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Chun DI, Cho JH, Choi IH, Yi Y, Kim JY, Kim JH, Won SH. Osteochondroma of ventral scapula associated with chest pain due to rib cage compression: A case report. Medicine (Baltimore) 2018; 97:e0510. [PMID: 29703017 PMCID: PMC5944560 DOI: 10.1097/md.0000000000010510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The scapula is relatively rare site for osteochondroma. Scapula osteochondroma is usually asymptomatic, however it may present with features such as pseudowinging, snapping scapula, bursa formation, chronic pain, and cosmetic deformities. To our best knowledge, this is the first report in the English literature about osteochondroma of ventral scapula associated with chest pain due to rib cage compression. PATIENT CONCERNS A 14-year-old boy was transferred to the orthopedic clinic from thoracic surgery department with a complaint of intermittent, dull, and diffuse aching pain around left chest wall and back from the past 2 months. The patient was previously diagnosed with multiple osteochondromas on another side; proximal tibia and distal femur. DIAGNOSIS A radiopaque mass like lesion was observed on the scapula in the posteroanterior view of the chest, and compression of chest wall was also seen. In chest computed tomography (CT), pedunculated outgrowing bony mass was noted in the anterior aspect of the left scapular wing, which showed the continuity of bony cortex and medulla. This bony mass showed the mass effect on the left chest wall, causing left thoracic cavity deformity by making it narrower than the right INTERVENTIONS:: Surgery was performed under general anesthesia. After the surgery, the arm was immobilized by putting it in an abductor pillow brace for 3 weeks, and during that period pendulum exercise was permitted. OUTCOMES The patient's symptoms resolved in the immediate postoperative period. At 1 year's follow-up, the patient was symptom free and there was no evidence of recurrence of the tumor. LESSONS We recommend that in case of patients who have a history of osteochondroma and complaint of chest pain, surgeons should become suspicious of the presence of osteochondroma of the ventral scapula. In this situation, we recommend chest radiography, pulmonary function test, and chest CT for early detection and treatment.
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Barsaoui M, Riahi H, Chelly Bouaziz M, Ladeb MF. Diagnostic features of elastofibroma dorsi: about 4 cases. LA TUNISIE MEDICALE 2018; 96:64-67. [PMID: 30324995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Elastofibromas are rare benign soft tissue tumors that are commonly located at the inferior pole of the scapula, typically in the right side, deep to the serratus anterior muscle. They occur mainly in elderly women and are usually asymptomatic. We present four cases of elastofibroma dorsi in which the clinical and ultrasound diagnosis was confirmed by CT and magnetic resonance imaging. The location of the lesions (bilateral in two cases) was typical, in the thoraco-scapular region. When the lesion show typical imaging features and produces no symptoms, as is usually the case; further investigations are probably unnecessary.
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Kim KH, Oh HH, Son DJ, Hong JY, Jeong YH, Jung JS, Yu HM, Myung DS, Cho SB, Lee WS, Kim JW, Joo YE. Scapular metastasis of hepatocellular carcinoma presenting as acute bleeding and hematoma: A case report of safe and effective treatment. Medicine (Baltimore) 2017; 96:e8736. [PMID: 29145320 PMCID: PMC5704865 DOI: 10.1097/md.0000000000008736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The occurrence of bleeding and hematoma from bone metastasis of hepatocellular carcinoma (HCC) is extremely rare. PATIENT CONCERNS We present a case of scapular metastasis of HCC in a 69-year-old man who presented with acute bleeding and hematoma. DIAGNOSES Chest computed tomography showed a large hematoma within the right pectoral muscle of the right upper chest and an exophytic metastatic mass in the right scapula with bony destruction, which caused the intramuscular hematoma. The final diagnosis was scapular metastasis of HCC presenting as acute bleeding and hematoma. INTERVENTIONS Selective right subclavian angiography showed a hypervascular metastatic lesion in the right scapula. Subsequently, embolization of the tumoral feeding artery using a microcoil was performed and tumoral bleeding was stopped. OUTCOMES The patient was discharged on hospital day 14 without any complications. LESSONS Despite being extremely rare, the possibility of bleeding from bone metastasis of HCC needs to be considered. Transcatheter arterial embolization may be an effective means to treat bleeding from bone metastasis of HCC.
