method based on age and sex. The proposed reference values may be used for detecting talents and promoting health in children and adolescents.

Preliminary evaluation of the sensitivity to change of DE-STA motor unit number estimation in the upper trapezius muscle in amyotrophic lateral sclerosis.

PubMed

Ives, Colleen T; Findlater, Karen; Shoesmith, Christen L; Doherty, Timothy J

2015-07-01

To compare the sensitivity to change of decomposition-enhanced spike-triggered averaging (DE-STA) motor unit number estimation (MUNE) in the upper trapezius (UT) to that of various clinical outcome measures in subjects with amyotrophic lateral sclerosis (ALS). Ten patients with clinically probable or definite ALS were assessed at baseline, 2, 4 and 6months with the following outcome measures: manual muscle testing in five upper extremity muscle groups, scapular elevation and elbow flexion peak force measured with hand-held dynamometry, MUNE, forced vital capacity and the Revised ALS Functional Rating Scale (ALSFRS-R). ALSFRS-R was the only outcome measure for which there was a significant difference between baseline and 6months (p=0.034). ALSFRS-R had the largest standardized response mean (SRM), and was thus the most sensitive to change. MUNE demonstrated a decline over 6months and a moderate SRM (-0.63). This study has demonstrated a moderate degree of sensitivity to change for DE-STA MUNE as applied to the UT in subjects with ALS. In this preliminary study, DE-STA MUNE detected motor unit loss over 6months, with a moderate degree of sensitivity, in the upper trapezius of subjects with ALS. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

The antiquity of riverine adaptations in Iniidae (Cetacea, Odontoceti) documented by a humerus from the late Miocene of the Ituzaingó Formation, Argentina.

PubMed

Gutstein, Carolina Simon; Cozzuol, Mario Alberto; Pyenson, Nicholas D

2014-06-01

"River dolphins" are a paraphyletic group of toothed whales (Odontoceti) that represent independent secondary invasions of freshwater habitats. Different "river dolphin" lineages display suites of convergent morphological specializations that commonly reflect adaptations to riverine and freshwater environments, such as longirostry, reduced orbits, and wide, paddle-like flippers. One lineage, the Iniidae, is presently endemic to South America, and includes several extinct Neogene taxa along with their sole extant genus, Inia (the Amazon River dolphin). We report here a humerus recovered from the late Miocene deposits of the Ituzaingó Formation in the Paraná Basin of Argentina. The specimen exhibits diagnostic features of the family Iniidae, including a scapular-sternal joint of the humerus, which is a unique anatomical connection among mammals. This joint permits enhanced parasagittal adduction of the flipper as a control surface, relative to other odontocetes, providing Inia with a high degree of maneuverability in its structurally complex and heterogenous riverine habitat. This unique anatomical connection, here documented from the late Miocene (∼9 million years-6.5 million years old), not only provides the oldest diagnostic record for Iniidae, but it also indicates a similar habitat use for this lineage, a finding coincident with the current paleoenvironmental interpretation for the Ituzaingó Formation. Copyright © 2014 Wiley Periodicals, Inc.

Acute high-grade acromioclavicular joint injuries: quality of life comparison between patients managed operatively with a hook plate versus patients managed non-operatively.

PubMed

Natera Cisneros, Luis Gerardo; Sarasquete Reiriz, Juan

2017-04-01

Surgical indication for acromioclavicular joint (ACJ) injuries still represents a reason for shoulder and trauma debate. In high-grade injuries, surgery is advocated because some of the non-operatively managed patients may have persistent shoulder pain that could make them unable to return to their previous activity. It has been shown that many of the patients with high-grade ACJ injuries that are managed non-operatively involve the development of scapular dyskinesis, situation that may result in loss of strength and weakness. On the other side, it has been widely reported that the period while the hook plate is present involves functional limitations and pain. The purpose of this study was to compare the quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed operatively with a hook plate versus the QoL of patients managed non-operatively, 24 months or more after shoulder injury. Patients with acute high-grade ACJ injuries managed operatively (hook plate) or non-operatively, between 2008 and 2012 were included. The QoL was evaluated by means of the Health Survey questionnaire (SF36), the Visual Analogue Scale (VAS) for pain, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the Global Satisfaction (scale from 0 to 10) assessed at the last follow-up visit. The presence of scapular dyskinesis was assessed. Comparison between groups was made. Thirty-two patients were included: 11 hook plate-group (PLATE group) (5 Rockwood III and 6 V) and 21 conservative-group (CONS group) (4 Rockwood III and 17 V). The mean age was 41 [19-55] years old for the PLATE group and 38 [19-55] for the CONS group (p = 0.513). The mean follow-up was 32.50 ± 11.64 months for the PLATE group and 34.77 ± 21.98 months for the CONS group (p = 0.762). The mean results of the questionnaires assessed at the last follow-up visit were: (1) physical SF36 score (PLATE group 53.70 ± 4.33 and CONS group 52.10 ± 6.11, p = 0.449); (2) mental SF36 score (PLATE group 53.06 ± 6.10 and CONS group 56.99 ± 6.47, p = 0.110); (3) VAS for pain (PLATE group 1.45 ± 1.51 and CONS group 1.50 ± 1.79, p = 0.943); (4) DASH score (PLATE group 4.79 ± 5.60 and CONS group 5.83 ± 6.76, p = 0.668); (5) Constant score (PLATE group 91.36 ± 6.84 and CONS group 91.05 ± 7.35, p = 0.908); (6) Global Satisfaction (PLATE group 8.00 ± 1.18 and CONS group 8.45 ± 1.73, p = 0.449). There was evidence of scapular dyskinesis in 18 % (2/11) of the patients of the PLATE group and in 52.4 % (11/21) of the patients of the CONS group (p = 0.127). Patients with acute high-grade ACJ injuries managed operatively with a hook plate may have the same QoL and self-reported questionnaires than patients with high-grade ACJ injuries managed non-operatively, 24 months or more after shoulder injury. If surgery is advocated for this type of injury, the orthopedic population must be aware that the hook-plate system might not represent the most suitable option. Level IV therapeutic; retrospective comparative study.

The cat vertebral column: stance configuration and range of motion

NASA Technical Reports Server (NTRS)

Macpherson, J. M.; Ye, Y.; Peterson, B. W. (Principal Investigator)

1998-01-01

This study examined the configuration of the vertebral column of the cat during independent stance and in various flexed positions. The range of motion in the sagittal plane is similar across most thoracic and lumbar joints, with the exception of a lesser range at the transition region from thoracic-type to lumbar-type vertebrae. The upper thoracic column exhibits most of its range in dorsiflexion and the lower thoracic and lumbar in ventroflexion. Lateral flexion is limited to less than 5 degrees at all segments. The range in torsion is almost 180 degrees and occurs primarily in the midthoracic region, T4-T11. Contrary to the depiction in most atlases, the standing cat exhibits several curvatures, including a mild dorsiflexion in the lower lumbar segments, a marked ventroflexion in the lower thoracic and upper lumbar segments, and a profound dorsiflexion in the upper thoracic (above T9) and cervical segments. The curvatures are not significantly changed by altering stance distance but are affected by head posture. During stance, the top of the scapula lies well above the spines of the thoracic vertebrae, and the glenohumeral joint is just below the bodies of vertebrae T3-T5. Using a simple static model of the vertebral column in the sagittal plane, it was estimated that the bending moment due to gravity is bimodal with a dorsiflexion moment in the lower thoracic and lumbar region and a ventroflexion moment in the upper thoracic and cervical region. Given the bending moments and the position of the scapula during stance, it is proposed that two groups of scapular muscles provide the major antigravity support for the head and anterior trunk. Levator scapulae and serratus ventralis form the lateral group, inserting on the lateral processes of cervical vertebrae and on the ribs. The major and minor rhomboids form the medial group, inserting on the spinous tips of vertebrae from C4 to T4. It is also proposed that the hypaxial muscles, psoas major, minor, and quadratus lumborum could support the lumbar trunk during stance.

Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle?

PubMed Central

2010-01-01

Background The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players. Methods Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group). Results Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group. Conclusions This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases PMID:20184752

Predictors of upper trapezius pain with myofascial trigger points in food service workers: The STROBE study.

PubMed

Hwang, Ui-Jae; Kwon, Oh-Yun; Yi, Chung-Hwi; Jeon, Hye-Seon; Weon, Jong-Hyuck; Ha, Sung-Min

2017-06-01

Shoulder pain occurs commonly in food service workers (FSWs) who repetitively perform motions of the upper limbs. Myofascial trigger points (MTrPs) on the upper trapezius (UT) are among the most common musculoskeletal shoulder pain syndromes. This study determined the psychological, posture, mobility, and strength factors associated with pain severity in FSWs with UT pain due to MTrPs.In this cross-sectional study, we measured 17 variables in 163 FSWs with UT pain due to MTrPs: a visual analog scale (VAS) pain score, age, sex, Borg rating of perceived exertion (BRPE) scale, beck depression inventory, forward head posture angle, rounded shoulder angle (RSA), shoulder slope angle, scapular downward rotation ratio, cervical lateral-bending side difference angle, cervical rotation side difference angle, glenohumeral internal rotation angle, shoulder horizontal adduction angle, serratus anterior (SA) strength, lower trapezius (LT) strength, bicep strength, and glenohumeral external rotator strength, in 163 FSWs with UT pain due to MTrPs.The model for factors influencing UT pain with MTrPs included SA strength, age, BRPE, LT strength, and RSA as predictor variables that accounted for 68.7% of the variance in VAS (P < .001) in multiple regression models with a stepwise selection procedure. The following were independent variables influencing the VAS in the order of standardized coefficients: SA strength (β = -0.380), age (β = 0.287), BRPE (β = 0.239), LT strength (β = -0.195), and RSA (β = 0.125).SA strength, age, BRPE, LT strength, and RSA variables should be considered when evaluating and intervening in UT pain with MTrPs in FSWs.

Predictors of upper trapezius pain with myofascial trigger points in food service workers

PubMed Central

Hwang, Ui-Jae; Kwon, Oh-Yun; Yi, Chung-Hwi; Jeon, Hye-Seon; Weon, Jong-Hyuck; Ha, Sung-Min

2017-01-01

Abstract Shoulder pain occurs commonly in food service workers (FSWs) who repetitively perform motions of the upper limbs. Myofascial trigger points (MTrPs) on the upper trapezius (UT) are among the most common musculoskeletal shoulder pain syndromes. This study determined the psychological, posture, mobility, and strength factors associated with pain severity in FSWs with UT pain due to MTrPs. In this cross-sectional study, we measured 17 variables in 163 FSWs with UT pain due to MTrPs: a visual analog scale (VAS) pain score, age, sex, Borg rating of perceived exertion (BRPE) scale, beck depression inventory, forward head posture angle, rounded shoulder angle (RSA), shoulder slope angle, scapular downward rotation ratio, cervical lateral-bending side difference angle, cervical rotation side difference angle, glenohumeral internal rotation angle, shoulder horizontal adduction angle, serratus anterior (SA) strength, lower trapezius (LT) strength, bicep strength, and glenohumeral external rotator strength, in 163 FSWs with UT pain due to MTrPs. The model for factors influencing UT pain with MTrPs included SA strength, age, BRPE, LT strength, and RSA as predictor variables that accounted for 68.7% of the variance in VAS (P < .001) in multiple regression models with a stepwise selection procedure. The following were independent variables influencing the VAS in the order of standardized coefficients: SA strength (β = −0.380), age (β = 0.287), BRPE (β = 0.239), LT strength (β = −0.195), and RSA (β = 0.125). SA strength, age, BRPE, LT strength, and RSA variables should be considered when evaluating and intervening in UT pain with MTrPs in FSWs. PMID:28658117

Scapula kinematics of pull-up techniques: Avoiding impingement risk with training changes.

PubMed

Prinold, Joe A I; Bull, Anthony M J

2016-08-01

Overhead athletic activities and scapula dyskinesia are linked with shoulder pathology; pull-ups are a common training method for some overhead sports. Different pull-up techniques exist: anecdotally some are easier to perform, and others linked to greater incidences of pathology. This study aims to quantify scapular kinematics and external forces for three pull-up techniques, thus discussing potential injury implications. An observational study was performed with eleven participants (age=26.8±2.4 years) who regularly perform pull-ups. The upward motions of three pull-up techniques were analysed: palms facing anterior, palms facing posterior and wide-grip. A skin-fixed scapula tracking technique with attached retro-reflective markers was used. High intra-participant repeatability was observed: mean coefficients of multiple correlations of 0.87-1.00 in humerothoracic rotations and 0.77-0.90 for scapulothoracic rotations. Standard deviations of hand force was low: <5% body weight. Significantly different patterns of humerothoracic, scapulothoracic and glenohumeral kinematics were observed between the pull-up techniques. The reverse technique has extreme glenohumeral internal-external rotation and large deviation from the scapula plane. The wide technique has a reduced range of pro/retraction in the same HT plane of elevation and 90° of arm abduction with 45° external rotation was observed. All these factors suggest increased sub-acromial impingement risk. The scapula tracking technique showed high repeatability. High arm elevation during pull-ups reduces sub-acromial space and increases pressure, increasing the risk of impingement injury. Wide and reverse pull-ups demonstrate kinematics patterns linked with increased impingement risk. Weight-assisted front pull-ups require further investigation and could be recommended for weaker participants. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Inter-rater and intra-rater reliability of a movement control test in shoulder.

PubMed

Rajasekar, S; Bangera, Rakshith K; Sekaran, Padmanaban

2017-07-01

Movement faults are commonly observed in patients with musculoskeletal pain. The Kinetic Medial Rotation Test (KMRT) is a movement control test used to identify movement faults of the scapula and gleno-humeral joints during arm movement. Objective tests such as the KMRT need to be reliable and valid for the results to be applied across different clinical settings and patient populations. The primary objective of the present study was to determine the intra-rater and inter-rater reliability of KMRT in subjects with and without shoulder pain. Sixty subjects were included in this study based on specific inclusion and exclusion criteria. Two musculoskeletal physiotherapists with different levels of clinical experience performed the tests. The intra-rater reliability was tested in twenty asymptomatic subjects by a single assessor at two week intervals. An equal number of subjects with and without shoulder pain were tested by both the assessors to determine the inter-rater reliability. Both components of the KMRT, the Gleno- Humeral Anterior Translation (GHAT) and the Scapular Forward Tilt (SCFT) were tested. The Kappa values for inter-rater reliability of the GHAT and SCFT were K = 0.68 & K = 0.65 respectively in subjects with shoulder pain. In asymptomatic subjects, the inter-rater reliability of GHAT was K = 0.61 and SCFT was K = 0.85. Intra-rater reliability ranged from K = 0.66 for GHAT to K = 0.87 for SCFT. Our study found substantial agreement in inter-rater reliability of KMRT in subjects with shoulder pain, whereas substantial to near perfect agreement was found in intra-rater and inter-rater reliability of KMRT in subjects without shoulder pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Manual therapy is an effective treatment for frozen shoulder in diabetics: an observational study.

PubMed

Düzgün, Irem; Baltaci, Gül; Atay, Ozgür Ahmet

2012-01-01

This study aims to compare the efficacy of manual therapy in the frozen shoulder patients with or without diabetes mellitus. Between May 2006 and January 2008, 50 patients (10 males, 40 females; mean age 52 ± 10 years; range 40 to 65 years) orthopedic surgeons referred to the Sports Physiotherapy Unit were included in the study. The patients were divided into two groups, including patients with primary frozen shoulder with type II diabetes mellitus (n=12) and non diabetics (n=38). All patients underwent a rehabilitation program including cold application, manual therapy and exercises twice a week. A total of 16 treatment sessions were performed. The most important part of the manual therapy included scapular mobilization and posterior capsule stretching. The range of motion was measured by goniometry. Functional activity status was assessed by Constant's score. The pain level was evaluated by visual analog scale, while muscle strength was evaluated by hand-held dynamometer. Student t-test was used to compare between the parameters of groups, while Paired sample t-test was used to compare pre- and post-treatment parameters of the patients. The range of motion, functional activity status and muscular strength were improved and the pain level was reduced after rehabilitation in all of the patients in both groups (p<0.05). There was no difference in duration of the treatment between the groups (p>0.05). There were no differences in range of motion, functional activity status, pain level, and muscle strength before and after rehabilitation between the groups (p>0.05). Manual therapy approaches may be safely applied in diabetic patients with frozen shoulder.

Incidence of the coracoclavicular joint in South African populations.

