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Gokaraju K, Mahmoud A, Williams D, Duke PFR, Ross M. Scapulothoracic tenodesis using hamstring tendon graft for treatment of problematic scapula winging: A new surgical technique. Shoulder Elbow 2024; 16:274-284. [PMID: 38818097 PMCID: PMC11135188 DOI: 10.1177/17585732231174178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 06/01/2024]
Abstract
Introduction Winging of the scapula occurs due to dysfunction of its stabilising muscles, most commonly serratus anterior and/or trapezius, for example in facioscapulohumeral muscular dystrophy. Resultant loss of scapular control and abnormal kinematics can decrease shoulder function due to glenohumeral joint instability, loss of range of motion and pain. Previously described treatment for cases resistant to physiotherapy includes scapulothoracic arthrodesis which involves risk of non-union and metalwork failure, as well as reduced respiratory function due to immobilisation of a segment of the adjacent chest wall. Technique We present a novel surgical approach to the management of problematic scapular winging by using hamstring graft to achieve a scapulothoracic tenodesis. Discussion We believe this technique provides an adequately stable scapula for improved shoulder movement and function, a sufficiently mobile chest wall for improved lung function and avoidance of complications specifically associated with arthrodesis.
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Affiliation(s)
- Kishan Gokaraju
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Queensland, Australia
- Orthopaedic Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Ahmed Mahmoud
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Queensland, Australia
- Orthopaedic Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Daniel Williams
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Queensland, Australia
- Orthopaedic Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Phillip FR Duke
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Queensland, Australia
- Orthopaedic Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Queensland, Australia
- Orthopaedic Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
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Aslan L, Subasi O, Gedik CC, Birsel O, Lazoglu I, Demirhan M, Eren I. In silico analysis of rib force distribution in postscapulothoracic arthrodesis model. J Orthop Res 2024; 42:942-949. [PMID: 38111178 DOI: 10.1002/jor.25771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
Scapulothoracic arthrodesis (STA) is carried out by fixing the scapula to thoracic ribs which in turn allows the patient suffering from Facioscapulohumeral Muscular Dystrophy to carry out shoulder-joint dependent activities of daily living. A biomechanical analysis of this procedure has not been conducted in the literature and, for the first time, this study investigates the finite element calculated glenohumeral-applied load distributions on ribs by creating a post-STA model. Three loading directions on the glenohumeral joint are designated: anterior-posterior, superior-inferior, and lateral-medial. Reaction forces on the ribs are calculated based on the glenoid force percent. Simulations are repeated by removing a singular rib contact to observe the change in force distributions in the case of missing levels or failed bonding as well as the impact of clavicle osteotomy. Total load distribution is observed highest at T2 followed by T3 and T6. In the T2 missing scenario, total loads on T3 and T4 increase. In the T4 missing case, the most affected level is T3. In the T6 missing scenario, total loads on T5 and T7 increase. In the clavicular osteotomy scenario, all levels' loads increase; the highest is recorded in T7 by 460%, followed by T5, T4, T2, T6, and T3. While all levels contribute to fixation strength, T2 is subjected to the highest loads, and, in the missing level scenarios, the loads are tolerated sufficiently by the remaining levels. Missing T4 scenario has the least effect on the system, which is interpreted as potentially the only skippable level of fixation. Clavicular osteotomy has the highest effect on the arthrodesis site.
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Affiliation(s)
- Lercan Aslan
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Omer Subasi
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Manufacturing and Automation Research Center, Koc University, Istanbul, Turkey
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Ismail Lazoglu
- Manufacturing and Automation Research Center, Koc University, Istanbul, Turkey
| | - Mehmet Demirhan
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Ilker Eren
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
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Ba PA, Schoch B, Werthel JD. Scapulothoracic Fusion Using Multiple Suture Tape Cerclage. Tech Hand Up Extrem Surg 2023; 27:175-181. [PMID: 37073680 DOI: 10.1097/bth.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
ABSTRACT Scapulothoracic arthrodesis has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy. It was introduced to improve shoulder function. Several methods of fixation have been proposed to obtain the union of the scapula to the ribs. These include plates, screws, cables, or wires with or without bone grafting. The purpose of this manuscript is to describe the surgical technique of scapulothoracic arthrodesis using plate and cerclage suture tapes. LEVEL OF EVIDENCE Level IV, treatment study (case series).