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Jia X, Chen C, Chen L, Yu C, Kondo T. Large malignant granular cell tumor with suprascapular nerve and brachial plexus invasion: A case report and literature review. Medicine (Baltimore) 2017; 96:e8531. [PMID: 29095317 PMCID: PMC5682836 DOI: 10.1097/md.0000000000008531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Malignant granular cell tumor is a kind of rare and highly aggressive malignant tumor that commonly occurs in lower extremity, trunk, and peritoneal cavity. Huge malignant granular cell tumor (MGCT) with suprascapular nerve and brachial plexus invasion was extremely rare. PATIENT CONCERNS We present a special case of a 48-year-old orthopedist who suffered from MGCT. The orthopedist had regarded that he suffered from scapulohumeral periarthritis. DIAGNOSES The disease was noticed until a painless mass on his right neck was discovered 9 months later. MRI result confirmed a large occupying in axillary fossa, supraclavicular and infraclavicular region. INTERVENTIONS During the operation, a tumor measuring 22 × 13 × 6 cm with suprascapular nerve and brachial plexus invasion was identified. The tumor was fractional resected carefully to maintain the integrity of nerves and vessels. Lymph nodes were simultaneously resected. OUTCOMES The motor function and sensation of the upper extremity were same to that of preoperation. The postoperative histological diagnosis was MGCT. At a 12-month follow-up, there was no recurrence of the tumor showed by MRI. LESSONS This study presents a rare case of large MGCT with suprascapular nerve and brachial plexus invasion that was successfully managed by surgery.
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Schmidt VJ, Wietbrock JO, Leibig N, Hernekamp JF, Henn D, Radu CA, Kneser U. Haemodynamically stimulated and in vivo generated axially vascularized soft-tissue free flaps for closure of complex defects: Evaluation in a small animal model. J Tissue Eng Regen Med 2017; 12:622-632. [PMID: 28509443 DOI: 10.1002/term.2477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 12/25/2022]
Abstract
The arteriovenous (AV) loop model permits the creation of significant volumes of axially vascularized tissue that represents an alternative to conventional free flaps, circumventing their common limitations. However, such AV loop-based flaps have never before been examined in standardized animal models with respect to their suitability for reconstruction of critical bone-exposing defects. In the course of our preliminary studies, we implemented a novel defect model in rats that provides standardized and critical wound conditions and evaluated whether AV loop-generated flaps are suitable for free microsurgical transfer and closure of composite defects. We compared three groups of rodents with similar scapular defects: one received the AV flap, whereas controls were left to heal by secondary intention or with supplementary acellular matrix alone. To create the flaps, AV loops were placed into subcutaneous Teflon chambers filled with acellular matrix and transferred to the thigh region. Flap maturation was evaluated by histological analysis of angiogenesis and cell migration at days 14 and 28 after loop creation. Flap transfer to the scapular region and microsurgical anastomoses were performed after 14 days. Postoperative defect closure and perfusion were continually compared between groups. Within the AV flap chamber, the mean vessel number, cell count and the proportion of proliferating cells increased significantly over time. The novel defect model revealed that stable wound coverage with homogeneous vascular integration was achieved by AV loop-vascularized soft-tissue free flaps compared with controls. In summary, our study indicates for the first time that complex composite defects in rats can successfully be treated with AV loop-based free flaps.