PubMed Central

Nalla, S; Asvat, R

1995-01-01

The presence of a diarthrotic coracoclavicular joint, as represented by an articular facet on the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula, was investigated. The sample consisted of 60 white and 180 black South African (60 Sotho, 60 Xhosa and 60 Zulu) skeletons. Each group consisted of 30 male and 30 female skeletons. The presence of the articular facet was recorded as either bilateral, unilateral left or unilateral right. The effect of clavicular length, scapular size and first rib angle on the presence of the coracoclavicular joint was also investigated. The presence of the articular facet was noted in 23 (9.6%) of the 240 individuals studied. Of these 23 individuals, 6 (26.1%) were white and 17 (73.9%) were black. Males (56.5%) presented a higher incidence of this anomaly than females (43.5%). The articular facet occurred bilaterally in 47.9% (11/23), unilaterally on the left in 30.4% (7/23) and unilaterally on the right in 21.7% (5/23). Sexual, racial and tribal differences were not statistically significant. Individuals possessing the joint showed statistically significantly (P < 0.01) larger scapulae (increased border lengths and superior angles), longer clavicles and longer first ribs. No statistically significant differences in the first rib angles were observed between individuals who possessed the joint and those who did not, thus implying similar thoracic inlet size. It is proposed that the aforementioned morphometry of the scapulae, clavicles and first ribs may restrict associated movements of the scapulae, resulting in the development of the coracoclavicular joint. Images Fig. 4 Fig. 5 PMID:7559137

Neck proprioception, strength, flexibility, and posture in pilots with and without neck pain history.

PubMed

Nagai, Takashi; Abt, John P; Sell, Timothy C; Clark, Nicholas C; Smalley, Brian W; Wirt, Michael D; Lephart, Scott M

2014-05-01

Neck pain (NP) is common among military helicopter pilots. Older age and more flight-hours have been associated with pilots with a history of NP. However, modifiable neuromuscular and musculoskeletal characteristics such as neck proprioception, strength, flexibility, and posture have rarely been investigated in military helicopter pilots with a history of NP. The purpose of the study was to compare demographics, flight characteristics, physical fitness information, neck proprioception, strength, flexibility, and posture between helicopter pilots with and without a history of NP. A total of 27 Army helicopter pilots with NP in the past 12 mo (pain group) were matched based on age with pilots without a history of NP (nonpain group). All pilots had flown at least 100 h in the past 12 mo and were cleared for flight and physical training. All pilots completed a battery of laboratory testing: neck proprioception, neck and scapular muscular strength, neck active range-of-motion (ROM), forward head and shoulder posture, and pectoralis minor length. Paired t-tests or Wilcoxon tests were used to compare differences between groups. The pain group had significantly less cervical extension (63.7 +/- 8.5 degrees) and rotation ROM (R rotation: 67.7 +/- 8.8 degrees; L rotation: 67.4 +/- 9.0 degrees) when compared to the nonpain group (extension: 68.3 +/- 7.4 degrees; R rotation: 73.4 +/- 7.4 degrees; L rotation: 72.9 +/- 6.8 degrees). No significant differences were found for other variables. The results demonstrate less neck active ROM in pilots with a history of NP. Operating a helicopter with limited neck ROM or NP may negatively impact flight safety and force readiness. Continued research is warranted.

Eye-lens accommodation load and static trapezius muscle activity.

PubMed

Richter, H O; Bänziger, T; Forsman, M

2011-01-01

The purpose of this experimental study was to investigate if sustained periods of oculomotor load impacts on neck/scapular area muscle activity. The static trapezius muscle activity was assessed from bipolar surface electromyography, normalized to a submaximal contraction. Twenty-eight subjects with a mean age of 29 (range 19-42, SD 8) viewed a high-contrast fixation target for two 5-min periods through: (1) -3.5 dioptre (D) lenses; and (2) 0 D lenses. The target was placed 5 D away from the individual's near point of accommodation. Each subject's ability to compensate for the added blur was extracted via infrared photorefraction measurements. Subjects whose accommodative response was higher in the -D blur condition (1) showed relatively more static bilateral trapezius muscle activity level. During no blur (2) there were no signs of relationships. The results indicate that sustained eye-lens accommodation at near, during ergonomically unfavourable viewing conditions, could possibly represent a risk factor for trapezius muscle myalgia.

Risks, consequences, and prevention of falls of older people in oral healthcare centers.

PubMed

de Baat, Cees; de Baat, Paul; Gerritsen, Anneloes E; Flohil, Karien A; van der Putten, Gert-Jan; van der Maarel-Wierink, Claar D

2017-03-01

One-third of community-dwelling people older than 65 years of age fall each year, and half of them fall at least twice a year. Older care home residents are approximately three times more likely to fall when compared to community-dwelling older people. Risk indicators for falls are related to the older people's body, environment, behavior, and activities. An important health risk indicator is (orthostatic or postprandial) hypotension, which may induce cerebral hypoperfusion. Although the majority of falls remain without major consequences, 10% to 25% of falls in care homes result in bodily trauma. Prevalent fall-related injuries are brain injury, lower extremity fracture including hip fracture and forearm/wrist fracture, facial fracture, humeral fracture, and rib/scapular fracture. As fall accidents by older people can have severe consequences, prevention of falls is of paramount importance. Healthcare providers, including oral healthcare providers, should inform older people on risks of falling and draw attention to potentially hazardous arrangements. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

Comparison of grip and pinch strength in young women with and without hyperkyphosis: A cross-sectional study.

PubMed

Yoosefinejad, Amin Kordi; Ghaffarinejad, Farahnaz; Hemati, Mahbubeh; Jamshidi, Narges

2018-05-21

Hyperkyphosis is a common postural defect with high prevalence in the 20 to 50 year old population. It appears to compromise proximal scapular stability. Grip and pinch strength are used to evaluate general upper extremity function. The aim of this study was to compare pinch and grip strength between young women with and without hyperkyphosis. Thirty young women (18-40 years old) with hyperkyphosis and 30 healthy women matched for age and body mass index participated in the study. Hyperkyphosis was confirmed by measuring the kyphosis angle with a flexible ruler. Grip strength was measured with the Waisa method and a dynamometer. Pinch strength was assessed with a pinch meter. Grip (P= 0.03) and pinch strength (P= 0.04) were significantly lower in women with hyperkyphosis compared to the control group. Kyphosis angle correlated weakly with grip (r= 0.26) and pinch strength (r= 0.23). Hyperkyphotic posture has led to decreased grip and pinch strength compared to people without hyperkyphosis.

[Clinical and muscular evaluation in patients with subclinical hypothyroidism].

PubMed

Reuters, Vaneska Spinelli; Buescu, Alexandru; Reis, Fabiola A Aarão; Almeida, Cloyra Paiva; Teixeira, Patrícia F dos S; Costa, Antônio J Leal; Wagman, Márcia Branco; Ferreira, Márcia Martins; de Castro, Carmen Lucia N; Vaisman, Mario

2006-06-01

Some symptoms and signs of hypothyroidism, as well as some laboratory abnormalities, may be present in subclinical hypothyroidism (SH). This study evaluates the prevalence of signs and symptoms of hypothyroidism and skeletal muscle dysfunction in 57 patients with SH compared to 37 euthyroid controls. The participants received a clinical score based on signs and symptoms of hypothyroidism. The muscle strength was estimated by manual testing and chair dynamometer and inspiratory force by manuvacuometer. Thyroid hormones and muscle enzymes were measured. The SH group presented with higher score (p< 0.01), complained about myalgia and weakness more frequently (p< 0.05), and showed strength disability in scapular and pelvic girdles (p< 0.05). The median free T4 serum levels were lower in SH (p< 0.001). These findings suggest that signs and symptoms of thyroid dysfunction may be related to lower levels of FT4 in SH and should be taken into account in the decision of beginning LT4 therapy.

Antimicrobial Active Clothes Display No Adverse Effects on the Ecological Balance of the Healthy Human Skin Microflora

PubMed Central

Hoefer, Dirk; Hammer, Timo R.

2011-01-01

The progressive public use of antimicrobial clothes has raised issues concerning skin health. A placebo-controlled side-to-side study was run with antimicrobial clothes versus fabrics of similar structure but minus the antimicrobial activity, to evaluate possible adverse effects on the healthy skin microflora. Sixty volunteers were enrolled. Each participant received a set of form-fitting T-shirts constructed in 2 halves: an antibacterial half, displaying activities of 3–5 log-step reductions due to silver-finishes or silver-loaded fibres and a nonantibacterial control side. The microflora of the scapular skin was analyzed weekly for opportunistic and pathogenic microorganisms over six weeks. The antibacterial halves did not disturb the microflora in number or composition, whereas a silver-containing deodorant displayed a short-term disturbance. Furthermore, parameters of skin morphology and function (TEWL, pH, moisture) did not show any significant shifts. In summary, antimicrobial clothes did not show adverse effects on the ecological balance of the healthy skin microflora. PMID:22363849

A hybrid system for upper limb movement restoration in quadriplegics.

PubMed

Varoto, Renato; Barbarini, Elisa Signoreto; Cliquet, Alberto

2008-09-01

Generally, quadriplegic individuals have difficulties performing object manipulation. Toward satisfactory manipulation, reach and grasp movements must be performed with voluntary control, and for that, grasp force feedback is essential. A hybrid system aiming at partial upper limb sensory-motor restoration for quadriplegics was built. Such device is composed of an elbow dynamic orthosis that provides elbow flexion/extension (range was approximately from 20 degrees to 120 degrees , and average angular speed was approximately 15 degrees /s) with forearm support, a wrist static orthosis and neuromuscular electrical stimulation for grasping generation, and a glove with force sensors that allows grasping force feedback. The glove presents two user interface modes: visual by light emitting diodes or audio emitted by buzzer. Voice control of the entire system (elbow dynamic orthosis and electrical stimulator) is performed by the patient. The movements provided by the hybrid system, combined with the scapular and shoulder movements performed by the patient, can aid quadriplegic individuals in tasks that involve reach and grasp movements.

The Effects of Posterior Rotator Cuff Cable Tears on Glenohumeral Biomechanics in a Cadaveric Model of the Throwing Shoulder

PubMed Central

Photopoulos, Christos Demetris; ElAttrache, Neal S.; Doermann, Alex; Akeda, Masaki; McGarry, Michelle H.; Lee, Thay Q.

2017-01-01

Objectives: The rotator cuff cable has been postulated to be the primary load bearing substructure of the superior part of the rotator cuff. Tears of the posterior rotator cable are frequently seen in overhead throwing athletes. Although the biomechanical significance of the anterior rotator cable has been well described, our current understanding of the relevance of the posterior cable is limited. The purpose of this study was to examine how partial-thickness tears and full-thickness tears of the posterior rotator cable would alter glenohumeral biomechanics and kinematics in cadaveric shoulder models. Methods: Eight fresh-frozen cadaveric shoulder specimens were prepared and tested. To simulate the sequence of glenohumeral positions during the throwing motion, specimens were mounted on a custom shoulder testing system with the humerus positioned at 90° of abduction (30° scapular upward rotation, 60° glenohumeral abduction) and tested at 30, 60, 90, and 120 degrees of external rotation. After a circumferential capsulotomy was performed, rotator cuff muscles were loaded based on physiologic cross-sectional area ratios, and testing for each specimen was performed on each the following three conditions: intact posterior cable, partial-thickness (50%) articular-sided posterior cable tear, and full-thickness posterior cable tear. Primary outcome measures tested for each condition under the various degrees of glenohumeral rotation were: 1) anterior and total glenohumeral translation after application of a 30N anterior force; 2) path of glenohumeral articulation; 3) glenohumeral joint force. Results: With a 30N anterior force at 120° of external rotation, there was a significant increase in anterior glenohumeral translation between intact and full-thickness tear specimens (7.28±2.00mm and 17.49±3.75mm, respectively; p<0.05). Similarly, total joint translation at 120° of external rotation significantly increased between intact and full-thickness tear specimens (10.37±3.18mm and 23.37±5.05mm, respectively; p<0.05). No significant differences were apparent at other degrees of rotation (30, 60, 90 degrees), or with partial-thickness tears. Changes in the path of glenohumeral articulation were likewise most evident at 120° of external rotation, with a progressively anterior, inferior, and lateral shift in articulation with sequential sectioning of the posterior cable. Lastly, with regards to alterations in glenohumeral joint force, no significant changes were seen in any of the conditions. Conclusion: In this cadaveric shoulder model of the throwing shoulder, tears of the posterior rotator cuff cable lead to altered glenohumeral biomechanics and kinematics. These changes were most profound at 120° of external rotation, suggesting the importance of an intact posterior cable as a potential stabilizer during the late-cocking phase of throwing.

Upper Girdle Imaging in Facioscapulohumeral Muscular Dystrophy

PubMed Central

Tasca, Giorgio; Monforte, Mauro; Iannaccone, Elisabetta; Laschena, Francesco; Ottaviani, Pierfrancesco; Leoncini, Emanuele; Boccia, Stefania; Galluzzi, Giuliana; Pelliccioni, Marco; Masciullo, Marcella; Frusciante, Roberto; Mercuri, Eugenio; Ricci, Enzo

2014-01-01

Background In Facioscapulohumeral muscular dystrophy (FSHD), the upper girdle is early involved and often difficult to assess only relying on physical examination. Our aim was to evaluate the pattern and degree of involvement of upper girdle muscles in FSHD compared with other muscle diseases with scapular girdle impairment. Methods We propose an MRI protocol evaluating neck and upper girdle muscles. One hundred-eight consecutive symptomatic FSHD patients and 45 patients affected by muscular dystrophies and myopathies with prominent upper girdle involvement underwent this protocol. Acquired scans were retrospectively analyzed. Results The trapezius (100% of the patients) and serratus anterior (85% of the patients) were the most and earliest affected muscles in FSHD, followed by the latissimus dorsi and pectoralis major, whilst spinati and subscapularis (involved in less than 4% of the patients) were consistently spared even in late disease stages. Asymmetry and hyperintensities on short-tau inversion recovery (STIR) sequences were common features, and STIR hyperintensities could also be found in muscles not showing signs of fatty replacement. The overall involvement appears to be disease-specific in FSHD as it significantly differed from that encountered in the other myopathies. Conclusions The detailed knowledge of single muscle involvement provides useful information for correctly evaluating patients' motor function and to set a baseline for natural history studies. Upper girdle imaging can also be used as an additional tool helpful in supporting the diagnosis of FSHD in unclear situations, and may contribute with hints on the currently largely unknown molecular pathogenesis of this disease. PMID:24932477

A New Method for Treatment of Lymphedema of Limbs: Standardized Manual Massage with a New Device Linforoll in Conservative and Surgical Therapy Protocols.

PubMed

Olszewski, Waldemar L; Zaleska, Marzanna; Michelin, Sandro

2016-12-01

Edema fluid in lymphedematous limbs should be evacuated to sites where it can be absorbed. It should be moved either to the hypogastrium or arm/scapular regions along tissue channels or implanted silicon channels or through lymphovenous anastomoses. For that purpose, the manual lymphatic drainage of limb is an effective method. Standardization of manual massage applied force and timing becomes necessary. A device with known pressing area and continuously showing the applied force while moving it toward the root of the limb is needed. Moreover, force could be adjusted to the stiffness of the massaged tissues that varies at different levels of the limb. Results from such a device would be repeatable and reproducible by others. In this study we present data on tissue fluid hydromechanics obtained from 20 patients with obstructive limb lymphedema during massage with a massaging roller called Linforoll. Linforoll is composed of a hand piece with roller and pressure sensor connected wireless to the computer displaying the pressure curve of the applied force. Electron microscopy studies for checking eventual tissue changes were done. Linforoll provides the possibilities of: 1) regulating the applied force according to the hydromechanic conditions of the massaged tissues; 2) standardization of massage repeatable in the same patient; 3) decrease of limb volume; 4) evident increase in tissue elasticity; 5) application as a driving force for fluid flow along the surgically implanted tubing and vessels running to the lymphovenous shunts.

Reference standards to assess physical fitness of children and adolescents of Brazil: an approach to the students of the Lake Itaipú region—Brazil

PubMed Central

Hobold, Edilson; Pires-Lopes, Vitor; Gómez-Campos, Rossana; de Arruda, Miguel; Andruske, Cynthia Lee; Pacheco-Carrillo, Jaime

2017-01-01

Background The importance of assessing body fat variables and physical fitness tests plays an important role in monitoring the level of activity and physical fitness of the general population. The objective of this study was to develop reference norms to evaluate the physical fitness aptitudes of children and adolescents based on age and sex from the lake region of Itaipú, Brazil. Methods A descriptive cross-sectional study was carried out with 5,962 students (2,938 males and 3,024 females) with an age range of 6.0 and 17.9 years. Weight (kg), height (cm), and triceps (mm), and sub-scapular skinfolds (mm) were measured. Body Mass Index (BMI kg/m2) was calculated. To evaluate the four physical fitness aptitude dimensions (morphological, muscular strength, flexibility, and cardio-respiratory), the following physical education tests were given to the students: sit-and-reach (cm), push-ups (rep), standing long jump (cm), and 20-m shuttle run (m). Results and Discussion Females showed greater flexibility in the sit-and-reach test and greater body fat than the males. No differences were found in BMI. Percentiles were created for the four components for the physical fitness aptitudes, BMI, and skinfolds by using the LMS method based on age and sex. The proposed reference values may be used for detecting talents and promoting health in children and adolescents. PMID:29204319

A comparison of isometric, isotonic concentric and isotonic eccentric exercises in the physiotherapy management of subacromial pain syndrome/rotator cuff tendinopathy: study protocol for a pilot randomised controlled trial.