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Affiliation(s)
- Papa Amadou Ba
- Department of Orthopedic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Bradley Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FLA
| | - Jean-David Werthel
- Department of Orthopedic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
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Eren İ, Gedik CC, Kılıç U, Abay B, Birsel O, Demirhan M. Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes. EFORT Open Rev 2022; 7:734-746. [PMID: 36475552 PMCID: PMC9780611 DOI: 10.1530/eor-22-0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition. Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle. There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft. The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores. There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon. In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.
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Affiliation(s)
- İlker Eren
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey,Correspondence should be addressed to İlker Eren;
| | - Cemil Cihad Gedik
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Uğur Kılıç
- Koç University, School of Medicine, Istanbul, Turkey
| | - Berk Abay
- Koç University, School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Demirhan
- Koç University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Loock E, Guerre E, Morel V, Chantelot C, Saab M. ScapuloThoracic Arthrodesis for Facio-Scapulo-Humeral Dystrophy: Outcomes at mean 7.3 years [3.5-13] follow-up. CT measurement of the fixation position of the arthrodesis and radioclinical correlations. Orthop Traumatol Surg Res 2022; 108:103331. [PMID: 35597545 DOI: 10.1016/j.otsr.2022.103331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Scapulothoracic arthrodesis may be proposed to patients having facio-scapulohumeral dystrophy to achieve gains in shoulder motion and pain relief. This study aimed to assess shoulder motion, pain and functional scores at last follow-up and to present a method of computed tomography measurements of the position of the scapulothoracic arthrodesis and study their correlations with shoulder motion. PATIENTS AND METHODS Seven patients (11 arthrodesis) were included. Shoulder motion, pain, respiratory function and deltoid strength were compared with preoperative values and Constant, Brooke and Vignos scores were assessed at last follow-up. The elevation/depression and upward/downward position of the scapula were measured by performing postoperative 3D CT reconstruction. The protraction/retraction position was measured with 2D CT reconstructions on axial view. Correlations between these measurements and shoulder flexion and abduction were analysed. All complications were searched. RESULTS We found a significant improvement in mean VAS (from 3±2 to 1±1, p=0,008) shoulder flexion (64°± 11 to 113°±20, p=0,003) and abduction (from 63°±9 to 92°±13°, p=0,004). Postoperative external rotation wasn't significantly different (from 49°±19 to 43°±10, p=0,112) and on internal rotation, the hand reached on average the 9th thoracic vertebra (S1-T2). Scapulothoracic arthrodesis was mainly positioned in regard to the 1st and the 6th rib. The mean protraction/retraction position was 38,5°±8° and the mean scapular upward/downward rotation position was 92°±15°. No correlations were found between the scapular position and shoulder flexion and abduction. CONCLUSIONS Scapulothoracic arthrodesis for facioscapulohumeral dystrophy improved pain, shoulder flexion and abduction and provided good functional outcomes at 3,5 to 13 years of follow up. A method of CT assessment of the position of the arthrodesis is presented to analyse precisely the position of the scapula but no correlations with shoulder motions were found. Preoperative evaluation of deltoid function and scapular winging seemed to be the most important predictors of shoulder motions gains after this procedure. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Elise Loock
- CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, 59000 Lille, France
| | - Elvire Guerre
- CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, 59000 Lille, France
| | - Vincent Morel
- CHU Lille, Musculoskeletal Imaging Department, Hôpital Roger Salengro, 59000 Lille, France
| | - Christophe Chantelot
- CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, 59000 Lille, France
| | - Marc Saab
- CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, 59000 Lille, France.
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Lotan Y, Essa A, Yaseen NH, Tamir E, Golan N, Agar G, Beer Y. Intrathoracic scapular dislocation following radical surgical chondrosarcoma resection from chest wall. Shoulder Elbow 2022; 14:410-414. [PMID: 35846401 PMCID: PMC9284299 DOI: 10.1177/17585732211027336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
Locked scapula or intrathoracic scapular dislocation is an extremely rare entity encountered in the emergency department, with very few cases reported in literature. Conservative vs surgical approach in treating intrathoracic scapular dislocation is not well defined in literature. In this case report, we present a rare case of intrathoracic scapular dislocation, following multiple ribs resection due to malignant bone tumour, which was treated by closed manipulation reduction technique.