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Rossi DM, Pedroni CR, Martins J, de Oliveira AS. Intrarater and interrater reliability of three classifications for scapular dyskinesis in athletes. PLoS One 2017; 12:e0181518. [PMID: 28749966 PMCID: PMC5531566 DOI: 10.1371/journal.pone.0181518] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 07/03/2017] [Indexed: 11/19/2022] Open
Abstract
Clinical evaluation of scapular dyskinesis (SD) aims to identify abnormal scapulothoracic movement, underlying causal factors, and the potential relationship with shoulder symptoms. The literature proposes different methods of dynamic clinical evaluation of SD, but improved reliability and agreement values are needed. The present study aimed to evaluate the intrarater and interrater agreement and reliability of three SD classifications: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). Seventy-five young athletes, including 45 men and 30 women, were evaluated. Raters evaluated the SD based on the three methods during one series of 8-10 cycles (at least eight and maximum of ten) of forward flexion and abduction with an external load under the observation of two raters trained to diagnose SD. The evaluation protocol was repeated after 3 h for intrarater analysis. The agreement percentage was calculated by dividing the observed agreement by the total number of observations. Reliability was calculated using Cohen Kappa coefficient, with a 95% confidence interval (CI), defined by Kappa coefficient ±1.96 multiplied by the measurement standard error. The interrater analyses showed an agreement percentage between 80% and 95.9% and an almost perfect reliability (k>0.81) for the three classification methods in all the test conditions, except the 4-type and SDT classification methods, which had substantial reliability (k<0.80) in shoulder abduction. Intrarater analyses showed agreement percentages between 80.7% and 89.3% and substantial reliability (0.67 to 0.81) for both raters in the three classifications. CIs ranged from moderate to almost perfect categories. This indicates that the three SD classification methods investigated in this study showed high reliability values for both intrarater and interrater evaluation throughout a protocol that provided SD evaluation training of raters and included several repetitions of arm movements with external load during a live assessment.
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Clausen M, Witten A, Holm K, Christensen K, Attrup M, Hölmich P, Thorborg K. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index. BMC Musculoskelet Disord 2017; 18:302. [PMID: 28716019 PMCID: PMC5513121 DOI: 10.1186/s12891-017-1667-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines. The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function. METHODS Cross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia. RESULTS Significant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29-33% deficits), and less for scapulothoracic strength and internal rotation ROM (8-18% deficits). Pain variables influenced SPADI and SPADI-F score to a high degree (R2 = 23.4-31.6%, p < 0.001), while strength and ROM did not. CONCLUSION Substantial strength and ROM impairments were found in patients with SIS. Only pain significantly influenced patient-reported function, while impairments did not. As SPADI score does not reflect the substantial strength and ROM impairments in external rotation and abduction observed in patients with SIS, supplemental assessment of these impairments seems important.
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Christman-Skieller C, McIntyre LK, Plevin R, Friedrich JB, Smith DG. A Posterolateral Approach to the Scapula for Evacuation of a Subscapular Abscess: A Case Report. JBJS Case Connect 2017; 7:e57. [PMID: 29252887 DOI: 10.2106/jbjs.cc.16.00241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We present the case of a subscapular abscess that was drained via a posterolateral approach to the scapula. Complete evacuation of the abscess was achieved, and the incisions healed without difficulty. There were no immediate postoperative complications from this approach. CONCLUSION To our knowledge, a posterolateral approach for evacuating a subscapular abscess has not been described previously in the literature. Utilizing the internervous plane between the teres major and latissimus dorsi muscles, along with medial counterincisions, allows for safe drainage of this rare type of abscess.
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Carroll C, Bass B. Winging of the scapula diagnosed as Parsonage-Turner syndrome: a case report. U.S. ARMY MEDICAL DEPARTMENT JOURNAL 2017:99-101. [PMID: 28853127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 24-year-old active duty female Soldier complained of right shoulder burning, stinging, electrical shock-like pain with radiation to the right hand after completing a ruck march. She also complained of swelling and feelings of her cold right hand. Examination showed a deficit in the deltoid, upper trapezius, supraspinatus, and also right winging of the scapula. She also exhibited weakness to right arm, weak right hand grip, and decreased sensation over the dorsal right hand. The right hand was also noticed to be colder to touch than the left one. She had tenderness to palpation over right paracervical muscles from C3 to C7. A previous magnetic resonance arthrogram of the right shoulder revealed no findings. The cervical magnetic resonance imagery showed mild disc protrusion at C5-C6 without spinal cord impingement. Based on the history and the physical findings, the patient was diagnosed with Parsonage-Turner syndrome.