PubMed

Kinsella, Rita; Cowan, Sallie M; Watson, Lyn; Pizzari, Tania

2017-01-01

Subacromial pain syndrome (SPS) involving rotator cuff tendinopathy is a common cause of shoulder pain and disability. Evidence suggests that structured physiotherapy may be as effective as surgery in this condition with significant improvements demonstrated in trials involving scapular retraining, rotator cuff strengthening and flexibility exercises. Most published programs typically utilise isotonic concentric and/or eccentric strengthening modes. Recently, immediate analgesic effects and muscle strength gains following heavy-load isometric exercises in lower limb tendinopathy conditions have been observed. It is pertinent to ascertain whether such outcomes can be replicated in SPS/rotator cuff tendinopathy. The primary aim of this study is to establish the feasibility of undertaking a full-scale randomised controlled trial (RCT) that compares the effects of isometric, isotonic concentric and isotonic eccentric rotator cuff contractions when used as part of a semi-standardised exercise-based physiotherapy program in patients diagnosed with SPS. The secondary aim is to explore potential trends or treatment effects of the exercise intervention. Thirty-six participants diagnosed with SPS will be randomised to one of three intervention groups and undergo a one-on-one exercise-based physiotherapy intervention, involving scapular and rotator cuff muscle retraining and strengthening. Each group will utilise a different mode of rotator cuff strengthening-isometric, isotonic concentric or isotonic eccentric. Rotator cuff tendon responses to isometric loading are not yet established in the literature; hence, individualised, progressive loading will be used in this pilot study in accordance with symptoms. The intervention will involve two phases: during Phase 1 (weeks 1-6) participants undertake the active group-specific physiotherapy treatment; in Phase 2 (weeks 6-12), they undertake a progressive, but no longer group-specific exercise program. To determine feasibility, an evaluation of key study parameters including (a) ease of recruitment (rate and number as well as suitability of the assessment algorithm), (b) adherence to all phases of the exercise intervention including home program compliance and logbook completion, (c) participant non-completion (drop out number and rate) and (d) adverse events (nature and number) will be undertaken. Secondary outcomes will measure immediate effects: (i) within-treatment changes in pain perception (verbal rating scale (VRS) and shoulder muscle strength (hand-held dynamometer) as well as longer-term changes: (ii) shoulder-related symptoms and disability (Western Ontario Rotator Cuff Index (WORC) and Shoulder Pain and Disability Index (SPADI)), (iii) perception of pain (11-point numerical rating scale (NRS), (iv) shoulder muscle strength (hand-held dynamometer) and (v) perceived global rating of change score. The immediate within-treatment assessment of pain and muscle strength will be undertaken in treatments 2 and 3, and the longer term measures will be collected at the primary (conclusion of Phase 1 at 6 weeks) and secondary (conclusion of Phase 2 at 12 weeks) end-points of the study. The findings of this pilot study will permit evaluation of this study design for a full-scale RCT. Australian New Zealand Clinical Trials Registry, ACTRN12616001676404.

Do magnetic resonance imaging and computed tomography provide equivalent measures of rotator cuff muscle size in glenohumeral osteoarthritis?

PubMed

Chalmers, Peter N; Beck, Lindsay; Stertz, Irene; Aleem, Alexander; Keener, Jay D; Henninger, Heath B; Tashjian, Robert Z

2018-05-10

Rotator cuff muscle volume is associated with outcomes after cuff repair and total shoulder arthroplasty. Muscle area on select magnetic resonance imaging (MRI) slices has been shown to be a surrogate for muscle volume. The purpose of this study was to determine whether computed tomography (CT) provides an equivalent measurement of cuff muscle area to a previously validated MRI measurement. We included 30 patients before they were undergoing total shoulder arthroplasty with both preoperative CT and MRI scans performed within 30 days of one another at 1 institution using a consistent protocol. We reoriented CT sagittal and MRI sagittal T1 series orthogonal to the scapular plane. On both CT and MRI scans, we measured the area of the supraspinatus, infraspinatus-teres minor, and subscapularis on 2 standardized slices as previously described. We calculated intraclass correlation coefficients and mean differences. For the 30 subjects included, when MRI and CT were compared, the mean intraclass correlation coefficients were 0.989 (95% confidence interval [CI], 0.976-0.995) for the supraspinatus, 0.978 (95% CI, 0.954-0.989) for the infraspinatus-teres minor, and 0.977 (95% CI, 0.952-0.989) for the subscapularis. The mean differences were 0.2 cm 2 (95% CI, 0.0-0.4 cm 2 ) for the supraspinatus (P = .052), 0.8 cm 2 (95% CI, 0.1-1.4 cm 2 ) for the infraspinatus-teres minor (P = .029), and -0.3 cm 2 (95% CI, -1.2 to 0.5 cm 2 ) for the subscapularis (P = .407). CT provides nearly equivalent measures of cuff muscle area to an MRI technique with previously validated reliability and accuracy. While CT underestimates the infraspinatus area as compared with MRI, the difference is less than 1 cm 2 and thus likely clinically insignificant. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effect of Disrupting Seven-in-Absentia Homolog 2 Function on Lung Cancer Cell Growth

PubMed Central

Ahmed, Atique U.; Schmidt, Rebecca L.; Park, Cheol Hong; Reed, Nanette R.; Hesse, Shayla E.; Thomas, Charles F.; Molina, Julian R.; Deschamps, Claude; Yang, Ping; Aubry, Marie C.

2008-01-01

Background Hyperactivated epidermal growth factor receptor (EGFR) and/or RAS signaling drives cellular transformation and tumorigenesis in human lung cancers, but agents that block activated EGFR and RAS signaling have not yet been demonstrated to substantially extend patients’ lives. The human homolog of Drosophila seven-in-absentia—SIAH-1 and SIAH-2—are ubiquitin E3 ligases and conserved downstream components of the RAS pathway that are required for mammalian RAS signal transduction. We examined whether inhibiting SIAH-2 function blocks lung cancer growth. Methods The antiproliferative and antitumorigenic effects of lentiviral expression of anti-SIAH-2 molecules (ie, a dominant-negative protease-deficient mutant of SIAH-2 [SIAH-2PD] and short hairpin RNA [shRNA]–mediated gene knockdown against SIAH-2) were assayed in normal human lung epithelial BEAS-2B cells and in human lung cancer BZR, A549, H727, and UMC11 cells by measuring cell proliferation rates, by assessing MAPK and other activated downstream components of the RAS pathway by immunoblotting, assessing apoptosis by terminal deoxynucleotidyltransferase–mediated UTP end-labeling (TUNEL) assay, quantifying anchorage-independent cell growth in soft agar, and assessing A549 cell–derived tumor growth in athymic nude mice (groups of 10 mice, with two injections of 1 × 106 cells each at the dorsal left and right scapular areas). All statistical tests were two-sided. Results SIAH-2 deficiency in human lung cancer cell lines reduced MAPK signaling and statistically significantly inhibited cell proliferation compared with those in SIAH-proficient cells (P < .001) and increased apoptosis (TUNEL-positive A549 cells 3 days after lentivirus infection: SIAH-2PD vs control, 30.1% vs 0.0%, difference = 30.1%, 95% confidence interval [CI] = 23.1% to 37.0%, P < .001; SIAH-2-shRNA#6 vs control shRNA, 27.9% vs 0.0%, difference = 27.9%, 95% CI = 23.1% to 32.6%, P < .001). SIAH-2 deficiency also reduced anchorage-independent growth of A549 cells in soft agar (mean number of colonies: SIAH-2PD vs control, 124.7 vs 57.3, difference = 67.3, 95% CI = 49.4 to 85.3, P < .001; shRNA-SIAH-2#6 vs shRNA control: 27.0 vs 119.7, difference = 92.7, 95% CI = 69.8 to 115.5, P < .001), and blocked the growth of A549 cell–derived tumors in nude mice (mean tumor volume on day 36 after A549 cell injection: SIAH-2PD infected vs uninfected, 191.0 vs 558.5 mm3, difference = 367.5 mm3, 95% CI = 237.6 to 497.4 mm3, P < .001; SIAH-2PD infected vs control infected, 191.0 vs 418.3 mm3, difference = 227.5 mm3, 95% CI = 87.4 to 367.1 mm3, P = .003; mean resected tumor weight: SIAH-2PD infected vs uninfected, 0.12 vs 0.48 g, difference = 0.36 g, 95% CI = 0.23 to 0.50 g, P < .001; SIAH-2PD infected vs control infected, 0.12 vs 0.29 g, difference = 0.17 g, 95% CI = 0.04 to 0.31 g, P = .016). Conclusions SIAH-2 may be a viable target for novel anti-RAS and anticancer agents aimed at inhibiting EGFR and/or RAS-mediated tumorigenesis. PMID:19001609

Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model.

PubMed

Cobo-Vázquez, Carlos; De Blas, Gemma; García-Canas, Pablo; Del Carmen Gasco-García, María

2018-01-01

Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 μV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 μV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.

The split portal: Description of a new accessory posterior portal for arthroscopic shoulder instability procedures.

PubMed

Mirouse, Guillaume; Nourissat, Geoffroy

2016-02-01

Open approach to the posterior shoulder during bone block for posterior shoulder instability is challenging. Anatomical study was performed to identify landmarks of a portal, avoiding soft tissue damage, between the infraspinatus (IS) and teres minor (TM) muscles and distant from the supra-scapular nerve (SSN) for arthroscopic shoulder bone block. Eight fresh-frozen cadaveric shoulder specimens were used. The arthroscope was introduced through the soft point (SP). A guide wire was placed through the SP, in the rotator interval direction. A posterior open dissection exposed the split between the IS and TM. A new guide wire was placed into the split, parallel to the first wire, to locate the new posterior arthroscopic approach. Ten distances were measured to define the safe position. The mean values were: SP to split IS-TM: 2 ± 0.2 (2-2.8); spinal bone to split IS-TM: 5 ± 0.5 (3-6.2); split IS-TM to posterior glenoid 6 o'clock: 1.3 ± 0.3 (0.6-1.6), 9 o'clock: 1.5 ± 0.3 (1-1.9), and 12 o'clock: 2 ± 0.1 (2.1-2.4); SSN to posterior glenoid 6 o'clock: 2.4 ± 0.2 (2.1-2.6), 9 o'clock: 1.7 ± 0.1 (1.5-1.8), and 12 o'clock: 1.5 ± 0.3 (1.2-2.1); and SSN to split IS-TM: 2 ± 0.3 (1.2-2.1). This preliminary anatomical study described a posterior arthroscopic portal located 2 cm under the SP, parallel to the SP portal direction, and finishing between 7 and 8 o'clock at the posterior rim of the glenoid. For arthroscopic shoulder bone block, this portal can avoid muscle and SSN lesions.

Does a critical rotator cuff tear stage exist?: a biomechanical study of rotator cuff tear progression in human cadaver shoulders.

PubMed

Oh, Joo Han; Jun, Bong Jae; McGarry, Michelle H; Lee, Thay Q

2011-11-16

It is unknown at which stage of rotator cuff tear the biomechanical environment is altered. The purpose of this study was to determine if a critical rotator cuff tear stage exists that alters glenohumeral joint biomechanics throughout the rotational range of shoulder motion, and to evaluate the biomechanical effect of parascapular muscle-loading. Eight cadaver shoulders were used with a custom testing system. Four progressive rotator cuff tear stages were investigated on the basis of footprint anatomy. Three muscle-loading conditions were examined: rotator cuff only; rotator cuff with deltoid muscle; and rotator cuff, deltoid, pectoralis major, and latissimus dorsi muscles. Testing was performed in the scapular plane with 0°, 30°, and 60° of shoulder abduction. The maximum internal and external rotations were measured with 3.4 Nm of torque. The position of the humeral head apex with respect to the glenoid was calculated with use of a MicroScribe 3DLX digitizing system throughout the rotational range of motion. The abduction capability was determined as the abduction angle achieved with increasing deltoid load. Tear of the entire supraspinatus tendon significantly increased maximum external rotation and significantly decreased abduction capability with higher deltoid loads (p < 0.05). Tear of the entire supraspinatus tendon and half of the infraspinatus tendon significantly shifted the humeral head apex posteriorly at the midrange of rotation and superiorly at maximum internal rotation (p < 0.05). Loading the pectoralis major and latissimus dorsi muscles decreased the amount of humeral head elevation due to deltoid loading. Tear of the entire supraspinatus tendon was the critical stage for increasing rotational range of shoulder motion and for decreased abduction capability. Further tear progression to the infraspinatus muscle was the critical stage for significant changes in humeral head kinematics. The pectoralis major and latissimus dorsi muscles played an important role in stabilizing the humeral head as the rotator cuff tear progressed.

The reliability of humerothoracic angles during arm elevation depends on the representation of rotations.

PubMed

López-Pascual, Juan; Cáceres, Magda Liliana; De Rosario, Helios; Page, Álvaro

2016-02-08

The reliability of joint rotation measurements is an issue of major interest, especially in clinical applications. The effect of instrumental errors and soft tissue artifacts on the variability of human motion measures is well known, but the influence of the representation of joint motion has not yet been studied. The aim of the study was to compare the within-subject reliability of three rotation formalisms for the calculation of the shoulder elevation joint angles. Five repetitions of humeral elevation in the scapular plane of 27 healthy subjects were recorded using a stereophotogrammetry system. The humerothoracic joint angles were calculated using the YX'Y" and XZ'Y" Euler angle sequences and the attitude vector. A within-subject repeatability study was performed for the three representations. ICC, SEM and CV were the indices used to estimate the error in the calculation of the angle amplitudes and the angular waveforms with each method. Excellent results were obtained in all representations for the main angle (elevation), but there were remarkable differences for axial rotation and plane of elevation. The YX'Y" sequence generally had the poorest reliability in the secondary angles. The XZ'Y' sequence proved to be the most reliable representation of axial rotation, whereas the attitude vector had the highest reliability in the plane of elevation. These results highlight the importance of selecting the method used to describe the joint motion when within-subjects reliability is an important issue of the experiment. This may be of particular importance when the secondary angles of motions are being studied. Copyright © 2016 Elsevier Ltd. All rights reserved.

Subacromial impingement syndrome: An electromyographic study of shoulder girdle muscle fatigue.

PubMed

Alizadehkhaiyat, Omid; Roebuck, Margaret M; Makki, Ahmed T; Frostick, Simon P

2018-02-01

Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the contributing factors to the development of subacromial impingement syndrome (SAIS). Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics of SAIS has not been reported. This study aimed to measure and compare fatigue progression within the shoulder girdle musculature of patients and healthy controls. 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital Anxiety and Depression Scale) were also assessed. The results were compared between patient and control groups according to the gender. Despite marked fatigue observed in the majority of muscles particularly during flexion and abduction at 90°, overall results indicated a lower tendency of fatigue progression in the impingement group across the tests (p < 0.05 - p < 0.001). Shoulder Strength, pain experience, and psychological status were significantly different between the two groups (P < .05). Lower tendency to fatigue progression in the impingement group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, which in turn lead to adaptations in motor programme to reduce muscle recruitment and activation. The significantly higher levels of pain experience and anxiety/depression in the impingement group further support this proposition. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Terata catydidymus dicephalus: description of a case].

PubMed

Alò, P L; Trombetta, G; Marcone, P; De Quarto, A; Memeo, L; Di Tondo, U

1997-10-01

Conjoined twinning is the result of an abnormal developmental process of "twinning" in which two similar weighted and sized twins are partially conjoined and show a total symmetry independently from the pattern of conjunction. They are classified in three groups: Terata Catydidymus, Terata Anadidyma and Terata Anacatadidyma. Among Terata Catydidymus the dicephalus subtype is a rare abnormality with a severe prognosis compared to other subtypes as: diprosopus, pyophagus and ischiopagus. We report the case of a fetus at the 15th weeks of pregnancy. The external examination revealed severe diffuse somatic malformations consisting of dicephalia with a double neck in conjunction to a single chest, a single abdomen, a double spine conjoined distally near the sacrum, buds of ribs in between the two spines with mid clavicular and scapular fusion following the major axis of the two bones. Arms and legs revealed no abnormalities. Central nervous system structures were normally developed and the two hemispheres seemed completely separated and independent one to the other. We believe that the case described is interesting being Terata Catydidymus a rare phenomenon, being the dicephalus subtype still lesser frequent and its occurrence in males quite exceptional.

