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Cochrane D, Leyten C. Investigating scapula positioning in individuals with non-specific lower back pain: A preliminary study. J Bodyw Mov Ther 2024; 38:47-53. [PMID: 38763595 DOI: 10.1016/j.jbmt.2023.12.007] [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: 04/08/2022] [Revised: 08/31/2023] [Accepted: 12/21/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Low back pain (LBP) is an economic and physically disabling burden on individuals and society. With 70% of cases classed as non-specific, there is a need for further research into the causes and consequences associated. The involvement of postural balance in musculoskeletal conditions is gaining increasing interest in research and health practice. However, there is a lack of literature surrounding LBP and posture in distal segments of the body. OBJECTIVE The current study investigated scapula positioning in those with non-specific LBP. METHODS Scapula angle of rotation, scapula protraction, and scapula elevation were assessed in nine participants with chronic non-specific LBP and compared with that of nine asymptomatic controls (aged 18-60 years). The degree of pelvic tilt was assessed across both groups as a secondary outcome measure. RESULTS No difference was identified between the two sample groups for scapula angle of rotation (p = 0.707), protraction (p = 0.755), or elevation (p = 0.691). Anterior pelvic tilt was greater in those with LBP (p = 0.046), supporting previous literature. CONCLUSION The findings for the scapula position are novel, given that research in this field is limited. It is concluded that there is no change in scapula positioning in those with non-specific LBP, but there is an increased anterior pelvic tilt.
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Affiliation(s)
- Darryl Cochrane
- School of Sport, Exercise & Nutrition, Massey University, New Zealand.
| | - Cara Leyten
- School of Sport, Exercise & Nutrition, Massey University, New Zealand
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Murray T, Agarwal A, Cresswell M, Flores DV. CT-guided scapulothoracic bursal injection-technical considerations in planning needle trajectory and confirming bursal distribution. Skeletal Radiol 2023; 52:1015-1021. [PMID: 35781610 DOI: 10.1007/s00256-022-04111-8] [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: 05/10/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe a technique of targeted CT-guided scapulothoracic bursal injections in an illustrated and step-wise manner. MATERIALS AND METHODS This technical report describes the authors' experience in using CT guidance for targeted scapulothoracic bursal injections in 8 patients with suspected scapulothoracic bursitis over an 18-month period. RESULTS The outcome of the image-guided injection was retrospectively assessed in 8 patients. None of the patients had any complications related to the procedure. Symptomatic improvement was achieved in 62.5% of the patients while 25% of patients did not report any benefit from the injection. CONCLUSION In providing a record of needle tip position and contrast distribution, CT-guided scapulothoracic bursal injections provide an objective record of the procedure, which may assist in further treatment planning.
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Affiliation(s)
- Timothy Murray
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Mark Cresswell
- St. Paul's Hospital, Vancouver, British Columbia, Canada
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McGill KC, Patel R, Chen D, Okwelogu N. Ultrasound-guided bursal injections. Skeletal Radiol 2023; 52:967-978. [PMID: 36008730 PMCID: PMC10027639 DOI: 10.1007/s00256-022-04153-y] [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: 05/02/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 02/02/2023]
Abstract
The native bursa is a structure lined by synovium located adjacent to a joint which may serve to decrease friction between the tendons and overlying bone or skin. This extra-articular structure can become inflamed resulting in bursitis. Steroid injections have proven to be an effective method of treating bursal pathology in various anatomic locations. Performing these procedures requires a thorough understanding of relevant anatomy, proper technique, and expected outcomes. Ultrasound is a useful tool for pre procedure diagnostic evaluation and optimizing needle position during these procedures while avoiding adjacent structures. The purpose of this article is to review core principles of ultrasound-guided musculoskeletal procedures involving bursae throughout the upper and lower extremities.