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Echchaoui A, Sadrati Y, Elbir Y, Elktaibi A, Benyachou M, Mazouz SE, Gharib NE, Abbassi A. Proximal-type epithelioid sarcoma: a new case report and literature review. Pan Afr Med J 2016; 24:238. [PMID: 27800093 PMCID: PMC5075453 DOI: 10.11604/pamj.2016.24.238.8535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/02/2016] [Indexed: 12/01/2022] Open
Abstract
Proximal-type epithelioid sarcoma is a rare soft tissue neoplasm which arises from the more proximal part of body and occurs more often in young people; the definite diagnosis depends mainly on the pathological examination; early detection and complete excision remain the foundation of treatment. Due to its aggressive behavior, high capacity of recurrence and the great ability to metastasize, a careful clinical long-term monitoring is required. We report a new case of a 20 years old girl, presented with proximal-type epithelioid sarcoma in her right scapular region, confirmed by pathological examination and removed surgically without recurrence or metastasis at eighteen months of follow-up.
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Knowles NK, Carroll MJ, Keener JD, Ferreira LM, Athwal GS. A comparison of normal and osteoarthritic humeral head size and morphology. J Shoulder Elbow Surg 2016; 25:502-9. [PMID: 26597658 DOI: 10.1016/j.jse.2015.08.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate and to compare the size and morphologic patterns among normal and osteoarthritic (OA) humeral heads. METHODS This comparative anatomic imaging study evaluated 150 humeral heads that were separated into 3 cohorts: normal, OA with symmetric glenoid erosion, and OA with asymmetric (type B2) glenoid erosion. Three-dimensional models were created of the humeral head from computed tomography data, and point coordinates were extracted for evaluation. Parameters measured were diameter (sphere fit and circle fit), chord distance (superoinferior and anteroposterior), and humeral head height. RESULTS The sphere-fit diameter of the humeral head for the entire OA cohort (100 patients; mean diameter, 59 ± 9 mm) was significantly greater (P < .001) than that of the normal cohort (50 patients; mean diameter, 49 ± 5 mm). Similarly, the humeral head circle-fit diameters in the superoinferior and anteroposterior planes were significantly greater (P < .001) in the combined OA cohorts (59 ± 9 mm and 56 ± 10 mm, respectively) compared with the normal cohort (51 ± 5 mm and 47 ± 5 mm, respectively). However, there were no significant differences (P ≥ .099) between the symmetric and asymmetric OA cohorts in sphere-fit or circle-fit diameters. The mean values of humeral head heights were not significantly different (P = .382) between cohorts, 19 ± 2 mm, 18 ± 2 mm, and 18 ± 2 mm for the normal, symmetric, and asymmetric cohorts, respectively. DISCUSSION Although OA humeral head morphology varies significantly from normal, it does not vary as a function of the Walch classification between symmetric and asymmetric glenoids. Understanding of the morphologic variability of the pathologic humeral head may provide insight into the pathoanatomy of osteoarthritis and the development of various erosion patterns.