Free-flap surgical correction of facial deformity after anteromedial maxillectomy.

PubMed

Sarukawa, Shunji; Kamochi, Hideaki; Noguchi, Tadahide; Sunaga, Ataru; Uda, Hirokazu; Mori, Yoshiyuki; Nishino, Hiroshi; Yoshimura, Kotaro

2017-09-01

Anteromedial maxillectomy is typically performed in conjunction with low-dose radiotherapy and intraarterial chemotherapy. In doing so, the extent of surgical defects is reduced. However, nasal deviation and oral incompetence may ensue, due to cicatricial contracture of wounds, and may be distressing to these patients. Herein, we report a series of eight free perforator flap procedures (anterolateral thigh [ALT] flap, 6; thoracodorsal artery perforator [TAP] flap, 2) used to correct such deformities. The TAP flap was combined with scapular tip [ST] osseous flap in patients with added zygomatic prominence defects. Three adipocutaneous parts developed from each perforator flap were applied as follows: two to reconstruct nasal lining and oral vestibule, and one to augment cheek volume. All aesthetic results proved satisfactory, although orbital dystopia and contracture of mimic muscles were not resolved completely. These secondary interventions are suitable for sequelae of simple anteromedial maxillectomy. Immediate reconstruction should be considered if orbital floor and mimic muscles are involved. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Distinct distal myopathy phenotype caused by VCP gene mutation in a Finnish family.

PubMed

Palmio, Johanna; Sandell, Satu; Suominen, Tiina; Penttilä, Sini; Raheem, Olayinka; Hackman, Peter; Huovinen, Sanna; Haapasalo, Hannu; Udd, Bjarne

2011-08-01

Inclusion body myopathy with Paget disease and frontotemporal dementia (IBMPFD) is caused by mutations in the valosin-containing protein (VCP) gene. We report a new distal phenotype caused by VCP gene mutation in a Finnish family with nine affected members in three generations. Patients had onset of distal leg muscle weakness and atrophy in the anterior compartment muscles after age 35, which caused a foot drop at age 50. None of the siblings had scapular winging, proximal myopathy, cardiomyopathy or respiratory problems during long-term follow-up. Three distal myopathy patients developed rapidly progressive dementia, became bedridden and died of cachexia and pneumonia and VCP gene mutation P137L (c.410C>T) was then identified in the family. Late onset autosomal dominant distal myopathy with rimmed vacuolar muscle pathology was not sufficient for exact diagnosis in this family until late-occurring dementia provided the clue for molecular diagnosis. VCP needs to be considered in the differential diagnostic work-up in patients with distal myopathy phenotype. Copyright © 2011 Elsevier B.V. All rights reserved.

Three Echiniscidae species (Tardigrada: Heterotardigrada) new to the Polish fauna, with the description of a new gonochoristic Bryodelphax Thulin, 1928.

PubMed

GĄsiorek, Piotr; Degma, Peter

2018-04-16

During a faunistic survey in the Pieniny and Tatra Mountains three species of Echiniscidae new to Poland, including one new to science, were found. Bryodelphax instabilis sp. nov. is characterised by an instable number of ventral plates, deep faceting of the scapular plate, having dorsal plates covered either with pseudopores or pores, and striking sexual dimorphism. Two first records, namely Echiniscus militaris and E. spiniger, are rare taxa of upland-mountain character, which have already been reported from a few European countries since the original description at the beginning of the XXth century. The interspecific appendage length variability and development of pedal plates in the spinulosus group, to which E. spiniger belongs, and their taxonomic importance is discussed. Notes relating to sexual dimorphism within the newly recorded Pseudechiniscus facettalis, are also presented. Echiniscus testudo is reported from the Polish part of the Tatra Mountains for the first time. Succeeding findings confirm the high tardigrade α-diversity in the Polish mountain ranges. An amended key for Polish Heterotardigrada is provided.

A Unique Branching Pattern of the Axillary Artery: A Case Report

PubMed Central

Bagoji, Ishwar B.; Hadimani, Gavishiddappa A.; Bannur, Balappa M.; Patil, B.G.; Bharatha, Ambadasu

2013-01-01

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation. PMID:24551680

A unique branching pattern of the axillary artery: a case report.

PubMed

Bagoji, Ishwar B; Hadimani, Gavishiddappa A; Bannur, Balappa M; Patil, B G; Bharatha, Ambadasu

2013-12-01

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation.

An Abnormal Bone Lesion of the Scapula in a Collegiate Basketball Player: A Case Report

PubMed Central

O'Brien, Matthew S.; Donnell, Allison; Miller, Jason; Iven, Val Gene; Pascale, Mark

2013-01-01

Objective: To present the case of a bone lesion of the scapula in a collegiate basketball player. Background: A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion. Differential Diagnosis: Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture. Treatment: The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken. Uniqueness: Most simple bone cysts affect the proximal humerus and femur, whereas our patient's lesion was in the acromial complex. Conclusions: Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma. PMID:23725460

Scapulothoracic Dissociation: Evaluation and Management.

PubMed

Choo, Andrew M; Schottel, Patrick C; Burgess, Andrew R

2017-05-01

Scapulothoracic dissociation is a rare, potentially limb- and life-threatening injury of the shoulder girdle. The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. The typical physical examination findings consist of substantial swelling of the shoulder girdle, along with weakness, numbness, and pulselessness in the ipsilateral upper extremity. Radiographic evaluation includes measurement of the scapular index on a nonrotated chest radiograph and assessment for either a distracted clavicle fracture or a disrupted acromioclavicular or sternoclavicular joint. Although vascular injury occurs in most patients, emergent surgery is performed only in patients with either limb-threatening ischemia or active arterial hemorrhage. Management of neurologic injury can be delayed if necessary. The location and severity of neurologic injury determine whether observation, nerve grafting, nerve transfer, or above-elbow amputation is performed. Skeletal stabilization procedures include plate fixation of clavicle fractures and reduction of distracted acromioclavicular or sternoclavicular joints. The extent of neurologic injury determines clinical outcomes. Medical Outcomes Study 36-Item Short Form scores are significantly lower in patients with complete brachial plexus avulsion injury than in patients with postganglionic injury.

[Scapulo-thoracic mycetoma. A rare localization, a particular form].

PubMed

Sy, M H; Diouf, S; Ndiaye, A; Dansokho, A V; Ndiaye, P D; Diop, C A; Sèye, S I

1998-07-01

An uncommon form and a rare localization of mycetoma is reported. The aim of this report was to distinguish this inhabitual form of mycetoma from some tropical diseases like onchocerca and other fungal diseases. A 55 year old man was admitted 10 years after a septic worm-hole for a scapulo-thoracic tumor. This encapsulated mass was a bending and rounded polyfistular one attached to the dorsal aspect of left shoulder. The fistula discharge a serosanguineous or purulent exudate. The characteristic red granule was not visible. The tumor was removed and histological examination was performed. A typical granuloma of red granule of streptomyces pelletieri was found. A good result was obtained with associated cotrimoxazole treatment. Scapulo-thoracic form included: scapular, axillary and chest form of mycetoma. All these localizations are rare. One of them can be complicated by osteitis or pleuro-pulmonary localization. Streptomyces pellitieri is the actinomycetic causal agent. This encapsulated form is uncommon. Scapulo-thoracic mycetoma is rare. Encapsulated and pedicular form is uncommon. Around Sahel areas, differential diagnosis must be evoked such as parasitic and mycobacterial infections.

On the development of the shoulder girdle in Crocidura russula (Soricidae) and other placental mammals: evolutionary and functional aspects

PubMed Central

Großmann, Martin; Sánchez-Villagra, Marcelo R; Maier, Wolfgang

2002-01-01

The development of the shoulder girdle was studied in embryonic stages and a neonate of Crocidura russula using histological sections and 3-D reconstructions. Neonatal stages of Suncus etruscus and Mesocricetus auratus, both altricial placentals, were also studied. The earliest stage of C. russula, in which the scapula is still partially blastematous, has already a supraspinous fossa. The dorsal portion of the scapular spine does not develop from the anterior margin of the scapula. Its mode of development varies among the placentals studied to date. In some it is completely appositional bone, in others it consists of bone formed mostly by endochondral ossification of a dorsal cartilaginous process stemming from the acromium. During development the supraspinatus muscle increases in size in proportion to the infraspinatus muscle and the humeral head increases in size in relation to the glenoid fossa. Placentals have secondary cartilage in the sternal and acromial ends of the clavicle, a derived feature absent in Marsupialia. Even the most altricial placentals have a more developed shoulder girdle at birth than any newborn marsupial studied to date. PMID:12448772

The relationship of strength and muscle balance to shoulder pain and impingement syndrome in elite quadriplegic wheelchair rugby players.

PubMed

Miyahara, M; Sleivert, G G; Gerrard, D F

1998-04-01

Wheelchair athletes are susceptible to injuries related to overuse of the shoulder, in particular shoulder impingement syndrome. The present study examined the relationship of shoulder pain to demographic details, isokinetic strength and muscle balance in 8 elite quadriplegic rugby players. Demographic data were collected using personal interviews and each subject was clinically examined for signs of impingement syndrome by a physician. In addition each subject underwent bilateral isokinetic strength testing of the shoulder at 60 and 180 deg/s for abduction/adduction and internal/external rotation. A series of step-wise multiple discriminant analysis successfully predicted clinical symptoms from demographic, muscular strength and balance data. In particular, there was a significant deficit in adductor strength and this was related to shoulder pain and wasting of the scapular muscles. This strength deficit may be due to the high level of spinal lesions in the quadriplegic population. The level of spinal lesion may contribute to the aetiology of shoulder pathology in quadriplegia, and differentiate it from that observed in able-bodied athletes who exhibit weak abductors.

Glenohumeral internal rotation deficit in throwing athletes: current perspectives

PubMed Central

Rose, Michael B; Noonan, Thomas

2018-01-01

Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible. PMID:29593438

Neuromuscular dentistry: Occlusal diseases and posture

PubMed Central

Khan, Mohd Toseef; Verma, Sanjeev Kumar; Maheshwari, Sandhya; Zahid, Syed Naved; Chaudhary, Prabhat K.

2013-01-01

Neuromuscular dentistry has been a controversial topic in the field of dentistry and still remains debatable. The issue of good occlusion and sound health has been repeatedly discussed. Sometimes we get complains of sensitive teeth and sometimes of tired facial muscles on getting up in the morning. Owing to the intimate relation of masticatory apparatus with the cranium and cervico-scapular muscular system, the disorders in any system, draw attention from concerned clinicians involved in management, to develop an integrated treatment protocol for the suffering patients. There may be patients reporting to the dental clinics after an occlusal restoration or extraction, having pain in or around the temporomandibular joint, headache or neck pain. Although their esthetic demands must not be undermined during the course of treatment plan, whenever dental treatment of any sort is planned, occlusion/bite should be given prime importance. Very few dentist are able to diagnose the occlusal disease and of those who diagnose many people resort to aggressive treatment modalities. This paper aims to report the signs of occlusal disease, and discuss their association with TMDs and posture. PMID:25737904

Neuromuscular dentistry: Occlusal diseases and posture.

PubMed

Khan, Mohd Toseef; Verma, Sanjeev Kumar; Maheshwari, Sandhya; Zahid, Syed Naved; Chaudhary, Prabhat K

2013-01-01

Neuromuscular dentistry has been a controversial topic in the field of dentistry and still remains debatable. The issue of good occlusion and sound health has been repeatedly discussed. Sometimes we get complains of sensitive teeth and sometimes of tired facial muscles on getting up in the morning. Owing to the intimate relation of masticatory apparatus with the cranium and cervico-scapular muscular system, the disorders in any system, draw attention from concerned clinicians involved in management, to develop an integrated treatment protocol for the suffering patients. There may be patients reporting to the dental clinics after an occlusal restoration or extraction, having pain in or around the temporomandibular joint, headache or neck pain. Although their esthetic demands must not be undermined during the course of treatment plan, whenever dental treatment of any sort is planned, occlusion/bite should be given prime importance. Very few dentist are able to diagnose the occlusal disease and of those who diagnose many people resort to aggressive treatment modalities. This paper aims to report the signs of occlusal disease, and discuss their association with TMDs and posture.

Anthropometric differences among natives of Abuja living in urban and rural communities: correlations with other cardiovascular risk factors.

PubMed

Adediran, Olufemi Sola; Adebayo, Philip Babatunde; Akintunde, Adeseye Abiodun

2013-03-27

There is an increase of obesity and other cardiovascular risk factors worldwide, but especially in developing countries where multifaceted transitions are occurring. There is need for more evidence for the cardio-metabolic effect of changing lifestyles and urbanization in Nigeria. This study aimed at defining rural-urban differences in anthropometric parameters in two Nigerian communities of the same ancestral origin and to determine the cardiovascular risk correlates of these anthropometric measurements. This was a cross-sectional epidemiological study using stratified cluster sampling method. We studied 335 and 332 urban and rural dwellers respectively. A complete cardiovascular profile as well as anthropometric measurements was compared between the two populations. All anthropometric indices considered in this study (weight, BMI, waist circumference, waist circumference/height ratio, abdominal height; biceps, triceps, sub-scapular, abdominal, superior iliac skinfold thicknesses) were significantly higher in urban than in the rural population (p = <0.001). Overweight, obesity and hypertension were significantly prevalent among the urban population (p = <0.001) while there was no significant difference in the prevalence of dyslipidaemia (p = 0.096) and diabetes (p = 0.083) between the two cohorts. Females tend to have a higher chance of obesity than males although there was no gender difference in waist circumference and central skin fold thickness in the rural population. Age was the significant predictor of systolic blood pressure among the rural (R(2) = 0.157, β = 0.258, p = 0.016) and urban female population (R(2) = 0.201, β = 0.351, p = <0.001) while Abdominal height (R(2) = 0.16, β = 0.281, p = 0.001) and waist circumference (R(2) = 0.064 β = 0.064, p = .003) were predictors of systolic blood pressure in urban and rural men respectively. Anthropometric indices were significantly higher among the urban than the rural populations. Cardiovascular risks were equally more prevalent among the urban population. Appropriate health education and lifestyle modification strategies may reduce the increased burden of cardiovascular risk factors associated with rural-urban migration.

Motorcycle-related hospitalization of adolescents in a Level I trauma center in southern Taiwan: a cross-sectional study.

PubMed

Liang, Chi-Cheng; Liu, Hang-Tsung; Rau, Cheng-Shyuan; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

2015-08-28

The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center. Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion. Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet. Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

A New Basal Sauropodomorph (Dinosauria: Saurischia) from Quebrada del Barro Formation (Marayes-El Carrizal Basin), Northwestern Argentina

PubMed Central

Apaldetti, Cecilia; Martinez, Ricardo N.; Alcober, Oscar A.; Pol, Diego

2011-01-01

Background Argentinean basal sauropodomorphs are known by several specimens from different basins; Ischigualasto, El Tranquilo, and Mogna. The Argentinean record is diverse and includes some of the most primitive known sauropodomorphs such as Panphagia and Chromogisaurus, as well as more derived forms, including several massospondylids. Until now, the Massospondylidae were the group of basal sauropodomorphs most widely spread around Pangea with a record in almost all continents, mostly from the southern hemisphere, including the only record from Antarctica. Methodology/Principal Finding We describe here a new basal sauropodomorph, Leyesaurus marayensis gen. et sp. nov., from the Quebrada del Barro Formation, an Upper Triassic-Lower Jurassic unit that crops out in northwestern Argentina. The new taxon is represented by a partial articulated skeleton that includes the skull, vertebral column, scapular and pelvic girdles, and hindlimb. Leyesaurus is diagnosed by a set of unique features, such as a sharply acute angle (50 degrees) formed by the ascending process of the maxilla and the alveolar margin, a straight ascending process of the maxilla with a longitudinal ridge on its lateral surface, noticeably bulging labial side of the maxillary teeth, greatly elongated cervical vertebrae, and proximal articular surface of metatarsal III that is shelf-like and medially deflected. Phylogenetic analysis recovers Leyesaurus as a basal sauropodomorph, sister taxon of Adeopapposaurus within the Massospondylidae. Moreover, the results suggest that massospondylids achieved a higher diversity than previously thought. Conclusions/Significance Our phylogenetic results differ with respect to previous analyses by rejecting the massospondylid affinities of some taxa from the northern hemisphere (e.g., Seitaad, Sarahsaurus). As a result, the new taxon Leyesaurus, coupled with other recent discoveries, suggests that the diversity of massospondylids in the southern hemisphere was higher than in other regions of Pangea. Finally, the close affinities of Leyesaurus with the Lower Jurassic Massospondylus suggest a younger age for the Quebrada del Barro Formation than previously postulated. PMID:22096511

A new basal sauropodomorph (Dinosauria: Saurischia) from Quebrada del Barro Formation (Marayes-El Carrizal Basin), northwestern Argentina.