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Affiliation(s)
- Youval Lotan
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel,Ahmad Essa, Department of Orthopedics, Shamir
Medical Center, Zerifin, POB 2007, Kfar-Qasim 48810, Israel.
| | - Ahmad Essa
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel
| | - Naser Haj Yaseen
- Department of Thoracic Surgery, Shamir Medical Center, Zerifin, Israel
| | - Eran Tamir
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel
| | - Nir Golan
- Department of Thoracic Surgery, Shamir Medical Center, Zerifin, Israel
| | - Gabriel Agar
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel
| | - Yiftah Beer
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel
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Scollan JP, Chughtai M, Evans PJ, Styron JF. Scapulothoracic fusion using nonabsorbable suture fixation: surgical technique and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:118-126. [PMID: 37588150 PMCID: PMC10426597 DOI: 10.1016/j.xrrt.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Historically, scapulothoracic fusion (STF) is performed using steel wire and plate construct fixation. The purpose of this study is to report a recent fusion achieved through ultra-high-molecular-weight polyethylene-reinforced suture fixation as well as to perform a systematic literature review of techniques, fusion rates, complications, and reoperation. Methods Patient data were gathered from chart review and clinical encounters. For the review, MEDLINE, Embase, and Ovid databases were queried for STF cases. Thirty articles reporting on 386 fusion procedures were included. Results Including this patient, 5 of 387 (1.3%) STFs have been attempted with fiber suture. Fusion rates of metal-only constructs is 90.8% (346 of 381) with 11.3% (43 of 381) requiring wire removal or trimming because of symptomatic hardware and 7% (27 of 381) causing a postoperative pneumothorax. Although a small sample size, all fiber-suture constructs have achieved union without implant removal and without pneumothorax development. In this patient, fusion was determined radiographically at 6 months with substantial improvement in pain level and function. Conclusion Scapulothoracic fusion has benefit to patients to have failed other management options for winged scapula, most commonly those with neurologic trauma or facioscapulohumeral muscular dystrophy. With advancements in surgical options, fiber-suture offers an alternative to steel wire to achieve fusion. Further cases with longer term follow-up are needed to determine if significant differences in outcomes exist between constructs.
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Affiliation(s)
- Joseph P. Scollan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter J. Evans
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Cleveland Clinic Martin Health, Stuart, FL, USA
| | - Joseph F. Styron
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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8
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A team approach in the diagnosis and management of facioscapulohumeral muscular dystrophy: a case report. JSES Int 2020; 4:485-490. [PMID: 32939472 PMCID: PMC7479020 DOI: 10.1016/j.jseint.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Eren İ, Birsel O, Öztop Çakmak Ö, Aslanger A, Gürsoy Özdemir Y, Eraslan S, Kayserili H, Oflazer P, Demirhan M. A novel shoulder disability staging system for scapulothoracic arthrodesis in patients with facioscapulohumeral dystrophy. Orthop Traumatol Surg Res 2020; 106:701-707. [PMID: 32430271 DOI: 10.1016/j.otsr.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 01/22/2020] [Accepted: 03/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Scapulothoracic arthrodesis (STA) is a well-established surgical technique to provide scapular stabilisation in patients with facioscapulohumeral dystrophy (FSHD). There is no staging or scoring systems available to guide surgical decision. The aim of this study was to develop a staging system to evaluate the shoulder disability in patients with FSHD to guide surgical decision-making and assess its reliability among surgeons. METHODS Fifty-seven shoulders of 29 patients (15 male, 14 female) with an average age of 34.5 years (13-73) were included. Six stages of the disease were defined to create a system consisting of shoulder elevation, deltoid function and scapular winging. Patients were assessed by two independent orthopaedic surgeons who were blind to each other. Statistical analyses included mean and standard deviation for descriptive variables, Pearson's correlation and Cohen's Kappa for inter- and intraobserver agreement. RESULTS Measurement of elevation showed excellent correlation in both inter- and intraobserver assessment. There was substantial agreement on deltoid function and moderate agreement on scapular winging. Decisions on stage showed excellent agreement on interobserver and substantial agreement on intraobserver assessment. Surgical decision using the stage showed excellent agreement on both inter- and intraobserver assessment. CONCLUSION This novel staging system has an excellent inter observer agreement on FSHD patients' shoulder disability. This would provide surgeons a beneficial tool to define patient groups that would have negatively or positively affected from STA.