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Walia P, Patel RM, Gottschalk L, Kuklis M, Jones MH, Fening SD, Miniaci A. The Reduction in Stability From Combined Humeral Head and Glenoid Bony Defects Is Influenced by Arm Position. Am J Sports Med 2016; 44:715-22. [PMID: 26792704 DOI: 10.1177/0363546515620588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Combined defects of the glenoid and humeral head are often a cause for recurrent shoulder instability. PURPOSE/HYPOTHESIS The aim of this study was to evaluate the influence of combined bony lesions on shoulder instability through varying glenohumeral positions. The hypothesis was that instability due to combined defects would be magnified with increasing abduction and external rotation. STUDY DESIGN Controlled laboratory study. METHODS Eighteen cadaveric shoulders were tested. Experiments were performed at combinations of glenohumeral abduction angles of 20°, 40°, and 60° and external rotations of 0°, 40°, and 80°. The various glenoid defect sizes created were 10%, 20%, and 30% of the glenoid width. Four humeral head defects were created based on humeral head diameter (6%, 19%, 31%, and 44%). Each experiment consisted of translating the glenoid in a posterior direction to simulate an anterior dislocation under a 50-N load. The instability was measured as a percentage of intact translation (ie, loss in translational distance normalized to the no-defect condition). RESULTS At 20° of abduction, instability increased from 100% to 85%, 70%, and 43% with increasing glenoid defect sizes of 10%, 20% and 30%, respectively, with a 6% humeral head defect. However, at a functional arm position of apprehension, these values were significantly decreased (P < .05) for humeral head defect sizes of 19%, 31%, and 44%, with translation values of 49%, 27%, and 2%, respectively. CONCLUSION A humeral defect leads to rotational instability with the arm rotated into a functional position rather than a resting position. However, a significant glenoid defect can lead to loss of translation independent of changes in arm position. Combined defects as large as 44% of humeral head and 20% glenoid did not show instability at 20° of abduction and neutral position; however, defects as small as 19% humeral defect and 10% glenoid defect led to significant instability in the position of apprehension. CLINICAL RELEVANCE Instability at lower levels of abduction and external rotation clinically indicates larger bony defects and may need to be directly addressed, depending on the patient's age and function.
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Dare D, Dines JS, Tebo C, Edwards TB, Craig EV, Dines DM. Scapular Notching. Instr Course Lect 2016; 65:145-156. [PMID: 27049187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Developed in 1985, the Grammont-style reverse total shoulder arthroplasty offered a biomechanical advantage for the deltoid muscle as well as predictably reduced pain and improved shoulder function in rotator cuff-deficient shoulders. Despite favorable outcomes, reverse total shoulder arthroplasty is associated with a unique set of complications, one of which is scapular notching. Scapular notching is believed to be a result of mechanical impingement of the humeral component on the lateral scapular pillar. Although it appears that scapular notching progresses with time, its effect on implant survivorship and clinical outcomes is unknown. Factors associated with scapular notching are categorized into several groups, including patient-specific risk factors, surgical approach and technique, and prosthetic design. Surgical strategies to reduce the rate of scapular notching include inferior positioning of the glenosphere, inferior tilting of the glenosphere, and increasing the size of the glenosphere. A lateralized center of rotation and a decreased humeral shaft-neck angle also decrease the incidence of scapular notching. As the indications for reverse total shoulder arthroplasty expand, it is important for orthopaedic surgeons to understand the etiology and incidence, predictive factors, and clinical relevance of scapular notching as well as strategies to avoid it.
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Oleinikov BV, Knyazhishche AN, Oleinikov DB. [Myofascial meridional reflexotherapy of scapulohumeral periarthrosis in the course of the combined spa and health resort-based treatment]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2015; 92:45-47. [PMID: 26841529 DOI: 10.17116/kurort2015645-47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors draw attention to the role of a whiplash injury in the pathogenesis of scapulohumeral periarthrosis (SHP). Peculiarities of the specific pathological biomechanical changes associated with this condition are described. The study included a group of 64 patients in whom the localization of the myofascial trigger points (MFTT) of the shortened muscles is described with reference to the differential techniques for soft-tissue manual therapy. Spatial emphasis is laid on the diagnostic dynamic ischemic compression of trigger points (TT) for their inactivation using the method proposed by J. Travel in the original modifications proposed by the authors of the present article. The results of the application of myofascial meridional reflexotherapy of scapulohumeral periarthrosis are presented and analysed in the context of the combined spa and health resort-based treatment.