PubMed

Apaldetti, Cecilia; Martinez, Ricardo N; Alcober, Oscar A; Pol, Diego

2011-01-01

Argentinean basal sauropodomorphs are known by several specimens from different basins; Ischigualasto, El Tranquilo, and Mogna. The Argentinean record is diverse and includes some of the most primitive known sauropodomorphs such as Panphagia and Chromogisaurus, as well as more derived forms, including several massospondylids. Until now, the Massospondylidae were the group of basal sauropodomorphs most widely spread around Pangea with a record in almost all continents, mostly from the southern hemisphere, including the only record from Antarctica. We describe here a new basal sauropodomorph, Leyesaurus marayensis gen. et sp. nov., from the Quebrada del Barro Formation, an Upper Triassic-Lower Jurassic unit that crops out in northwestern Argentina. The new taxon is represented by a partial articulated skeleton that includes the skull, vertebral column, scapular and pelvic girdles, and hindlimb. Leyesaurus is diagnosed by a set of unique features, such as a sharply acute angle (50 degrees) formed by the ascending process of the maxilla and the alveolar margin, a straight ascending process of the maxilla with a longitudinal ridge on its lateral surface, noticeably bulging labial side of the maxillary teeth, greatly elongated cervical vertebrae, and proximal articular surface of metatarsal III that is shelf-like and medially deflected. Phylogenetic analysis recovers Leyesaurus as a basal sauropodomorph, sister taxon of Adeopapposaurus within the Massospondylidae. Moreover, the results suggest that massospondylids achieved a higher diversity than previously thought. Our phylogenetic results differ with respect to previous analyses by rejecting the massospondylid affinities of some taxa from the northern hemisphere (e.g., Seitaad, Sarahsaurus). As a result, the new taxon Leyesaurus, coupled with other recent discoveries, suggests that the diversity of massospondylids in the southern hemisphere was higher than in other regions of Pangea. Finally, the close affinities of Leyesaurus with the Lower Jurassic Massospondylus suggest a younger age for the Quebrada del Barro Formation than previously postulated.

Rotator cuff strength in recurrent anterior shoulder instability.

PubMed

Edouard, Pascal; Degache, Francis; Beguin, Laurent; Samozino, Pierre; Gresta, Giorgio; Fayolle-Minon, Isabelle; Farizon, Frédéric; Calmels, Paul

2011-04-20

Although rotator-cuff muscle contraction plays an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in the pathophysiology of recurrent anterior instability. We intended to analyze the association between isokinetic internal rotator and external rotator muscle strength and glenohumeral joint instability in patients with recurrent anterior instability that was not previously treated surgically. We enrolled thirty-seven patients with unilateral recurrent anterior posttraumatic shoulder dislocation and eleven healthy nonathletic subjects in this controlled study. The association between internal rotator and external rotator strength and shoulder instability was analyzed by side-to-side comparisons and comparisons with a control group. Isokinetic internal rotator and external rotator strength was evaluated with a Con-Trex dynamometer, with the subject seated and the shoulder abducted 45° in the scapular plane. Tests were performed at 180°/s, 120°/s, and 60°/s in concentric mode for both sides. Peak torque normalized to body weight and external rotator to internal rotator ratio were calculated for each angular velocity. Clinical and isokinetic evaluation was done by the same rehabilitation physician. The association between shoulder instability and internal rotator and external rotator strength was associated with side-to-side differences (p < 0.05). Compared with a control group, strength values were lower on the pathological shoulder side of the patients with shoulder instability than on the healthy contralateral shoulder of control subjects at 180°/s and 120°/s (p < 0.05). The side-to-side differences were increased when the nondominant upper-extremity side was involved and were decreased when the dominant side was involved. There was no association between glenohumeral joint instability and external rotator to internal rotator ratio. Internal rotator and external rotator weakness was associated with recurrent anterior instability, and side-to-side differences depended on the side of hand dominance. Use of a control group may help in the analysis of the influence of constraints on shoulder strength. Further prospective studies are necessary to determine whether the weakness is a cause or an effect of the instability.

Toxoplasma gondii Infection in Seagull Chicks Is Related to the Consumption of Freshwater Food Resources

PubMed Central

Cabezón, Oscar; Cerdà-Cuéllar, Marta; Morera, Virginia; García-Bocanegra, Ignacio; González-Solís, Jacob; Napp, Sebastian; Ribas, Maria P.; Blanch-Lázaro, Berta; Fernández-Aguilar, Xavier; Antilles, Noelia; López-Soria, Sergio; Lorca-Oró, Cristina; Dubey, Jitender P.; Almería, Sonia

2016-01-01

Understanding the spread of Toxoplasma gondii (T. gondii) in wild birds, particularly in those with opportunistic feeding behavior, is of interest for elucidating the epidemiological involvement of these birds in the maintenance and dissemination of the parasite. Overall, from 2009 to 2011, we collected sera from 525 seagull chicks (Yellow-legged gull (Larus michahellis) and Audouin’s gull (L. audouinii)) from 6 breeding colonies in Spain and tested them using the modified agglutination test (MAT) for the presence of antibodies against T. gondii. Chick age was estimated from bill length. Main food source of seagull chicks was evaluated using stable isotope analyses from growing scapular feathers. Overall T. gondii seroprevalence was 21.0% (IC95% 17.5–24.4). A generalized linear mixed-effects model indicated that year (2009) and food source (freshwater) were risk factors associated to the individual risk of infection by T. gondii, while age (days) was close to significance. Freshwater food origin was related to the highest seroprevalence levels, followed by marine origin, supporting freshwater and sewages as important routes of dispersion of T. gondii. Year differences could indicate fluctuating rates of exposure of seagull chicks to T. gondii. Age ranged from 4 to 30 days and seropositivity tended to increase with age (P = 0.07), supporting that seropositivity is related to T. gondii infection rather than to maternal transfer of antibodies, which in gulls is known to sharply decrease with chick age. This study is the first to report T. gondii antibodies in Yellow-legged and Audouin’s gulls, thereby extending the range of intermediate hosts for this parasite and underscoring the complexity of its epidemiology. PMID:26974667

Effect of Integrated Approach of Yoga Therapy on Male Obesity and Psychological Parameters-A Randomised Controlled Trial

PubMed Central

Subramanya, Pailoor

2016-01-01

Introduction Obesity is a growing global epidemic and cause of non-communicable diseases. Yoga is one of the effective ways to reduce stress which is one of the causes of obesity. Aim To assess the effect of Integrated Approach of Yoga Therapy (IAYT) yoga module on adult male obesity in an urban setting. Materials and Methods RCT (Randomized Controlled Trial) was conducted for 14 weeks on obese male subjects with yoga and control groups. Total number of subjects were 72 and they were randomized into two groups (Yoga n=37, Control n=35). The subjects were from an urban setting of Mumbai and were doing yoga for the first time. Special yoga training of IAYT was given to yoga group for one and half hour for 5 days in a week for 14 weeks. The control group continued regular physical activities and no specific physical activity was given. The assessments were anthropometric parameters of weight, Body Mass Index (BMI), MAC (Mid Upper Arm Circumferences) of Left and Right Arm, Waist Circumference (WC), HC (Hip Circumference), WHR (Waist Hip Ratio), SKF(Skin Fold Thickness of Biceps, Triceps, Sub scapular, suprailiac and cumulative), Percentage body fat based on SKF and Psychological Questionnaires of Perceived Stress Scale (PSS) and AAQW (Acceptance and Action Questionnaire for Weight Related Difficulty). These were taken before and after intervention for both yoga and control groups. Within and between group analysis & correlation of differences from post to pre readings among the variables, were carried out using SPSS 21. Results The anthropometric and psychological parameters were improved in both the groups but changes were significant in yoga group. Conclusion Incorporating the IAYT for obese male in urban setting will be effective for obesity treatment and for reducing the obesity related problems. PMID:27891357

The myocutaneous trapezius flap revisited: a treatment algorithm for optimal surgical outcomes based on 43 flap reconstructions.

PubMed

Can, Anil; Orgill, Dennis P; Dietmar Ulrich, J O; Mureau, Marc A M

2014-12-01

Because the vascular anatomy of the trapezius flap is highly variable, choosing the most appropriate flap type and design is essential to optimize outcomes and minimize postoperative complications. The aim of this study was to develop a surgical treatment algorithm for trapezius flap transfers. The medical files of all consecutive patients with a myocutaneous trapezius flap reconstruction of the head, neck, and upper back area treated at three different university medical centers between July 2001 and November 2012 were reviewed. There were 43 consecutive flaps performed in 38 patients with a mean follow-up time of 15 months (range, 1-48 months). Eleven patients had a mentosternal burn scar contracture (12 flaps), 12 patients (13 flaps) presented with cancer, and 15 patients (18 flaps) were suffering from chronic wounds due to failed previous reconstruction (n = 6), osteoradionecrosis (n = 1), chronic infection (n = 3), bronchopleural fistula (n = 3), and pressure sores (n = 2). The mean defect size was 152 cm(2). Sixteen flaps were based on the superficial cervical artery (SCA; type 2), 16 were based on the dorsal scapular artery (DSA; type 3), one was based on the intercostal arteries (type 4), and 10 flaps were based on both the DSA and SCA. Recipient-site complications requiring reoperation occurred in 16.3%, including one total flap failure (2.6%). The trapezius myocutaneous flap is a valuable option to reconstruct various head and neck and upper back defects. Based on our data, a surgical treatment algorithm was developed in an attempt to reduce variation in care and improve clinical outcomes. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

ECONOMIC SIGNIFICANCE OF TROPICAL THEILERIOSIS ON A HOLSTEIN FRIESIAN DAIRY FARM IN PAKISTAN.

PubMed

Rashid, Muhammad; Haroon, Akbar; Rashid, Muhmmad Imran; Khalid, Saeed; Liaquat, Ahmad; Saghir, Abdullah; Wasim, Shehzad; Saher, Islam; Shahid, Farooqi

2018-03-09

The dairy industry in Pakistan is booming and investors are anxious to fund dairy farms that are using high milk producing (exotic) cattle breeds such as Holsteins that are not native to the country. Unfortunately, the benefits of increased milk production do not provide resistance to pathogens present in regions where the exotic breeds are introduced. Therefore, the current study was conducted to evaluate the economic impact of Theileria annulata on a commercial Holstein dairy farm in the District of Ranjanpur, in the Province of Punjab, Pakistan. The economic impact of T. annulata infection was calculated for cattle with subclinical and clinical theileriosis. Losses were estimated based on milk production, morbidity, mortality and tick control costs (organophosphate sprays). Animals were classified into groups after screening for mastitis, teat abnormality, abnormal parturition, intestinal parasites and hemoparasites (T. annulata, Babesia spp., and Anaplasma spp.). Microscopy was done for hemoparasites and intestinal parasites. PCR was used to confirm microscopic identification of T. annulata. Animals were classified into 3 groups, comprising group A (normal), group B (subclinical theileriosis) and group C (acute theileriosis). Hemoparasites were observed microscopically in 28.7% of cows. Theileria annulata was found in 8% and the herd incidence (new cases) of T. annulata was 2.8%. Milk production, animal rectal temperature and body condition scores of group A with B and C were significantly different (P<0.05). But the enlargement of sub-scapular lymph node and interval of body condition score of the 3 groups were not significant (P>0.05). The total expenditure incurred due to theileriosis was US $74.98 per animal and 13.83% of total farm costs. Hence theileriosis caused significant economic loss of US $18743.76 (0.02 million) on this Holstein Friesian dairy.

Mechanical risk of rotator cuff repair failure during passive movements: A simulation-based study.

PubMed

Haering, Diane; Blache, Yoann; Raison, Maxime; Begon, Mickael

2015-12-01

Despite improvements in rotator cuff surgery techniques, re-tear rate remains above 20% and increases with tear severity. Mechanical stresses to failure of repaired tendons have been reported. While optimal immobilization postures were proposed to minimize this stress, post-operative rehabilitation protocols have never been assessed with respect to these values. Purpose was to use musculoskeletal simulation to predict when the stress in repaired tendons exceeds safety limits during passive movements. Hence, guidelines could be provided towards safer post-operative exercises. Sixteen healthy participants volunteered in passive three-dimensional shoulder range-of-motion and passive rehabilitation exercises assessment. Stress in all rotator cuff tendons was predicted during each movement by means of a musculoskeletal model using simulations with different type and size of tears. Safety stress thresholds were defined based on repaired tendon loads to failure reported in the literature and used to discriminate safe from unsafe ranges-of-motion. Increased tear size and multiple tendons tear decreased safe range-of-motion. Mostly, glenohumeral elevations below 38°, above 65°, or performed with the arm held in internal rotation cause excessive stresses in most types and sizes of injury during abduction, scaption or flexion. Larger safe amplitudes of elevation are found in scapular plane for supraspinatus alone, supraspinatus plus infraspinatus, and supraspinatus plus subscapularis tears. This study reinforces that passive early rehabilitation exercises could contribute to re-tear due to excessive stresses. Recommendations arising from this study, for instance to keep the arm externally rotated during elevation in case of supraspinatus or supraspinatus plus infraspinatus tear, could help prevent re-tear. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Statin Therapy Negatively Impacts Skeletal Muscle Regeneration and Cutaneous Wound Repair in Type 1 Diabetic Mice.

PubMed

Rebalka, Irena A; Cao, Andrew W; Raleigh, Matthew J; Henriksbo, Brandyn D; Coleman, Samantha K; Schertzer, Jonathan D; Hawke, Thomas J

2017-01-01

Those with diabetes invariably develop complications including cardiovascular disease (CVD). To reduce their CVD risk, diabetics are generally prescribed cholesterol-lowering 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors (i.e., statins). Statins inhibit cholesterol biosynthesis, but also reduce the synthesis of a number of mevalonate pathway intermediates, leading to several cholesterol-independent effects. One of the pleiotropic effects of statins is the reduction of the anti-fibrinolytic hormone plasminogen activator inhibitor-1 (PAI-1). We have previously demonstrated that a PAI-1 specific inhibitor alleviated diabetes-induced delays in skin and muscle repair. Here we tested if statin administration, through its pleiotropic effects on PAI-1, could improve skin and muscle repair in a diabetic rodent model. Six weeks after diabetes onset, adult male streptozotocin-induced diabetic (STZ), and WT mice were assigned to receive control chow or a diet enriched with 600 mg/kg Fluvastatin. Tibialis anterior muscles were injured via Cardiotoxin injection to induce skeletal muscle injury. Punch biopsies were administered on the dorsal scapular region to induce injury of skin. Twenty-four days after the onset of statin therapy (10 days post-injury), tissues were harvested and analyzed. PAI-1 levels were attenuated in statin-treated diabetic tissue when compared to control-treated tissue, however no differences were observed in non-diabetic tissue as a result of treatment. Muscle and skin repair were significantly attenuated in Fluvastatin-treated STZ-diabetic mice as demonstrated by larger wound areas, less mature granulation tissue, and an increased presence of smaller regenerating muscle fibers. Despite attenuating PAI-1 levels in diabetic tissue, Fluvastatin treatment impaired cutaneous healing and skeletal muscle repair in STZ-diabetic mice.

Activity of Shoulder Stabilizers and Prime Movers During an Unstable Overhead Press.

PubMed

Williams, Martin R; Hendricks, Dustin S; Dannen, Michael J; Arnold, Andrea M; Lawrence, Michael A

2018-06-08

Williams, MR Jr, Hendricks, DS, Dannen, MJ, Arnold, AM, and Lawrence, MA. Activity of shoulder stabilizers and prime movers during an unstable overhead press. J Strength Cond Res XX(X): 000-000, 2018-Overhead reaching is a common movement that relies heavily on muscles for dynamic stability. Stabilizer muscle activation increased during squatting and bench pressing with an unstable load, but the overhead press (OHP) has yet to be examined. The purpose of this study is to compare muscle activity of the shoulder stabilizers and prime movers and excursions of the center of pressure (CoP) during the OHP in 2 unstable and one stable conditions. Twelve men (aged 25.3 ± 2.7 years, mass: 91.5 ± 8.4 kg, height: 1.81 ± 0.06 m) pressed 50% of their 1 repetition maximum for 10 repetitions over 3 conditions: a straight stable barbell (SS), a straight unstable (SU) barbell with kettlebells suspend by elastic bands, and an unstable Earthquake (EU) bar with kettlebells suspended by elastic bands. Activity of the shoulder stabilizers and prime movers were measured via surface and indwelling electromyography. Center of pressure excursion of the right foot was also measured. A multivariate analysis was used to determine significant differences between conditions. Pressing with the EQ increased activation of the biceps brachii, erector spinae, latissimus dorsi, pectoralis major, rectus abdominus, rhomboids, and serratus anterior over the SS condition, whereas only the SU condition increased activation in the erector spinae and latissimus dorsi muscles. The EQ condition produced greater CoP excursion (35.3 ± 7.9% foot length) compared with the SU (28.0 ± 7.2% foot length) and SS (22.2 ± 6.3% foot length) conditions. Therefore, the EU condition may be an effective exercise to activate scapular stabilizers.