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Affiliation(s)
- İlker Eren
- Koc University, School of Medicine, Department of Orthopaedics and Traumatology, Koc Universitesi Hastanesi, Davutpasa Cd. No:4 Topkapi-Zeytinburnu, 34010 Istanbul Turkey.
| | - Olgar Birsel
- Koc University, School of Medicine, Department of Orthopaedics and Traumatology, Koc Universitesi Hastanesi, Davutpasa Cd. No:4 Topkapi-Zeytinburnu, 34010 Istanbul Turkey
| | - Özgür Öztop Çakmak
- Koc University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ayça Aslanger
- Koc University, School of Medicine, Department of Medical Genetics, Istanbul, Turkey
| | | | - Serpil Eraslan
- Koc University, School of Medicine, Department of Medical Genetics, Istanbul, Turkey
| | - Hülya Kayserili
- Koc University, School of Medicine, Department of Medical Genetics, Istanbul, Turkey
| | - Piraye Oflazer
- Koc University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Mehmet Demirhan
- Koc University, School of Medicine, Department of Orthopaedics and Traumatology, Koc Universitesi Hastanesi, Davutpasa Cd. No:4 Topkapi-Zeytinburnu, 34010 Istanbul Turkey
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10
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Boileau P, Pison A, Wilson A, van der Meijden O, Sacconi S, Trojani C, Gauci MO. Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences. J Shoulder Elbow Surg 2020; 29:931-940. [PMID: 31982337 DOI: 10.1016/j.jse.2019.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulothoracic arthrodesis (STA) has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy (FSHD). However, the rate of osseous fusion is variable, and there is a theoretical risk of reduced respiratory function after bilateral STA. METHODS This was a retrospective study of 10 STAs, performed sequentially, in 5 FSHD patients. The surgical technique involved use of a semitubular plate and wire construct with autograft (iliac crest) interposed between the scapula and rib cage. Osseous fusion, respiratory function, and shoulder function were evaluated. The mean follow-up period was 141 ± 67 months (range, 24-225 months). RESULTS Early complications included 1 pneumothorax and 1 pleural effusion. No late complications occurred, and no patients underwent reoperation. On postoperative computed tomography images, complete bony union of the scapula to the ribs was observed in 90% of shoulders (9 of 10). Comparison of preoperative and postoperative pulmonary function test results showed no significant difference in vital capacity (from 87% ± 14% to 85% ± 12%) and forced vital capacity (from 86% ± 16% to 77% ± 15%). Patients gained on average 40° of active forward elevation (from 62° ± 20° to 102° ± 4°) and 22° of abduction (from 58° ± 21° to 89° ± 7°) (P < .001). The mean Subjective Shoulder Value increased from 25% ± 8% to 72% ± 18% (P < .001). All patients were pleased with the results and would recommend the procedure to other persons. CONCLUSION In patients with FSHD, bilateral STA provides satisfactory shoulder function with a high rate of scapulothoracic fusion and few or no significant respiratory repercussions.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France.
| | | | - Adam Wilson
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Olivier van der Meijden
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Sabrina Sacconi
- Department of Neuroscience, Pasteur 2 Hospital, Nice, France
| | - Christophe Trojani
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
| | - Marc-Olivier Gauci
- Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France
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11
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Kord D, Liu E, Horner NS, Athwal GS, Khan M, Alolabi B. Outcomes of scapulothoracic fusion in facioscapulohumeral muscular dystrophy: A systematic review. Shoulder Elbow 2020; 12:75-90. [PMID: 32313557 PMCID: PMC7153204 DOI: 10.1177/1758573219866195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/09/2019] [Accepted: 07/05/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Facioscapulohumeral muscular dystrophy (FSHD) is a rare condition associated with selective weakness of the muscles of the upper arm, face, and shoulder girdle, negatively affecting daily activities. Scapulothoracic arthrodesis may restore shoulder function and improve quality of life. The purpose of this review is to evaluate the outcomes and complications of scapulothoracic arthrodesis in FSHD patients. METHODS Medline, Pubmed, and Embase were systematically searched. Studies were included if they described scapulothoracic arthrodesis in FSHD with follow-up, and outcomes were adequately reported. Thirteen eligible articles reported the outcomes of 199 arthrodesis in 130 patients. RESULTS The mean gain of shoulder forward elevation and abduction were 45° (p < 0.05) and 40° (p < 0.05), respectively. There was an overall cosmetic satisfaction and improved performance of daily activities. There is limited and heterogeneous data on changes in pulmonary function, but such changes are clinically insignificant. The rate of complications was 41% of which 10% were serious, requiring an intervention or re-admission. The most common complications were hardware failure (8%), non-union (6%), and pneumothorax (5%). DISCUSSION Scapulothoracic arthrodesis improved cosmesis, performance of daily activities and shoulder motion with no clinically significant loss of pulmonary function. The complication rate is high, and some are potentially serious.