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Ibrahim EF, Forrest NP, Forester A. Bilateral weighted radiographs are required for accurate classification of acromioclavicular separation: an observational study of 59 cases. Injury 2015; 46:1900-5. [PMID: 26194267 DOI: 10.1016/j.injury.2015.06.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 06/06/2015] [Accepted: 06/10/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Misinterpretation of the Rockwood classification system for acromioclavicular joint (ACJ) separations has resulted in a trend towards using unilateral radiographs for grading. Further, the use of weighted views to 'unmask' a grade III injury has fallen out of favour. Recent evidence suggests that many radiographic grade III injuries represent only a partial injury to the stabilising ligaments. This study aimed to determine (1) whether accurate classification is possible on unilateral radiographs and (2) the efficacy of weighted bilateral radiographs in unmasking higher-grade injuries. METHODS Complete bilateral non-weighted and weighted sets of radiographs for patients presenting with an acromioclavicular separation over a 10-year period were analysed retrospectively, and they were graded I-VI according to Rockwood's criteria. Comparison was made between grading based on (1) a single antero-posterior (AP) view of the injured side, (2) bilateral non-weighted views and (3) bilateral weighted views. Radiographic measurements for cases that changed grade after weighted views were statistically compared to see if this could have been predicted beforehand. RESULTS Fifty-nine sets of radiographs on 59 patients (48 male, mean age of 33 years) were included. Compared with unilateral radiographs, non-weighted bilateral comparison films resulted in a grade change for 44 patients (74.5%). Twenty-eight of 56 patients initially graded as I, II or III were upgraded to grade V and two of three initial grade V patients were downgraded to grade III. The addition of a weighted view further upgraded 10 patients to grade V. No grade II injury was changed to grade III and no injury of any severity was downgraded by a weighted view. Grade III injuries upgraded on weighted views had a significantly greater baseline median percentage coracoclavicular distance increase than those that were not upgraded (80.7% vs. 55.4%, p=0.015). However, no cut-off point for this value could be identified to predict an upgrade. CONCLUSIONS The accurate classification of ACJ separation requires weighted bilateral comparative views. Attempts to predict grade on a single AP radiograph result in a gross underestimation of severity. The value of bilateral weighted views is to 'unmask' a grade V injury, and it is recommended as a first-line investigation.
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Lädermann A, Gueorguiev B, Charbonnier C, Stimec BV, Fasel JHD, Zderic I, Hagen J, Walch G. Scapular Notching on Kinematic Simulated Range of Motion After Reverse Shoulder Arthroplasty Is Not the Result of Impingement in Adduction. Medicine (Baltimore) 2015; 94:e1615. [PMID: 26402829 PMCID: PMC4635769 DOI: 10.1097/md.0000000000001615] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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.
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Edelstein AI, Linn RL, Fritsch MK, Sagan M. Osteochondroma With Contiguous Bronchogenic Cyst of the Scapula. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2015; 44:E355-E357. [PMID: 26372765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Osteochondroma is a benign bone tumor composed of a bony protrusion with an overlying cartilage cap. Osteochondromas arise in the scapula in 3% to 5% of cases, making them the most common benign bone tumor in this location. Scapular osteochondromas cause various pathologies of the shoulder girdle, including snapping scapula syndrome, chest wall deformity, shoulder impingement, and bursa formation. Bronchogenic cyst is an exceedingly rare finding in the periscapular area. It is a congenital cystic mass lined by tracheobronchial structures and respiratory epithelium. To our knowledge, there are no reports of a contiguous osteochondroma and bronchogenic cyst. A 12-month-old boy presented with an incidentally noted mass on the spine of the scapula, which drained scant, clear fluid through an adjacent pinprick-sized hole. Imaging revealed an exostosis with an adjacent cystic mass. The mass and cyst were excised en bloc, and histopathologic examination confirmed the diagnosis of osteochondroma with contiguous bronchogenic cyst. In this case, we present the report of a novel dual lesion.
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Inarejos Clemente EJ, Vilanova JC, Riaza Martin L, Guirao-Marín S. A primary inflammatory myofibroblastic tumor of the scapula in a child: imaging findings. Skeletal Radiol 2015; 44:733-7. [PMID: 25307049 DOI: 10.1007/s00256-014-2023-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/18/2014] [Accepted: 09/28/2014] [Indexed: 02/02/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor characterized by inflammatory cell infiltration and differentiated myofibroblastic spindle cells. IMT was first described in the lung and retroperitoneum. Occurrence in bone has been well described in the maxilla and occasionally in the long bones in the adult population. We present a unique case of IMT arising primarily from the scapula in an 8-year-old patient, not described previously in the pediatric or adult literature. Imaging demonstrated an ill-defined and aggressive osteolytic lesion with cortical bone destruction associated with an important soft tissue component that extended into the adjacent muscles. Histologically, the tumor was composed of spindle and polygonal cells distributed in an inflammatory background with different proportions of plasma cells, lymphocytes, eosinophils and neutrophils. The absence of cellular atypia helped to differentiate this entity from malignant spindle cell tumors, and imaging could differentiate the tumor from the nontumoral inflammatory reaction.