A new rainfrog of the Pristimantis myersi Group (Amphibia, Craugastoridae) from Volcán Pichincha, Ecuador.

PubMed

Rojas-Runjaic, Fernando J M; C, J Amanda Delgado; Guayasamin, Juan M

2014-03-20

A new frog of the Pristimantis myersi Group is described from a bamboo patch within the Reserva Ecológica Verdecocha (0°5'46.9"S, 78°36'15.3"W; 2851 m), located at northwestern flank of the Volcán Pichincha, in the vicinities of Quito, Ecuador. The new species is known from eight adult males, whereas the females remain unknown; it can be readily distinguished from all species of the P. myersi Group that inhabit the highlands of the Ecuadorian Andes by the unique combination of the following characters: body small (adult male SVL 14.9-19.7 mm; females unknown); dorsal skin shagreen, with a barely visible middorsal raphe, scapular and dorsolateral folds; tympanum small but well-defined; upper eyelid with one enlarged tubercle; males with prominent vocal slits, but without nuptial pads on thumbs; fold-like tarsal tubercles. With this new species, the number of Pristimantis assigned to the P. myersi Group raises to 16, of which, 12 are in Ecuador. We provide notes on morphology and color variation, advertisement call, and natural history of the new species.

Hip and upper extremity kinematics in youth baseball pitchers.

PubMed

Holt, Taylor; Oliver, Gretchen D

2016-01-01

The purpose of this study was to examine the relationship between dynamic hip rotational range of motion and upper extremity kinematics during baseball pitching. Thirty-one youth baseball pitchers (10.87 ± 0.92 years; 150.03 ± 5.48 cm; 44.83 ± 8.04 kg) participated. A strong correlation was found between stance hip rotation and scapular upward rotation at maximum shoulder external rotation (r = 0.531, P = 0.002) and at ball release (r = 0.536, P = 0.002). No statistically significant correlations were found between dynamic hip rotational range of motion and passive hip range of motion. Hip range of motion deficits can constrain pelvis rotation and limit energy generation in the lower extremities. Shoulder pathomechanics can then develop as greater responsibility is placed on the shoulder to generate the energy lost from the proximal segments, increasing risk of upper extremity injury. Additionally, it appears that passive seated measurements of hip range of motion may not accurately reflect the dynamic range of motion of the hips through the progression of the pitch cycle.

Unicameral bone cyst of the humeral head: arthroscopic curettage and bone grafting.

PubMed

Randelli, Pietro; Arrigoni, Paolo; Cabitza, Paolo; Denti, Matteo

2009-01-01

Arthroscopic surgery has improved greatly over the past decade. Treatment of various juxta-articular disorders around the shoulder have benefited from endoscopic approaches. Cystic lesions of the shoulder on the scapular side have been treated in this way. This article describes a case of a 29-year-old patient with a unicameral bone cyst on the posterior aspect of the humeral head. Arthroscopic visualization using an accessory posteroinferior portal localized the cyst through the bare area of the humeral head. A cannulated burr was used to create an opening through the cortical wall between the cyst and the joint, and a careful curettage was performed. The cavity was filled with a demineralized bone matrix enriched with autologous blood packed into an arthroscopic cannula and delivered through the accessory portal. The patient reported pain relief immediately postoperatively and at follow-up. This case demonstrates the feasibility of arthroscopic treatment of a simple bone cyst of the humeral head. We believe that the knowledge of the juxta-articular anatomy allows the applications of scope-assisted procedures to be expanded, maximizing the results of a technique that allows a shorter recovery and less painful rehabilitation.

Perceived parenting behaviours predict young adolescents' nutritional intake and body fatness.

PubMed

Kim, Mi-Jeong; McIntosh, William A; Anding, Jenna; Kubena, Karen S; Reed, Debra B; Moon, Gap-Soon

2008-10-01

This study investigated whether perceptions of parenting behaviours predict young adolescents' nutritional intake and body fatness. The randomly selected study sample consisted of 106 13-15 years olds from Houston Metropolitan Statistical Area. Parenting style variables were created by cluster analysis and factor analysis. A two-cluster solution for both maternal and paternal parenting style represented authoritative vs. non-authoritative parenting. Two parenting dimension factors derived were maternal/paternal nurturing and control. For adolescents' energy and nutrient intake, greater maternal nurturing appeared to be most beneficial given its association with lower consumption of total kilocalorie and lower saturated fat intake. Paternal nurturing was associated with lower sodium intake, whereas paternal control predicted lower percentage of kilocalories from carbohydrate and percentage Dietary Reference Intake for dietary fibre, and greater percentage of kilocalories from total fat. Maternal authoritative parenting and lower maternal control over their adolescents may have protective effects against having heavier and fatter adolescents given their associations with adolescents' body weight, sub-scapular skinfold, waist circumference, body mass index, and the tendencies of being at risk of overweight and being overweight. None of paternal parenting styles or dimensions appeared to be significantly related to adolescents' body fatness.

Detection of Genes Regulated by Lmx1b During Limb Dorsalization

PubMed Central

Feenstra, Jennifer M.; Kanaya, Kohei; Pira, Charmaine U; Hoffman, Sarah E.; Eppey, Richard J.; Oberg, Kerby C.

2012-01-01

Lmx1b is a homeodomain transcription factor that regulates dorsal identity during limb development. Lmx1b knockout (KO) mice develop distal ventral-ventral limbs. Although induction of Lmx1b is linked to Wnt7a expression in the dorsal limb ectoderm, the downstream targets of Lmx1b that accomplish limb dorsalization are unknown. To identify genes targeted by Lmx1b, we compared gene arrays from Lmx1b KO and wildtype mouse limbs during limb dorsalization, i.e., 11.5, 12.5, and 13.5 days post coitum. We identified 54 target genes differentially expressed in all three stages. Several skeletal targets, including Emx2, Matrilin1 and Matrilin4, demonstrated a loss of scapular expression in the Lmx1b KO mice, supporting a role for Lmx1b in scapula development. Furthermore, the relative abundance of extracellular matrix-related soft tissue targets regulated by Lmx1b, such as collagens and proteoglycans, suggests a mechanism which includes changes in the extracellular matrix composition to accomplish limb dorsalization. Our study provides the most comprehensive characterization of genes regulated by Lmx1b during limb development to-date and provides targets for further investigation. PMID:22417325

A Unique Late Triassic Dinosauromorph Assemblage Reveals Dinosaur Ancestral Anatomy and Diet.

PubMed

Cabreira, Sergio Furtado; Kellner, Alexander Wilhelm Armin; Dias-da-Silva, Sérgio; Roberto da Silva, Lúcio; Bronzati, Mario; Marsola, Júlio Cesar de Almeida; Müller, Rodrigo Temp; Bittencourt, Jonathas de Souza; Batista, Brunna Jul'Armando; Raugust, Tiago; Carrilho, Rodrigo; Brodt, André; Langer, Max Cardoso

2016-11-21

Dinosauromorpha includes dinosaurs and other much less diverse dinosaur precursors of Triassic age, such as lagerpetids [1]. Joint occurrences of these taxa with dinosaurs are rare but more common during the latest part of that period (Norian-Rhaetian, 228-201 million years ago [mya]) [2, 3]. In contrast, the new lagerpetid and saurischian dinosaur described here were unearthed from one of the oldest rock units with dinosaur fossils worldwide, the Carnian (237-228 mya) Santa Maria Formation of south Brazil [4], a record only matched in age by much more fragmentary remains from Argentina [5]. This is the first time nearly complete dinosaur and non-dinosaur dinosauromorph remains are found together in the same excavation, clearly showing that these animals were contemporaries since the first stages of dinosaur evolution. The new lagerpetid preserves the first skull, scapular and forelimb elements, plus associated vertebrae, known for the group, revealing how dinosaurs acquired several of their typical anatomical traits. Furthermore, a novel phylogenetic analysis shows the new dinosaur as the most basal Sauropodomorpha. Its plesiomorphic teeth, strictly adapted to faunivory, provide crucial data to infer the feeding behavior of the first dinosaurs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Use of Pool Noodles for The Shoulder and Ankle

PubMed Central

2007-01-01

The purpose of this manuscript is to provide two clinical suggestions that are inexpensive, easy to fabricate, and very user-friendly activities that can be used for most patients and athletes. The first clinical suggestion is a method of restoring stability of the scapular muscles around the shoulder complex. Following a period of disuse, whether from a surgery or an injury, weakness may be present in the shoulder. This suggestion is an easy and inexpensive tool which can be used in restoring stability of the scapula in all planes of movement as well as combinations of these planes. The method can also be used as a progression from gravity assisted to gravity resisted active range of motion. The purpose of the second clinical suggestion is to provide an inexpensive and easy to use method of improving proprioception in the ankle. Ankle sprains are among the most common injuries seen in sports. Proprioceptive activities are used not only in the rehabilitation process following an injury but as a training tool to help prevent ankle injuries. This method can be used in the clinic, in a training facility, or as part of a home exercise program. PMID:21522214

Use of pool noodles for the shoulder and ankle.

PubMed

Nelson, Russell

2007-08-01

The purpose of this manuscript is to provide two clinical suggestions that are inexpensive, easy to fabricate, and very user-friendly activities that can be used for most patients and athletes. The first clinical suggestion is a method of restoring stability of the scapular muscles around the shoulder complex. Following a period of disuse, whether from a surgery or an injury, weakness may be present in the shoulder. This suggestion is an easy and inexpensive tool which can be used in restoring stability of the scapula in all planes of movement as well as combinations of these planes. The method can also be used as a progression from gravity assisted to gravity resisted active range of motion. The purpose of the second clinical suggestion is to provide an inexpensive and easy to use method of improving proprioception in the ankle. Ankle sprains are among the most common injuries seen in sports. Proprioceptive activities are used not only in the rehabilitation process following an injury but as a training tool to help prevent ankle injuries. This method can be used in the clinic, in a training facility, or as part of a home exercise program.

TBX15 mutations cause craniofacial dysmorphism, hypoplasia of scapula and pelvis, and short stature in Cousin syndrome.

PubMed

Lausch, Ekkehart; Hermanns, Pia; Farin, Henner F; Alanay, Yasemin; Unger, Sheila; Nikkel, Sarah; Steinwender, Christoph; Scherer, Gerd; Spranger, Jürgen; Zabel, Bernhard; Kispert, Andreas; Superti-Furga, Andrea

2008-11-01

Members of the evolutionarily conserved T-box family of transcription factors are important players in developmental processes that include mesoderm formation and patterning and organogenesis both in vertebrates and invertebrates. The importance of T-box genes for human development is illustrated by the association between mutations in several of the 17 human family members and congenital errors of morphogenesis that include cardiac, craniofacial, and limb malformations. We identified two unrelated individuals with a complex cranial, cervical, auricular, and skeletal malformation syndrome with scapular and pelvic hypoplasia (Cousin syndrome) that recapitulates the dysmorphic phenotype seen in the Tbx15-deficient mice, droopy ear. Both affected individuals were homozygous for genomic TBX15 mutations that resulted in truncation of the protein and addition of a stretch of missense amino acids. Although the mutant proteins had an intact T-box and were able to bind to their target DNA sequence in vitro, the missense amino acid sequence directed them to early degradation, and cellular levels were markedly reduced. We conclude that Cousin syndrome is caused by TBX15 insufficiency and is thus the human counterpart of the droopy ear mouse.

The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study.

PubMed

Ciampi, Pietro; Scotti, Celeste; Nonis, Alessandro; Vitali, Matteo; Di Serio, Clelia; Peretti, Giuseppe M; Fraschini, Gianfranco

2014-05-01

Rotator cuff repair typically results in a satisfactory, although variable, clinical outcome. However, anatomic failure of the repaired tendon often occurs. Patch augmentation can improve the results of open rotator cuff repair by supporting the healing process, protecting the suture, and reducing friction in the subacromial space. Cohort study; Level of evidence, 3. A total of 152 patients with a posterosuperior massive rotator cuff tear were treated by open repair only (control group; n = 51; mean age, 67.06 ± 4.42 years), open repair together with collagen patch augmentation (collagen group; n = 49; mean age, 66.53 ± 5.17 years), or open repair together with polypropylene patch augmentation (polypropylene group; n = 52; mean age, 66.17 ± 5.44 years) and were retrospectively studied. Patients were evaluated preoperatively and after 36 months with a visual analog scale (VAS) and the University of California, Los Angeles (UCLA) shoulder rating scale and by measuring elevation of the scapular plane and strength with a dynamometer. The VAS and UCLA scores were also obtained 2 months postoperatively. Tendon integrity was assessed after 1 year by ultrasound. Patients were homogeneous as per the preoperative assessment. After 2 months, results (mean ± standard deviation) for the control, collagen, and polypropylene groups, respectively, were as follows: VAS scores were 6.96 ± 1.11, 6.46 ± 1.02, and 4.92 ± 0.90, while UCLA scores were 11.29 ± 1.46, 11.40 ± 1.51, and 19.15 ± 1.99. After 36 months, the mean scores for the respective groups were 3.66 ± 1.05, 4.06 ± 1.02, and 3.28 ± 1.10 for the VAS and 14.88 ± 1.98, 14.69 ± 1.99, and 24.61 ± 3.22 for the UCLA scale. In addition, after 36 months, elevation on the scapular plane was 140.68° ± 9.84°, 140.61° ± 12.48°, and 174.71° ± 8.18°, and abduction strength was 8.73 ± 0.54 kg, 9.03 ± 0.60 kg, and 13.79 ± 0.64 kg for the control, collagen, and polypropylene groups, respectively. The retear rate after 12 months was 41% (21/51) for the control group, 51% (25/49) for the collagen group, and 17% (9/52) for the polypropylene group. In particular, the reduced 12-month retear rate and the increased UCLA scores, abduction strength, and elevation at 3-year follow-up were statistically significant for patients treated with a polypropylene patch compared with those treated with repair only or with a collagen patch. Polypropylene patch augmentation of rotator cuff repair was demonstrated to significantly improve the 36-month outcome in terms of function, strength, and retear rate.

Nutritional status and dietary pattern of male athletes in Ibadan, South Western Nigeria.

PubMed

Oladunni, M O; Sanusi, R A

2013-12-20

Several factors, including nutritional status and dietary pattern are paramount to optimum performance among athletes. Notwithstanding, risky behaviours that limit or impair athletic performance are widely prevalent among athletes; these include excessive weight reduction and inappropriate dietary practices. This study was conducted to provide information on the nutritional status and dietary pattern of athletes in Ibadan, Oyo State, Nigeria. This was a cross sectional descriptive study, involving 207 athletes aged 17 to 40 years in Ibadan. Nutritional status was assessed by anthropometric indices: Body Mass Index (BMI) and percentage body fat (%BF). BMI was calculated from weight and height measurements and %BF was estimated from the sum of skin-fold thickness at 4 sites (triceps, biceps, sub-scapular and supra-iliac skin-folds). Dietary pattern was assessed by food habits and food frequency questionnaire. Descriptive and inferential statistics were conducted to describe and examine relationships between variables. Mean (SD) for variables were: age; 26.09(±4.77) years, weight; 72.13(±0.45) kg, height; 1.74(±0.06)m, and BMI; 23.89(±3.34)kg/m2. Only 4(1.93%) of the participants were underweight, 39(18.84%) were overweight and 8(3.86%) obese. Mean (SD) of %BF among overweight athletes was 14.25(±3.12) and maximum %BF among overweight athletes was 21.2. A strong and positive correlation was observed between BMI and %BF and %BF increased with age among overweight athletes. About 72% of the athletes skipped meals, 77% drank water or sports drinks during sporting activities, about 11% spent less than #40.00 for each meal. About 49% ate before sports. Foods most frequently consumed by athletes in this study were meat, fish, roots/tubers, cereals, vegetables and fruits. Milk and legumes were less frequently consumed by these athletes. Most of these athletes had nutritional status adequate for their sport activity. With regards to food habits, most of these athletes performed poorly in frequency of meals intake but did considerably well in intake of fluids. With regards to dietary pattern, sources of daily intakes comprised of mostly of meats, fish, roots and tubers, cereals and vegetables.

Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players.

PubMed

Andersson, Stig Haugsboe; Bahr, Roald; Clarsen, Benjamin; Myklebust, Grethe

2017-07-01

Shoulder problems are highly prevalent among elite handball players. Reduced glenohumeral rotation, external rotation weakness and scapula dyskinesis have been identified as risk factors. Evaluate the effect of an exercise programme designed to reduce the prevalence of shoulder problems in elite handball. 45 elite handball teams (22 female teams, 23 male teams, 660 players) were cluster randomised (22 teams, 331 players in the intervention group, 23 teams, 329 players in the control group) and followed for 1 competitive season (7 months). The Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Programme, an exercise programme to increase glenohumeral internal rotation, external rotation strength and scapular muscle strength, as well as improve kinetic chain and thoracic mobility, was delivered by coaches and captains 3 times per week as a part of the handball warm-up. The main outcome measures, prevalence of shoulder problems and substantial shoulder problems, were measured monthly. The average prevalence of shoulder problems during the season was 17% (95% CI 16% to 19%) in the intervention group and 23% (95% CI 21% to 26%) in the control group (mean difference 6%). The average prevalence of substantial shoulder problems was 5% (95% CI 4% to 6%) in the intervention group and 8% (95% CI 7% to 9%) in the control group (mean difference 3%). Using generalised estimating equation models, a 28% lower risk of shoulder problems (OR 0.72, 95% CI 0.52 to 0.98, p=0.038) and 22% lower risk of substantial shoulder problems (OR 0.78, 95% CI 0.53 to 1.16, p=0.23) were observed in the intervention group compared with the control group. The OSTRC Shoulder Injury Prevention Programme reduced the prevalence of shoulder problems in elite handball and should be included as a part of the warm-up. ISRCTN96217107. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Neural Crest Origins of the Neck and Shoulder

PubMed Central

Matsuoka, Toshiyuki; Ahlberg, Per E.; Kessaris, Nicoletta; Iannarelli, Palma; Dennehy, Ulla; Richardson, William D.; McMahon, Andrew P.; Koentges, Georgy

2005-01-01

Summary The neck and shoulder region of vertebrates has undergone a complex evolutionary history. In order to identify its underlying mechanisms we map the destinations of embryonic neural crest and mesodermal stem cells using novel Cre-recombinase mediated transgenesis. The single-cell resolution of this genetic labelling reveals cryptic cell boundaries traversing seemingly homogeneous skeleton of neck and shoulders. Within this complex assembly of bones and muscles we discern a precise code of connectivity that mesenchymal stem cells of neural crest and mesodermal origin both obey as they form muscle scaffolds. Neural crest anchors the head onto the anterior lining of the shoulder girdle, while a Hox gene controlled mesoderm links trunk muscles to the posterior neck and shoulder skeleton. The skeleton that we identify as neural crest is specifically affected in human Klippel-Feil syndrome, Sprengel’s deformity and Arnold-Chiari I/II malformation, providing first insights into their likely aetiology. We identify genes involved in the cellular modularity of neck and shoulder skeleton and propose a new methodology for determining skeletal homologies that is based on muscle attachments. This has allowed us to trace the whereabouts of the cleithrum, the major shoulder bone of extinct land vertebrate ancestors which appears to survive as the scapular spine in living mammals. PMID:16034409

Pilot study of a robotic protocol to treat shoulder subluxation in patients with chronic stroke

PubMed Central

2013-01-01

Background Shoulder subluxation is a frequent complication of motor impairment after stroke, leading to soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain, thus limiting use of the affected extremity beyond weakness. In this pilot study, we determined whether robotic treatment of chronic shoulder subluxation can lead to functional improvement and whether any improvement was robust. Methods 18 patients with chronic stroke (3.9 ± 2.9 years from acute stroke), completed 6 weeks of robotic training using the linear shoulder robot. Training was performed 3 times per week on alternate days. Each session consisted of 3 sets of 320 repetitions of the affected arm, and the robotic protocol alternated between training vertical arm movements, shoulder flexion and extension, in an anti-gravity plane, and training horizontal arm movements, scapular protraction and retraction, in a gravity eliminated plane. Results Training with the linear robot improved shoulder stability, motor power, and resulted in improved functional outcomes that were robust 3 months after training. Conclusion In this uncontrolled pilot study, the robotic protocol effectively treated shoulder subluxation in chronic stroke patients. Treatment of subluxation can lead to improved functional use of the affected arm, likely by increasing motor power in the trained muscles. PMID:23914834

Pilot study of a robotic protocol to treat shoulder subluxation in patients with chronic stroke.

PubMed

Dohle, Carolin I; Rykman, Avrielle; Chang, Johanna; Volpe, Bruce T

2013-08-05

Shoulder subluxation is a frequent complication of motor impairment after stroke, leading to soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain, thus limiting use of the affected extremity beyond weakness. In this pilot study, we determined whether robotic treatment of chronic shoulder subluxation can lead to functional improvement and whether any improvement was robust. 18 patients with chronic stroke (3.9 ± 2.9 years from acute stroke), completed 6 weeks of robotic training using the linear shoulder robot. Training was performed 3 times per week on alternate days. Each session consisted of 3 sets of 320 repetitions of the affected arm, and the robotic protocol alternated between training vertical arm movements, shoulder flexion and extension, in an anti-gravity plane, and training horizontal arm movements, scapular protraction and retraction, in a gravity eliminated plane. Training with the linear robot improved shoulder stability, motor power, and resulted in improved functional outcomes that were robust 3 months after training. In this uncontrolled pilot study, the robotic protocol effectively treated shoulder subluxation in chronic stroke patients. Treatment of subluxation can lead to improved functional use of the affected arm, likely by increasing motor power in the trained muscles.

[Primary pulmonary hemangiopericytoma: 2 new cases].

PubMed

Essola, B; Remmelink, M; Kessler, R; Scillia, P; Rocmans, P

2003-10-01

We describe two new resected cases of primary pulmonary hemangiopericytoma and the review of cases published in the period 1954-2002. The first patient has a large pulmonary mass of the right apex revealed by scapular pain. The right upper lobectomy with free margins reveals hemangiopericytoma. Pelvic and pulmonary metastases appear two years after surgery, treated by two series of chemotherapy without clinical response. After acute nephrotoxicity controlled by hemodialysis, the patient dies with distant metastases three years and an half after thoracotomy. The second patient develops dry cough and thoracic pain with discovery of a cavitary mass in the right pulmonary field. Fine needle aspiration cytology suggests a mesenchymatous lesion. Three months after extended pneumonectomy, the intrathoracic tumour relapses and regresses partially under chemotherapy. Femoral and brain metastases are irradiated. The patient dies 22 months after thoracotomy. Histology and immunohistochemistry of both tumours closely related to solitary fibrous tumour confirm malignant hemangiopericytoma. Primary pulmonary hemangiopericytoma is rare and may be benign or malignant. Radical resection is the best treatment. Chemotherapy and radiotherapy may improve the prognosis. Compared with lung cancer, the tumour is a slow growing mass, often voluminous, with delayed symptoms, very few lymph node dissemination, rare brain metastasis, more frequent cutaneous or retroperitoneal dissemination, often after long-term and requiring indeed a 10 to 20 years follow-up.

[Characteristics of vertebral and muscular tonic syndromes in acute and remote periods of cervical whiplash injuries].

PubMed

Makarov, G V; Levin, O S

2004-01-01

The study elicited the peculiarities of vertebral and muscular tonic syndromes in acute and remote periods of whip cervical trauma (WCT). Forty patients in acute period of WCT (2nd-3rd degree of severity) and 30 patients in remote period of WCT, who experienced pain and other symptoms 6 months after the trauma (late whip syndrome--LWS) were examined. The control group included 30 patients with neck and arm pain due to cervical osteochondrosis. In WCT, comparing to cervical osteochondrosis, more marked movement restriction in sagittal plane, more frequent blockade of the lower cervical spine segments, stronger correlation between pain syndrome and movement restriction in the cervical segments, more frequent muscular tonic syndrome in the anterior neck muscles and deeper neck flexors were found. In LWS, in contrast to the acute period of WCT, dissociation between more restricted active and more preserved passive movements in the cervical segments, weaker correlation between emerging of pain syndrome and restriction of movement volume, more frequent blockade of the upper cervical segments, more frequent occurrence of supraspinal muscles and shoulder-scapular syndromes were detected. The data obtained revealed a complex mechanism of symptoms formation in WCT that should be taken into account in treatment planning for acute and remote periods of cervical trauma.

Surgical management of coracoid fractures: technical tricks and clinical experience.

PubMed

Hill, Brian W; Jacobson, Aaron R; Anavian, Jack; Cole, Peter A

2014-05-01

The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures; surgical management may be warranted to avoid functional compromise or impingement. A direct approach through Langer's lines allows for easy exposure and direct visualization for an anatomic reduction of simple fractures through the shaft or base of the coracoid. An anterior approach for fractures that extend into the superior glenoid fossa allows for direct exposure to obtain an anatomic articular reduction and indirect reduction of the coracoid fracture. In cases where a complex glenoid or scapula neck/body fracture is being addressed simultaneously either a posterior Judet approach can be used with an indirect reduction method or a separate anterior approach must be combined to address it if not in continuity with the superior scapular segment. Implant selection, primarily interfragmentary screws or a buttress plate, should be based on the size of the fragment, the degree of comminution, and the degree of articular involvement to ensure adequate stabilization. The purpose of this manuscript was to describe a stepwise approach to the surgical management of displaced coracoid fractures, describe surgical tips and techniques, and to present the clinical outcomes in 22 patients after surgical treatment with this approach.

The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation.

PubMed

Sanders, T G; Tirman, P F; Linares, R; Feller, J F; Richardson, R

1999-01-01

The purpose of this study was to describe the MR arthrography appearance of the glenolabral articular disruption (GLAD) lesion. Proper diagnosis of this lesion is important because it can be a source of persistent shoulder pain that requires surgical repair and because it is often difficult to diagnose clinically. Findings on MR arthrography were retrospectively correlated with the clinical histories and physical examination findings of six patients in whom we saw the typical appearance of the GLAD lesion. Four of these patients underwent follow-up arthroscopy that included surgical proof of GLAD lesions. Five of the six patients had a documented glenohumeral impaction injury associated with an abducted externally rotated shoulder. All six patients had persistent shoulder pain, but their shoulders were stable during routine examination. In all patients, MR arthrography showed a superficial tear of the anteroinferior labrum with an adjacent articular cartilage injury. The torn labrum remained firmly attached to the anterior scapular periosteum, and contrast material was seen to extend into the labral tear and cartilaginous defect. The MR arthrography findings of GLAD lesions include a nondisplaced tear of the anteroinferior labrum with an adjacent chondral injury. The pattern of chondral injury can range from a cartilaginous flap tear to a depressed osteochondral injury of the articular cartilage and underlying bone.

Detection of genes regulated by Lmx1b during limb dorsalization.

PubMed

Feenstra, Jennifer M; Kanaya, Kohei; Pira, Charmaine U; Hoffman, Sarah E; Eppey, Richard J; Oberg, Kerby C

2012-05-01

Lmx1b is a homeodomain transcription factor that regulates dorsal identity during limb development. Lmx1b knockout (KO) mice develop distal ventral-ventral limbs. Although induction of Lmx1b is linked to Wnt7a expression in the dorsal limb ectoderm, the downstream targets of Lmx1b that accomplish limb dorsalization are unknown. To identify genes targeted by Lmx1b, we compared gene arrays from Lmx1b KO and wild type mouse limbs during limb dorsalization, i.e., 11.5, 12.5, and 13.5 days post coitum. We identified 54 target genes that were differentially expressed in all three stages. Several skeletal targets, including Emx2, Matrilin1 and Matrilin4, demonstrated a loss of scapular expression in the Lmx1b KO mice, supporting a role for Lmx1b in scapula development. Furthermore, the relative abundance of extracellular matrix-related soft tissue targets regulated by Lmx1b, such as collagens and proteoglycans, suggests a mechanism that includes changes in the extracellular matrix composition to accomplish limb dorsalization. Our study provides the most comprehensive characterization of genes regulated by Lmx1b during limb development to-date and provides targets for further investigation. © 2012 The Authors. Development, Growth & Differentiation © 2012 Japanese Society of Developmental Biologists.

PHYSICAL THERAPY INTERVENTION FOR A FORMER POWER LIFTER AFTER ARTHROSCOPIC MICROFRACTURE PROCEDURE FOR GRADE IV GLENOHUMERAL CHONDRAL DEFECTS

PubMed Central

Sum, Jonathan

2011-01-01

Background: Power lifting places the shoulder complex at risk for injury. Microfracture is a relatively new procedure for chondral defects of the glenohumeral joint and is not well described in the literature. Objectives: The purpose of this case report is to describe the post-operative rehabilitation used with a power lifter who underwent a microfracture procedure to address glenoid and humeral chondral defects, debridement of type I superior labral anterior-posterior lesion, and a subacromial decompression. Case Description: The patient was a 46 year-old male who was evaluated nine weeks status-post arthroscopic microfracture procedure for glenoid and humeral chondral defects, debridement of superior labral anterior-posterior (SLAP) lesion, and subacromial decompression. Rehabilitation consisted of postural education, manual therapy, rotator cuff and scapular strengthening, dynamic stabilization, weightbearing exercises, and weight training over nine weeks (24 sessions). Lifting modifications were addressed. Outcomes: Results of the QuickDASH indicate that activities of daily living (ADLs), work, and sports modules all improved significantly, and the patient was able to return to recreational power lifting with limited discomfort or restrictions. Discussion: A structured post-operative physical therapy treatment program allowed this patient to return to recreational power lifting while restoring independent function for work-related activities and ADLs. PMID:21655454

A de novo mutation of the MYH7 gene in a large Chinese family with autosomal dominant myopathy

PubMed Central

Oda, Tetsuya; Xiong, Hui; Kobayashi, Kazuhiro; Wang, Shuo; Satake, Wataru; Jiao, Hui; Yang, Yanling; Cha, Pei-Chieng; Hayashi, Yukiko K; Nishino, Ichizo; Suzuki, Yutaka; Sugano, Sumio; Wu, Xiru; Toda, Tatsushi

2015-01-01

Laing distal myopathy (LDM) is an autosomal dominant myopathy that is caused by mutations in the slow/beta cardiac myosin heavy-chain (MYH7) gene. It has been recently reported that LDM presents with a wide range of clinical manifestations. We herein report a large Chinese family with autosomal dominant myopathy. The affected individuals in the family presented with foot drop in early childhood, along with progressive distal and proximal limb weakness. Their characteristic symptoms include scapular winging and scoliosis in the early disease phase and impairment of ambulation in the advanced phase. Although limb-girdle muscle dystrophy (LGMD) was suspected initially, a definite diagnosis could not be reached. As such, we performed linkage analysis and detected four linkage regions, namely 1q23.2-24.1, 14q11.2-12, 15q26.2-26.3 and 17q24.3. Through subsequent whole exome sequencing, we found a de novo p.K1617del causative mutation in the MYH7 gene and diagnosed the disease as LDM. This is the first LDM case in China. Our patients have severe clinical manifestations that mimic LGMD in comparison with the patients with the same mutation reported elsewhere. PMID:27081534

Risk Factors Associated With Shoulder Pain and Disability Across the Lifespan of Competitive Swimmers

PubMed Central

Tate, Angela; Turner, Gregory N.; Knab, Sarah E.; Jorgensen, Colbie; Strittmatter, Andrew; Michener, Lori A.

2012-01-01

Context: The prevalence of shoulder pain among competitive swimmers is high, but no guidelines exist to reduce shoulder injuries. Elucidating differences between swimmers with and without shoulder pain can serve as a basis for the development of a program to prevent shoulder injury that might lead to pain and dysfunction. Objective: To determine whether physical characteristics, exposure, or training variables differ between swimmers with and without shoulder pain or disability. Design: Cross-sectional study. Setting: Multisite swimming centers. Patients or Other Participants: A total of 236 competitive female swimmers aged 8 to 77 years. Data Collection and Analysis: Participants completed the Penn Shoulder Score and underwent testing of core endurance, range of motion, muscle force production, and pectoralis minor muscle length and the Scapular Dyskinesis Test. Swimmers were grouped by age for analysis: ages 8 to 11 years (n = 42), 12 to 14 years (n = 43), 15 to 19 years (high school, n = 84), and 23 to 77 years (masters, n = 67). Comparisons were made between groups with and without pain and disability using independent t tests for continuous data and χ2 analyses and Fisher exact tests for categorical data. Results: Nine (21.4%) swimmers aged 8 to 11 years, 8 (18.6%) swimmers aged 12 to 14 years, 19 (22.6%) high school swimmers, and 13 (19.4%) masters swimmers had shoulder pain and disability. Differences that were found in 2 or more age groups between athletes with and without shoulder pain and disability included greater swimming exposure, a higher incidence of previous traumatic injury and patient-rated shoulder instability, and reduced participation in another sport in the symptomatic groups (P < .05). Reduced shoulder flexion motion, weakness of the middle trapezius and internal rotation, shorter pectoralis minor and latissimus, participation in water polo, and decreased core endurance were found in symptomatic females in single varying age groups (P < .05). Conclusions: Female competitive swimmers have shoulder pain and disability throughout their lives. Given that exposure and physical examination findings varied between athletes with and without substantial pain and disability, a program to prevent shoulder injury that might lead to pain and dysfunction appears warranted and might include exposure reduction, cross-training, pectoral and posterior shoulder stretching, strengthening, and core endurance training. PMID:22488280

Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures.