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Affiliation(s)
- Dorsa Kord
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Eva Liu
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | | | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada,Moin Khan, St. Joseph's Healthcare Hamilton, Mary Grace Wing, Room G807, 50 Charlton Ave E., Hamilton L8N 4A6, Ontario, Canada.
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
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12
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Eren İ, Erşen A, Birsel O, Atalar AC, Oflazer P, Demirhan M. Functional Outcomes and Complications Following Scapulothoracic Arthrodesis in Patients with Facioscapulohumeral Dystrophy. J Bone Joint Surg Am 2020; 102:237-244. [PMID: 31658207 DOI: 10.2106/jbjs.19.00571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Facioscapulohumeral dystrophy (FSHD) is an autosomal-dominant myopathy characterized by facial and shoulder girdle muscle weakness with scapular winging. Scapulothoracic arthrodesis is a successful treatment approach for patients with <90° of shoulder elevation. The purpose of the present study was to assess functional outcomes and complications following scapulothoracic arthrodesis in patients with FSHD. METHODS We retrospectively reviewed the records of 40 patients (64 shoulders) in whom scapulothoracic arthrodesis was performed. To achieve fusion, multiple multifilament cables were used together with autologous bone and allograft bone. Preoperative and postoperative shoulder elevation and abduction; Disabilities of the Arm, Shoulder and Hand (Quick version, qDASH) scores; and pulmonary function were compared. Recorded complications were classified as pulmonary or scapular. RESULTS The mean age of the patients at the time of the operation was 25.4 years (range, 15 to 60 years), and the mean duration of follow-up was 71.2 months (range, 12 to 185 months). When the preoperative values were compared with those at the latest follow-up, significant improvement was noted in terms of elevation (from a mean [and standard deviation] of 60.6° ± 17.2° to 123.7° ± 26.7°; p < 0.001), abduction (from 52.7° ± 15.8° to 98.8° ± 20.3°; p < 0.001), and qDASH scores (from 34.7 ± 11.4 to 13.3 ± 13.1; p < 0.001). The overall complication rate was 26.6%. There were 7 pulmonary complications (4 pneumothoraxes, 2 pleural effusions, and 1 major atelectasis), and 5 chest tube placements were required. Ten complications (including 3 rib fractures, 1 brachial plexus palsy, 2 cases of implant irritation, 2 nonunions, 1 delayed union, and 1 scapular fracture) were related to the scapular fixation, and 7 revision procedures were required. Scapulothoracic fusion was achieved in all patients but 1, who had a scapular fracture. Pulmonary function tests were performed for 19 patients, and no difference was observed between preoperative and postoperative results. CONCLUSIONS Scapulothoracic arthrodesis with use of multifilament cables is a successful surgical technique with high fusion rates and low morbidity. Pulmonary complications are common but resolve with careful attention. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- İlker Eren
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopaedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Olgar Birsel
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
| | - Ata Can Atalar
- Department of Orthopaedics and Traumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Piraye Oflazer
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Demirhan
- Departments of Orthopaedics and Traumatology (İ.E., O.B., and M.D.) and Neurology (P.O.), Koc University School of Medicine, Istanbul, Turkey
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Hamel J, Tawil R. Facioscapulohumeral Muscular Dystrophy: Update on Pathogenesis and Future Treatments. Neurotherapeutics 2018; 15:863-871. [PMID: 30361930 PMCID: PMC6277282 DOI: 10.1007/s13311-018-00675-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
A reliable model of a disease pathomechanism is the first step to develop targeted treatment. In facioscapulohumeral muscular dystrophy (FSHD), the third most common muscular dystrophy, recent advances in understanding the complex genetics and epigenetics have led to the identification of a disease mechanism, moving the field towards targeted therapy development. FSHD is caused by expression of DUX4, a retrogene located on the D4Z4 macrosatellite repeat array on chromosome 4q35, a gene expressed in the germline but typically repressed in somatic tissue. DUX4 derepression results from opening of the chromatin structure either by contraction of the number of repeats (FSHD1) or by chromatin hypomethylation of the D4Z4 repeats resulting from mutations in SMCHD1, a gene involved in chromatin methylation (FSHD2). The resulting expression of DUX4, a transcriptional regulator, and its target genes is toxic to skeletal muscle. Efforts for targeted treatment currently focus on disrupting DUX4 expression or blocking 1 or more of several downstream effects of DUX4. This review article focuses on the underlying FSHD genetics, current understanding of the pathomechanism, and potential treatment strategies in FSHD. In addition, recent advances in the development of new clinical outcome measures as well as biomarkers, critical for the success of future clinical trials, are reviewed.