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Podgórski M, Topol M, Sibiński M, Grzelak P, Stefańczyk L, Polguj M. New parameters describing morphological variations in the suprascapular notch region as potential predictors of suprascapular nerve entrapment. BMC Musculoskelet Disord 2014; 15:396. [PMID: 25424972 PMCID: PMC4256739 DOI: 10.1186/1471-2474-15-396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 11/11/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The suprascapular notch (SSN), bridged by the superior transverse scapular ligament (STSL), creates a pathway for the suprascapular nerve (SN). Morphological variations in the SSN region are common and can increase the risk of neuropathy by constricting the space for the nerve. The aim of this study was to establish new objective parameters that take this complex morphology into account. METHODS The SSN region of 100 formalin-fixed cadaveric shoulders was dissected. The dimensions of the SSN, the STSL and the anterior coracoscapular ligament (ACSL), as well as diameters of the SN, associated vessels and SN passage area, were measured by means of quantitative visual data analysis software to assign those structures to present classifications. The area reduction coefficient (ARC) and the ambit occupation coefficient (AOC) were defined and calculated for each shoulder. RESULTS The mean ARC and AOC for ligaments in the suprascapular region were: ARCSTSL = 71.6%, ARCACSL = 9.6%, AOCSTSL = 56.8% and AOCACSL = 9.1%. The SN passage area, ARC and AOC did not differ significantly between SSN types. The SN passage area and ARC differed significantly between band- and fan-shaped types of STSL. A significant relationship was observed between ARC and AOC (R=0.6855; p<0.0001). The SN passage area correlated significantly with ARC (R=-0.7555; p<0.0001) and AOC (R=-0.5609; p<0.0001). CONCLUSIONS The proposed parameters convey the complex morphology of the SSN region in a quantitative manner. The area reduction coefficient seems to be a more relevant indicator than the AOC as it better correlates with the SN passage area. Contrary to the SSN type, the STSL type significantly influences SN passage area and ARC.
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Altan E, Ozbaydar MU, Tonbul M, Yalcin L. Comparison of two different measurement methods to determine glenoid bone defects: area or width? J Shoulder Elbow Surg 2014; 23:1215-22. [PMID: 24581417 DOI: 10.1016/j.jse.2013.11.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/15/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compared two different techniques that have been used to measure the glenoids of patients with recurrent anterior shoulder dislocation. METHODS We analyzed 36 patients who had received arthroscopic Bankart repair for anterior shoulder instability. Retrospectively, 3-dimensional computed tomography images of both shoulders were available for these patients. Two measurement methods were compared to determine the glenoid defects. One of these techniques is based on linear measurement, previously defined as the glenoid index. The other method is based on surface area measurement. Subsequently, 3 more diameters and the average values obtained from these diameters were compared with the surface measurement method. Pearson correlation coefficient (r) was assessed to determine the relationship. RESULTS There was an almost perfect relationship between measurement methods when the defect area was less than 6% of the inferior glenoid circle (r, 0.915; P < .001). This relation decreased and the difference became more pronounced (r, 0.343; P = .657) when the bone loss exceeded 14% of the inferior glenoid circle. The highest correlations with the actual defects were the average values obtained from 4 different diameters (r, 0.964; P < .001) and the 4-o'clock position of the single diameter measurements (r, 0.860; P = .001). In addition, 11 patients had crescent-like defects, demonstrating a relatively low correlation between the measurement methods (r, 0.679; P = .021). CONCLUSION Although the best correlation was achieved from average values obtained from different diameter positions, in practical use, we advise a linear measurement to estimate the glenoid bone loss at the 4-o'clock position to achieve a high correlation between the measurement techniques.