PubMed

Merolla, Giovanni; Tartarone, Antonio; Sperling, John W; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe

2017-01-01

The aim of this study was to assess the effectiveness of reverse total shoulder arthroplasty (RTSA) with an all-polyethylene glenosphere in patients with failed hemiarthroplasty (HH) or the sequelae of proximal humeral fractures. Thirty-six patients were assessed at a mean follow-up of 36 months using clinical scores and recording shoulder range of movement (ROM). Active anterior elevation (p < 0.001), lateral elevation (p < 0.001) and internal rotation (p < 0.0001) improved significantly, whereas improvement in external rotation was not significant. The mean Constant score rose significantly from 8.5 ± 7.6 to 40.7 ± 15.7 (p < 0.001) and the Simple Shoulder Test score from 0.42 ± 0.85 to 5.5 ± 2.6 (p < 0.001). Pain improved significantly from 8.7 ± 0.9 to 2.3 ± 1.2 (p < 0.001). Implant radiographic survivorship was 84.6 %. Scapular notching was detected in 7/36 patients (17.5 %). There were five complications: one (stiffness) among patients with fracture sequelae and four among those with failed HH (instability, n = 2; humeral component disassembly, n = 1; pain, n = 1). The two groups did not exhibit significant differences in pain, clinical scores or ROM. RTSA with an all-polyethylene glenosphere may have the potential to reduce the risk of biological notching due to polyethylene osteolysis. Further long-term studies are required to assess its efficacy. The good clinical performance and reasonable rate of notching of the polyethylene glenosphere support its use in primary and revision shoulder arthroplasty. Level 4, retrospective therapeutic case series.

The effects of localised fatigue on upper extremity jump shot kinematics and kinetics in team handball.

PubMed

Plummer, Hillary A; Oliver, Gretchen D

2017-01-01

Team handball is a popular sport worldwide that requires numerous throws to be made throughout the course of a game. Because of the upper extremity demands of repetitive throwing, it is possible that fatigue can alter the mechanics of a shot. The purpose of this study was to determine the influence of localised fatigue on jump shot kinematics and kinetics. Eleven male team handball players (23.1 ± 3.1 years; 185.1 ± 8.3 cm; 89.7 ± 12.2 kg) volunteered. An electromagnetic tracking system was used to examine the jump shot prior to and following localised fatigue. The fatiguing protocol consisted of throwing a 2.2 kg medicine ball into a rebounder until volitional fatigue. No significant kinematic or kinetic differences were observed following fatigue. Shoulder external rotation was -74.8 ± 14.9° prior to and -79.0 ± 14.7° following fatigue at MER. Scapula, external rotation at ball release (BR) prior to fatigue was -2.2 ± 7.0° and -3.2 ± 11.1° following fatigue. Scapular internal rotation, at maximum shoulder internal rotation (MIR), changed from 18.4 ± 11.2° to 20.4 ± 11.8°. Ball velocity decreased from19.8 m · s -1 to 18.8 m · s -1 (P = 0.12). Accuracy percentage in the pre-fatigue trials was 60.8 ± 14.1% and 52.8 ± 12.7% following fatigue (P = 0.20). While no significant changes were observed, it is possible that other fatiguing protocols that more closely represent the aerobic and throwing demands of the sport may have a greater effect on the kinematics and kinetics of the jump shot.

The relationship between latent trigger points and depression levels in healthy subjects.

PubMed

Celik, Derya; Kaya Mutlu, Ebru

2012-06-01

Our purpose was to study the relationship between latent trigger points (LTrP) and levels of depression in healthy subjects. A total of 76 healthy subjects consisting of 40 men and 36 women (mean age, 25.4 ± 4.8 years; age range, 19-42 years) from the School of Physical Therapy and Rehabilitation and the Orthopaedics and Traumatology Department of Istanbul University Medical Faculty were selected for the study. Latent trigger points on the scapular muscles of each subject were evaluated. The upper and middle trapezius, supraspinatus, serratus anterior, and rhomboideus muscles were examined respectively, by palpation with the thumb, to determine whether there was pain. The first group consisted of 30 subjects (20 men and 10 women; mean age, 24.2 ± 5.02 years) who had previously been diagnosed as negative after an LTrP examination (control group), while the second group consisted of 28 subjects (12 men and 16 women; mean age, 23.6 ± 2.24 years) who had been diagnosed with at least five LTrPs. The third group consisted of 18 subjects (8 men and 10 women; mean age, 26. 9 ± 7.23 years) who had been diagnosed with more than five LTrPs. All groups were assessed, using the Beck Depression Inventory (BDI). The mean BDI value was found to be 8.0 ± 4.2 in the first group, 10.3 ± 3.4 in the second, and 28.5 ± 4.8 in the third. A significant difference was found between the mean BDI values of the first and second groups and also between the first and third groups. The mean BDI values of the second and third groups were also found to be statistically significant (p = 0.042). We observed a close relationship between the presence of LTrPs and depression levels in healthy people.

A new species of Amazonian snouted treefrog (Hylidae: Scinax) with description of a novel species-habitat association for an aquatic breeding frog

PubMed Central

de Fraga, Rafael; Moravec, Jiří; Kaefer, Igor L.; Lima, Albertina P.

2018-01-01

The genus Scinax is one of the most specious genera of treefrogs of the family Hylidae. Despite the high number of potential new species of Scinax revealed in recent studies, the rate of species descriptions for Amazonia has been low in the last decade. A potential cause of this low rate may be the existence of morphologically cryptic species. Describing new species may not only impact the taxonomy and systematics of a group of organisms but also benefit other fields of biology. Ecological studies conducted in megadiverse regions, such as Amazonia, often meet challenging questions concerning insufficient knowledge of organismal alpha taxonomy. Due to that, detecting species-habitat associations is dependent on our ability to properly identify species. In this study, we first provide a description of a new species (including its tadpoles) of the genus Scinax distributed along heterogeneous landscapes in southern Amazonia; and secondly assess the influence of environmental heterogeneity on the new species’ abundance and distribution. Scinax ruberoculatus sp. nov. differs from all nominal congeners by its small size (SVL 22.6–25.9 mm in males and 25.4–27.5 mm in females), by having a dark brown spot on the head and scapular region shaped mainly like the moth Copiopteryx semiramis (or a human molar in lateral view, or a triangle), bicolored reddish and grey iris, snout truncate in dorsal view, bilobate vocal sac in males, by its advertisement call consisting of a single pulsed note with duration of 0.134–0.331 s, 10–23 pulses per note, and dominant frequency 1,809–1,895 Hz. Both occurrence and abundance of the new species are significantly influenced by silt content in the soil. This finding brings the first evidence that edaphic factors influence species-habitat association in Amazonian aquatic breeding frogs. PMID:29441233

Influence of disruption of the acromioclavicular and coracoclavicular ligaments on glenohumeral motion: a kinematic evaluation.

PubMed

Walley, Kempland C; Haghpanah, Babak; Hingsammer, Andreas; Harlow, Ethan R; Vaziri, Ashkan; DeAngelis, Joseph P; Nazarian, Ara; Ramappa, Arun J

2016-11-17

Changes to the integrity of the acromioclavicular (AC) joint impact scapulothoracic and clavicular kinematics. AC ligaments provide anterior-posterior stability, while the coracoclavicular (CC) ligaments provide superior-inferior stability and a restraint to scapular internal rotation. The purpose of this cadaveric study was to describe the effect of sequential AC and CC sectioning on glenohumeral (GH) kinematics during abduction (ABD) of the arm. We hypothesized that complete AC ligament insult would result in altered GH translation in the anterior-posterior plane during abduction, while subsequent sectioning of both CC ligaments would result in an increasing inferior shift in GH translation. Six cadaveric shoulders were studied to evaluate the impact of sequential sectioning of AC and CC ligaments on GH kinematics throughout an abduction motion in the coronal plane. Following an examination of the baseline, uninjured kinematics, the AC ligaments were then sectioned sequentially: (1) Anterior, (2) Inferior, (3) Posterior, and (4) Superior. Continued sectioning of CC ligamentous structures followed: the (5) trapezoid and then the (6) conoid ligaments. For each group, the GH translation and the area under the curve (AUC) were measured during abduction using an intact cadaveric shoulder. Total translation was calculated for each condition between ABD 30° and ABD 150° using the distance formula, and a univariate analysis was used to compare total translation for each axis during the different conditions. GH kinematics were not altered following sequential resection of the AC ligaments. Disruption of the trapezoid resulted in significant anterior and lateral displacement of the center of GH rotation. Sectioning the conoid ligament further increased the inferior shift in GH displacement. A combined injury of the AC and CC ligaments significantly alters GH kinematics during abduction. Type III AC separations, result in a significant change in the shoulder's motion and may warrant surgical reconstruction to restore normal function.

Comparison of Physical Therapy with Energy Healing for Improving Range of Motion in Subjects with Restricted Shoulder Mobility

PubMed Central

Linda Baldwin, Ann; Schwartz, Gary E.

2013-01-01

Two forms of energy healing, Reconnective Healing (RH) and Reiki, which involve light or no touch, were tested for efficacy against physical therapy (PT) for increasing limited range of motion (ROM) of arm elevation in the scapular plane. Participants were assigned to one of 5 groups: PT, Reiki, RH, Sham Healing, or no treatment. Except for no treatment, participants were blinded as to grouping. Range of Motion, self-reported pain, and heart rate variability (HRV) were assessed before and after a 10-minute session. On average, for PT, Reiki, RH, Sham Healing, and no treatment, respectively, ROM increased by 12°, 20°, 26°, 0.6°, and 3° and pain score decreased by 11.5%, 10.1%, 23.9%, 15.4%, and 0%. Physical therapy, Reiki, and RH were more effective than Sham Healing for increasing ROM (PT: F = 8.05, P = 0.008; Reiki: F = 10.48, P = 0.003; RH: F = 30.19, P < 0.001). It is possible that this improvement was not mediated by myofascial release because the subjects' HRV did not change, suggesting no significant increase in vagal activity. Sham treatment significantly reduced pain compared to no treatment (F = 8.4, P = 0.007) and was just as effective as PT, Reiki, and RH. It is the authors' opinion that the accompanying pain relief is a placebo effect. PMID:24327820

Muscle load in reaching movements performed by a wheelchair user: a case study.

PubMed

van Drongelen, S; Wolf, S I; Fradet, L

2014-01-01

The aim of this study was to analyse the load on the shoulder muscles during reaching movements that are specific to wheelchair users in relation to the risk of impingement. Three activities of daily living were performed: putting a book on a shelf in front and at the side and putting a pack of water bottles on a table. The AnyBody shoulder model was used to calculate the activity and forces of the shoulder muscles. Handling the pack of bottles caused the highest forces in the deltoideus, trapezius, serratus anterior and rotator cuff muscles. For handling the book, the highest forces were found in the deltoideus (scapular part) and the serratus anterior, especially during the put phase. Handling heavy objects such as a pack of bottles or a wheelchair produces high forces on the rotator cuff muscles and can lead to early fatigue. Therefore, these activities seem to be associated with a high risk of developing impingement syndrome. Implications for Rehabilitation In a single patient, this study demonstrates that the load on the rotator cuff is high during reaching movements. Handling a pack of water bottles, which resembles wheelchair handling, represents an activity associated with a high risk of developing impingement syndrome. Shoulder muscles must be trained in a balanced way to provide stabilization at the shoulder joint and prevent fatigue.

Association between insulin resistance and risk of complications in children and adolescents with type 1 diabetes.

PubMed

Krochik, Andrea G; Botto, Marianela; Bravo, Mónica; Hepner, Mirta; Frontroth, Juan P; Miranda, Miguel; Mazza, Carmen

2015-01-01

It has been hypothesized that insulin resistance may be involved in the development of type 1 diabetes complications and early diagnosis would be important for their prevention. Our aim was to study insulin resistance in our population of children with type 1 diabetes and to identify associated early risk factors for micro- and macrovascular complications. A descriptive, cross-sectional study was conducted including 150 children with type 1 diabetes. Anthropometric, bioelectric impedance, carotid Doppler ultrasonography, electromyography, and conduction velocity studies were performed. Baseline plasma glucose, lipid profile, uric acid, plasma thyrotropin, glycosylated hemoglobin A1C, and microalbuminuria were assessed. More insulin-resistant patients were defined as those having an estimated glucose disposal rate (eGDR) value below the first quartile. Clinically manifest microvascular complications were not found in any of the patients. More insulin-resistant patients had a greater sub scapular fold thickness, a higher incidence of obesity (12% vs. 1.7% p 0.007), higher fructosamine levels (496 vs. 403 p<0.00019, and a higher incidence of altered lipid metabolism (70% vs. 39% p 0.0007). In the subgroup of patients with lower eGDR there were more children with lipid disorders, obesity, and worse diabetic control, which, if not corrected, may lead to development of micro- and macrovascular complications. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Neck Circumference as a Predictor of Adiposity among Healthy and Obese Children

PubMed Central

Hassan, Nayera E.; Atef, Abeer; El-Masry, Sahar A.; Ibrahim, Amany; Shady, Mones M. Abu; Al-Tohamy, Muhammad; Kamel, Iman H.; Elashry, Galal Ismail Ahmed

2015-01-01

BACKGROUND: Obesity, particularly in the upper part of body, is a major health problem. Because body mass index (BMI) does not adequately describe regional adiposity, other indices of body fatness are being explored. OBJECTIVES: To determine if neck circumference is a valid measure of adiposity (fat distribution) among group of Egyptian children. SUBJECTS AND METHODS: This is a cross sectional study, included 50 obese subjects, aged 7 - 12 years recruited from Endocrine, obesity and Metabolism Pediatric Unit at Children Hospital, Cairo University and 50 healthy children, age and sex matched. All children were subjected to blood pressure assessment (systolic SBP and diastolic DBP), and anthropometric assessment (body weight, height, neck circumference (NC), waist (WC) and hip (HC) circumferences, and skin fold thicknesses at three sites: biceps, triceps and sub scapular. BMI [weight (kg)/height (m2)] was calculated. RESULTS: In healthy females, significant associations were detected between NC and SBP, DBP and all anthropometric measurements. However, in healthy males NC was not significantly associated with BMI, SBP and DBP. In the obese group; both sexes; insignificant association was found between NC and SBP, DBP, BMI and skinfold thickness. CONCLUSION: NC is related to fat distribution among normal healthy female children. However, this relation disappears with increasing adiposity. The results do not support the use of NC as a useful screening tool for childhood obesity. PMID:27275287

PreFix™ external fixator used to treat a floating shoulder injury caused by gunshot wound.

PubMed

Vogels, J; Pommier, N; Cursolle, J-C; Belin, C; Tournier, C; Durandeau, A

2014-10-01

Open fractures of the shoulder are extremely rare, and their treatment is a major challenge for surgeons. Only cases encountered in military settings have been reported thus far. Such fractures are often the result of ballistic trauma, which causes extensive damage to both bony and soft tissues. Since these injuries are associated with a high risk of infection and the presence of comminuted fractures, external fixation is necessary for repair. Use of external fixators and revascularization techniques has reduced the number of cases requiring shoulder amputation or disarticulation. Injury to the proximal extremity of the humerus, acromion, and clavicle further complicates the treatment. No published studies have described the assembly of external fixators for fractures in the scapular region with significant bone loss. In addition, no cases have been described in civilian settings. However, with an increase in urban violence and the traffic of illegal arms, civilian surgeons are now encountering an increasing number of patients with these injuries. In this report, we not only present a rare case of floating shoulder injury in a civilian setting but also provide an overview of the existing treatment strategies for this type of trauma, with special focus on the use of external fixators in elective shoulder arthrodesis and on military cases. Copyright © 2014 Elsevier Masson SAS. All rights reserved.