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Affiliation(s)
- Johanna Hamel
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 673, Rochester, NY, 14642, USA.
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 673, Rochester, NY, 14642, USA
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Tomita M, Iwasaki A, Ayabe T, Maeda R, Nakamura K. Intrathoracic scapular dislocation following lung cancer resection. J Surg Case Rep 2018; 2018:rjy178. [PMID: 30046443 PMCID: PMC6055544 DOI: 10.1093/jscr/rjy178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/29/2018] [Indexed: 11/14/2022] Open
Abstract
A 64-year-old man underwent right upper lobectomy combined resection with third-fifth rib for lung cancer and reconstruction of chest wall using Dual Mesh. Six days after surgery, he experienced acute severe pain in the right shoulder. The purulent drainage through the drainage tube was also found. Chest CT showed that the inferior angle of the scapula protruded into the right intrathoracic cavity. We performed a removal of Mesh. Although we did not want to use synthetic materials because of infection, we performed titanium plate fifth rib fixation to avoid the recurrent dislocation of the scapula. After the redo surgery, continuous lavages with physiologic saline of the thoracic cavity was also performed. Patient is now doing well without recurrences of cancer, infection and scapular dislocation, 14 months after the redo surgery.
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Affiliation(s)
- Masaki Tomita
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, Japan
| | - Ayaka Iwasaki
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, Japan
| | - Takanori Ayabe
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, Japan
| | - Ryo Maeda
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, Japan
| | - Kunihide Nakamura
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, Japan
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Erşen A, Atalar AC, Bayram S, Demirel M, Tunalı O, Demirhan M. Long-term results of scapulothoracic arthrodesis with multiple cable method for facioscapulohumeral dystrophy: do the results deteriorate over time? Bone Joint J 2018; 100-B:953-956. [PMID: 29954200 DOI: 10.1302/0301-620x.100b7.bjj-2017-1438.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The present study aimed to investigate the long-term functional results of scapulothoracic fusion using multifilament cables in patients with facioscapulohumeral dystrophy (FSHD) to identify if the early improvement from this intervention is maintained. Patients and Methods We retrospectively investigated the long-term outcomes of 13 patients with FSHD (18 shoulders) in whom scapulothoracic fusion using multifilament cables was performed between 2004 and 2007. These patients have previously been reported at a mean of 35.5 months (24 to 87). There were eight men and five women with a mean age of 26 years. Their mean length of follow-up of our current study was 128 months (94 to 185). To evaluate long-term functional results, the range of shoulder flexion and abduction, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with a comparison of preoperatively, interim and at the final outcomes. The fusion was examined radiographically in all. Results The complication rate was 33% (six of 18 scapulothoracic fusions) in 13 patients, which comprised failure of fusion in four shoulders (four patients) all occurring within the first year postoperatively. In two shoulders (one patient) wound problems arose due to attribution from the cables which required shortening but the fusion developed satisfactorily. At the final examination, the mean QuickDASH score and range of movement significantly improved in all but one patient (p < 0.001, p < 0.001 and p < 0.001). In the comparison of 13 patients' mid- and long-term results, the mean QuickDASH score decreased from 9.8 (sd 6.7; 3 to 26) in the third year to 9.1 (sd 5.6; 3 to 22) in the tenth year (p = 0.7); the mean range of shoulder flexion and abduction decreased from 129° (sd 22°; 90° to 160°) and 124° (sd 12; 100° to 150°) at the mid-term to 103° (sd 12°; 80° to 120°) and 101° (sd 8°; 80° to 120°) at the long-term, respectively (p = 0.78 and p = 0.65). Conclusion Scapulothoracic fusion using a multiple cabling method can confer a considerable improvement in clinical and functional outcomes for most patients with FSHD after a long follow-up period. The technique requires careful execution to avoid complications. Cite this article: Bone Joint J 2018;100-B:953-6.