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Chang F, Liu GY, Zhang Q, Lin G, Huang H, Duan DS, Wang JC. Malawer limb salvage surgery for the treatment of scapular chondrosarcoma. World J Surg Oncol 2014; 12:196. [PMID: 24976133 PMCID: PMC4090394 DOI: 10.1186/1477-7819-12-196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
Chondrosarcoma is a common malignant bone tumor, which accounts for 20% of all malignant bone tumors. It often occurs in the long bones, but the incidence of scapular chondrosarcoma is rare. Here, we describe a case of a large chondrosarcoma occurring in the scapula which was treated with Malawer limb salvage surgery. The patient retained considerable limb function after complete removal of the tumor tissue as assessed at the follow-up visit two years and ten months following surgery.
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Zhao Y, Fang W, Yan A, Wang G, Liu CY. [Discussion on relationship between soft tissue tension and cervical physiological curvature change of patients with scapular muscle fasciitis]. ZHONGGUO GU SHANG = CHINA JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY 2014; 27:376-378. [PMID: 25167665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To discuss the relative association of soft tissue tension and cervical physiological curvature chang in patients with scapula muscle fasciitis. METHODS From February 2012 to December 2012,29 patients with scapula muscle fasciitis were investigated. There were 10 males and 19 females with an average age of 27.77 years old (ranged from 22 to 40 years old). Routine AP and lateral cervical X-rays were done in all patients. Cervical lordosis was measured according to Borden's method and the pain point tension was measured by soft tissue tension meter. Finally,perform statistic analysis to bove data. RESULTS Lateral X-rays showed 9 cases were normal cervical lordosis, 18 cases were cervical lordosis decreased, 2 cases were cervical lordosis increased. The regression equation of cerical lordosis changes D(Y) and soft tissue tension displacement D0.5 kg (X) was Y = -15.069 + 3.673X. CONCLUSION There is linear relationship between soft tissue tension and cervical physiological curvature change. With the soft tissue tension increases, the cervical lordosis trend to decrease.
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Daghfous A, Bouzaidi K, Affes M, Ben Rhouma N, Rezgui Marhoul L. Dorsal elastofibroma: usefulness of MRI imaging. LA TUNISIE MEDICALE 2014; 92:354-355. [PMID: 25504394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Rahman N, Siddiqui YS. Winging of the scapula. Saudi Med J 2014; 35:409-410. [PMID: 24749141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Tambasco D, Seccia A, Cimino A, Seccia A. Elastofibroma: management and surgical outcome. Ann Ital Chir 2014; 85:S2239253X14021434. [PMID: 25689890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Elastofibroma is a benign slow-growing neoplasm of soft tissues, originally defined Elastofibroma dorsi because of the typical localization in the connective tissue placed between the bottom corner of the scapula and the chest wall. From 1990 to 2013 at our center, 115 patients underwent elestofibroma surgical removal, including 2 bilateral and one relapsed. For all the patients ultrasound preoperative examination was requested, sometimes with a diagnosis of lipoma or fibrolipoma because of the rarity of this type of lesion and therefore the lack of experience of the radiologists. In all 115 patients the lesion was detected and removed, only in 7 cases it was necessary, intraoperatively, to mobilize the upper limb and shoulder in order to better visualize the lesion. On the operating table the lesion was situated below the muscle planes and looks like a solid mass, oval, with a pole firmly attached to the periosteum of the ribs and intercostal ligaments, with net margins and a diameter of 5-10 cm. The sides not attached to the chest wall were in continuity with the adipose tissue. The cutting surface was pink-graysh, with fibrous appearance. Foci of cystic degeneration interspersed with islands of fat that are vaguely reminiscent of the fibrolipoma could be found. The treatment of choice is the surgical excision and subsequent histological examination solve the diagnostic dilemma. If the removal is radical, it is definitve because the lesion has no tendency to relapse.
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