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Affiliation(s)
- Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Rina Patel
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - David Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
- Department of Radiology, University of California, Davis, CA, USA
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Lädermann A, Athwal GS, Bothorel H, Collin P, Mazzolari A, Raiss P, Charbonnier C. Scapulothoracic Alignment Alterations in Patients with Walch Type B Osteoarthritis: An In Vivo Dynamic Analysis and Prospective Comparative Study. J Clin Med 2020; 10:jcm10010066. [PMID: 33375443 PMCID: PMC7794942 DOI: 10.3390/jcm10010066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Kinematic changes of the scapulothoracic joint may influence the relative position of the glenoid fossa and, consequently, the glenohumeral joint. As the alignment of the scapula relative to the thorax differs between individuals, such variability may be another factor in the development of posterior head subluxation. The purpose of this study was to compare scapulothoracic alignment in pathologic type B shoulders with contralateral healthy shoulders. Methods: Seven adult volunteers with unilateral type B glenohumeral osteoarthritis (OA) underwent bilateral computed tomography (CT) scans of the shoulders and arms. A patient-specific, three-dimensional measurement technique that coupled medical imaging (i.e., CT) and optical motion capture was used. Results: The scapulothoracic distance at the trigonum was 75 ± 15 mm for pathologic shoulders and 78 ± 11 mm for healthy shoulders (p = 0.583), while at the inferior angle, it was 102 ± 18 mm for pathologic shoulders and 108 ± 12 mm for healthy shoulders (p = 0.466). Conclusion: Scapula positioning at a resting position did not differ between pathologic and healthy shoulders. However, pathologic shoulders tended to be limited in maximal glenohumeral motion and exhibited greater anterior tilt of the scapula in internal rotation at 90 degrees, which may be adaptive to the restricted glenohumeral motion.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland;
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-719-75-55; Fax: +41-22-719-60-77
| | - George S. Athwal
- Department of Surgery, Roth MacFarlane Hand and Upper Limb Center, St. Joseph’s Health Care London, London, ON N6A 4V2, Canada;
| | - Hugo Bothorel
- Research Department, La Tour Hospital, 1217 Meyrin, Switzerland;
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), 35760 Saint-Grégoire, France;
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland;
| | - Patric Raiss
- Shoulder and Elbow Surgery, OCM (Orthopädische Chirurgie München), Steinerstrasse 6, 81369 Munich, Germany;
| | - Caecilia Charbonnier
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland;
- Medical Research Department, Artanim Foundation, 1217 Meyrin, Switzerland
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de Carvalho SC, Castro ADAE, Rodrigues JC, Cerqueira WS, Santos DDCB, Rosemberg LA. Snapping scapula syndrome: pictorial essay. Radiol Bras 2019; 52:262-267. [PMID: 31435089 PMCID: PMC6696755 DOI: 10.1590/0100-3984.2017.0226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Snapping scapula syndrome manifests as an audible or palpable crackling during
the sliding movements of the scapula over the rib cage, often perceived during
physical or professional activities. It can be caused by morphological
alteration of the scapula and rib cage, by an imbalance in periscapular
musculature forces (dyskinesia), or by neoplasia (bone tumors or soft tissue
tumors). In this pictorial essay, we review the main causes of snapping scapula
syndrome, exemplified by a collection of didactic cases.
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Abstract
Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.
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Affiliation(s)
- Kimia Khalatbari Kani
- 1Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Felix S Chew
- 2Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Seattle, USA
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Bäcker HC, Galle SE, Maniglio M, Rosenwasser MP. Biomechanics of posterior shoulder instability - current knowledge and literature review. World J Orthop 2018; 9:245-254. [PMID: 30479971 PMCID: PMC6242730 DOI: 10.5312/wjo.v9.i11.245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/31/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year, even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare, biomechanical knowledge is limited. The purpose of our study was to perform an extensive literature search, including PubMed and Medline, and to give an overview of the current knowledge on the biomechanics of posterior shoulder instability. The PubMed/Medline databases were utilized, and all articles related to posterior shoulder instability and biomechanics were included to form a comprehensive compilation of current knowledge. A total of 93 articles were deemed relevant according to our inclusion and exclusion criteria. As expected with any newly acknowledged pathology, biomechanical studies on posterior shoulder instability remain limited in the literature. Current biomechanical models are performed in a static manner, which limits their translation for explaining a dynamic pathology. Newer models should incorporate dynamic stabilization of both the rotator cuff and scapulothoracic joint. There is a current lack of knowledge with regards to the pathomechanism of posterior shoulder instability, with no consensus on appropriate treatment regimens. Further investigation is therefore required at both basic science and clinical levels.
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Affiliation(s)
- Henrik Constantin Bäcker
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY 10032, United States
| | - Samuel E Galle
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY 10032, United States
| | - Mauro Maniglio
- Department of Orthopedics, HFR Cantonal Hospital of Fribourg, Fribourg 1752, Switzerland
| | - Melvin Paul Rosenwasser
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY 10032, United States
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Osias W, Matcuk GR, Skalski MR, Patel DB, Schein AJ, Hatch GFR, White EA. Scapulothoracic pathology: review of anatomy, pathophysiology, imaging findings, and an approach to management. Skeletal Radiol 2018; 47:161-171. [PMID: 29075809 DOI: 10.1007/s00256-017-2791-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/27/2017] [Accepted: 10/05/2017] [Indexed: 02/02/2023]
Abstract
Symptomatic scapulothoracic disorders, including scapulothoracic crepitus and scapulothoracic bursitis are uncommon disorders involving the scapulothoracic articulation that have the potential to cause significant patient morbidity. Scapulothoracic crepitus is the presence of a grinding or popping sound with movement of the scapula that may or may not be symptomatic, while scapulothoracic bursitis refers to inflammation of bursa within the scapulothoracic articulation. Both entities may occur either concomitantly or independently. Nonetheless, the constellation of symptoms manifested by both entities has been referred to as the snapping scapula syndrome. Various causes of scapulothoracic crepitus include bursitis, variable scapular morphology, post-surgical or post-traumatic changes, osseous and soft tissue masses, scapular dyskinesis, and postural defects. Imaging is an important adjunct to the physical examination for accurate diagnosis and appropriate treatment management. Non-operative management such as physical therapy and local injection can be effective for symptoms secondary to scapular dyskinesis or benign, non-osseous lesions. Surgical treatment is utilized for osseous lesions, or if non-operative management for bursitis has failed. Open, arthroscopic, or combined methods have been performed with good clinical outcomes.
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Affiliation(s)
- Walter Osias
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - Matthew R Skalski
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - Aaron J Schein
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA
| | - George F Rick Hatch
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA.
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