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Affiliation(s)
- A Erşen
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - A C Atalar
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - S Bayram
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - M Demirel
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - O Tunalı
- Department of Orthopedics and Traumatology, Acıbadem University Faculty of Medicine
| | - M Demirhan
- Department of Orthopaedics and Traumatology, KOÇ University School of Medicine, Istanbul, Turkey
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16
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Split Pectoralis Major Transfer for Chronic Medial Scapular Winging. Arthrosc Tech 2017; 6:e1781-e1788. [PMID: 29399464 PMCID: PMC5794454 DOI: 10.1016/j.eats.2017.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/28/2017] [Indexed: 02/03/2023] Open
Abstract
Scapular winging can be a significant source of chronic pain, weakness, and disability of the shoulder. Isolated serratus anterior palsy from long thoracic nerve injury, which is the most common cause of this condition, produces prominent winging and medial malpositioning of the inferior angle of the scapula. In the case of persistent symptoms despite conservative care, treatment options primarily include scapulothoracic fusion and pectoralis major transfer. Outcomes of scapulothoracic fusion are notable for a high complication rate and limited functional improvements. We describe our technique of indirect, split pectoralis major transfer to the inferolateral scapula with allograft tissue augmentation for the surgical treatment of chronic medial winging. This procedure provides dynamic stabilization of the scapula with secure and tension-free tendon transfer. Advantages over alternative treatments include a relatively low complication rate, acceptable cosmesis, and better range of motion. The rationale and technical aspects of this procedure are discussed. Additional clinical studies are warranted to compare outcomes for the direct and indirect split transfer methods.
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17
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Ghate NS, Cui H. Mineralized collagen artificial bone repair material products used for fusing the podarthral joints with internal fixation-a case report. Regen Biomater 2017; 4:295-298. [PMID: 29026643 PMCID: PMC5633689 DOI: 10.1093/rb/rbx015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 11/15/2022] Open
Abstract
In this study, we reported a case with collapse and subluxation of metatarsal-cuneiform joint, navicular-cuneiform joint with subluxed the right first metatarsophalangeal joint. The injured medial column was internally fixed with compression arthrodesis. The fusion site was firmed up with BonGold® Bone Sponge and Bone Putty. The prognosis of fused navicular-cuneiform joint and metatarsal-cuneiform joint were examined by X-ray shortly after surgical operation and followed up 2, 4, 6, 9 and 13 weeks after the surgical operation. The medial column was perfectly fused by compression arthrodesis. These results justified and favored the application of mineralized collagen as an excellent alternative to autograft in fusing the podarthral joints with internal fixation.
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Affiliation(s)
- Nihar S Ghate
- Division of Foot and Ankle Surgery, Indiana Regional Medical Center, Indiana, PA 15701, USA
| | - Helen Cui
- Beijing Allgens Medical Science and Technology Co., Ltd., Beijing 100176, China
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18
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Le Hanneur M, Saint-Cast Y. Long-term results of Letournel scapulothoracic fusion in facioscapulohumeral muscular dystrophy: A retrospective study of eight cases. Orthop Traumatol Surg Res 2017; 103:421-425. [PMID: 28159680 DOI: 10.1016/j.otsr.2016.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to evaluate long-term radio-clinical outcome in scapulothoracic fusion using the Letournel technique (where the fourth rib is passed through the wing of the scapula and cerclage wires are tightened to the two ribs below) for patients suffering from facioscapulohumeral muscular dystrophy (FSHMD), a degenerative pathology affecting scapula-stabilizing muscles, leading to scapular winging, shoulder pain and restricted shoulder abduction and flexion, despite a functional deltoid muscle. METHODS This retrospective study, with an average follow-up of 14 years (168 months; σ=73 months), included four patients who underwent a bilateral procedure, one side after the other, with shoulder abduction and flexion gain as primary endpoints. RESULTS Mean improvement in range of motion was 36° (σ=32°) in abduction and 40° (σ=44°) in flexion. Postoperatively, active abduction averaged 99° (σ=28°) and active flexion 110° (σ=45°). In one case, a 58 year-old patient, gain in motion was 50° for abduction and 60° for anterior elevation. In one patient, range of motion showed bilateral decrease due to the natural course of the FSHMD. No intraoperative complications were reported. DISCUSSION The Letournel technique seems to be an effective long-term solution in FSHMD, without age limit. Improvements appear to be steady over time, the only long-term limitations being the natural course of the disease itself. LEVEL OF EVIDENCE IV - retrospective case series.
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Affiliation(s)
- M Le Hanneur
- Hôpital Robert-Debré, département d'orthopédie pédiatrique, 48, boulevard Sérurier, 75019 Paris, France.
| | - Y Saint-Cast
- Centre de la main, 47, rue de la Foucaudière, 49800 Trélazé, France.
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19
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Tawil R, Mah JK, Baker S, Wagner KR, Ryan MM, Baker S, Corbett A, van Engelen B, McNamara S, Mah JK, Ryan MM, Rasko J, Raykar V, Sacconi S, Tapscott SJ, Tawil R, Wagner KR, Watts A. Clinical practice considerations in facioscapulohumeral muscular dystrophy Sydney, Australia, 21 September 2015. Neuromuscul Disord 2016; 26:462-71. [DOI: 10.1016/j.nmd.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/30/2016] [Indexed: 12/22/2022]
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20
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Dori Z, Sarig Bahat H. Unusual scapular winging - A case report. ACTA ACUST UNITED AC 2016; 24:75-80. [PMID: 26759220 DOI: 10.1016/j.math.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/06/2015] [Accepted: 12/13/2015] [Indexed: 11/19/2022]
Abstract
Scapular mobility has a central role in maintaining normal upper limb function. Scapular winging is characterized by a failure in the dynamic stabilization of the scapula against the thoracic wall resulting in a condition in which the medial border of the scapula is prominent. The following case describes a patient who was referred to physiotherapy due to abnormal scapular protrusion. The main findings of the physical examination showed weakness of the scapular stabilizers more prominent on the right side than of the left. Additionally, the physical examination demonstrated weakness of the abdominal muscles, hip adductors, and ankle dorsi-flexors, as well as some facial muscles. The electromyography results were inconclusive. Further examination led to clinical suspicion of Facioscapulohumeral Dystrophy (FSHD) as a diagnosis, which was confirmed by genetic testing. Facioscapulohumeral Dystrophy is characterized by symptoms related to motor function and in most cases becomes evident in patients in their 20s and 30s. The disease signs and symptoms are often identified in a clinical setting. Currently, there are no reports describing an effective treatment for the disease. However, physiotherapy, moderate physical exercise, counselling, and use of suitable aids and orthoses may help improve functionality and mobility. This case report aims to increase the awareness of musculoskeletal physiotherapists to this unique dystrophy, when encountering complex presentations with scapular winging.
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Affiliation(s)
- Zohar Dori
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 31905, Israel
| | - Hilla Sarig Bahat
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 31905, Israel.
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21
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Endrizzi DP, Shubert DJ, White RR. Scapulothoracic fusion for low-energy intrathoracic scapula dislocation: a report of two cases. J Shoulder Elbow Surg 2015; 24:e91-5. [PMID: 25648968 DOI: 10.1016/j.jse.2014.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/18/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Donald P Endrizzi
- Department of Surgery, Division of Orthopedics, Maine Medical Center, Portland, ME, USA.
| | | | - Raymond R White
- Department of Surgery, Division of Orthopedic Trauma, Maine Medical Center, Portland, ME, USA
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