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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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Gürkan Y, Şimşek D, Güllü B, Manici M, Darçin K, Yürük B, Demirhan M, Eren İ. Selective Dorsal Scapular Nerve and Long Thoracic Nerve Blocks for Rescue Analgesia in Scapulothoracic Arthrodesis Surgery: A Case Report. A A Pract 2024; 18:e01765. [PMID: 38498675 DOI: 10.1213/xaa.0000000000001765] [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: 03/20/2024]
Abstract
Scapulothoracic arthrodesis (STA) surgery is performed to stabilize the scapula in patients with facioscapulohumeral dystrophy (FSHD). Postoperative pain could be a major problem even while using erector spinae plane block (ESPB). We performed a preoperative ESPB with an intraoperative ESPB catheter, but rescue analgesia was needed for pain in the periscapular area in the postoperative period. The patient's pain score was reduced by applying an ultrasound-guided dorsal scapular nerve (DSN) and long thoracic nerve (LTN) block. Selective DSN and LTN blocks can be effective in enhancing postoperative analgesia in STA surgery.
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Affiliation(s)
- Yavuz Gürkan
- From the Departments of Anesthesiology and Reanimation
| | - Doğa Şimşek
- From the Departments of Anesthesiology and Reanimation
| | - Buğra Güllü
- Orthopaedics and Traumatology, Koç University Hospital, Koç University Medical School, Istanbul, Turkey
| | - Mete Manici
- From the Departments of Anesthesiology and Reanimation
| | - Kamil Darçin
- From the Departments of Anesthesiology and Reanimation
| | - Batuhan Yürük
- Orthopaedics and Traumatology, Koç University Hospital, Koç University Medical School, Istanbul, Turkey
| | - Mehmet Demirhan
- Orthopaedics and Traumatology, Koç University Hospital, Koç University Medical School, Istanbul, Turkey
| | - İlker Eren
- Orthopaedics and Traumatology, Koç University Hospital, Koç University Medical School, Istanbul, Turkey
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Sharareh B, Hsu JE, Matsen FA, Warme WJ. Which Components of the Simple Shoulder Test Show Improvement After Scapulothoracic Fusion for Recalcitrant Scapular Winging? Clinical Results at a Minimum of 5 Years of Follow-up. Clin Orthop Relat Res 2023; 481:2392-2402. [PMID: 37159275 PMCID: PMC10642883 DOI: 10.1097/corr.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/15/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Scapular winging is an uncommon but important cause of shoulder pain and disability. Surgical management can include soft tissue procedures such as split pectoralis major transfer, the Eden-Lange procedure, or a triple tendon transfer. When these procedures do not alleviate symptomatic winging or are inappropriate, scapulothoracic fusion is an alternative, but data on its longer-term effectiveness are sparse. QUESTIONS/PURPOSES (1) What changes in outcome scores were observed (VAS, Single Assessment Numeric Evaluation [SANE], and Simple Shoulder Test [SST] scores), and what proportion of the patients improved by an amount larger than the minimum clinically important difference (MCID) for the outcome tool in question? (2) Which components of the SST are patients able to perform at a minimum of 5 years? (3) What complications occurred after surgery? METHODS We performed a retrospective study in a single, large, urban referral medical center of patients who underwent scapulothoracic fusion. Between January 2011 and November 2016, 15 patients underwent scapulothoracic fusion to treat symptomatic scapular winging. Only patients with nondystrophic etiology were included in the analysis (n = 13). Of the 13 remaining patients, one patient was lost to follow-up and another patient died during data collection, leaving 11 patients for the final analysis. Six patients had brachial plexus injuries affecting multiple nerve roots and periscapular muscles, and five had persistent symptoms despite prior tendon transfer. The median age of the patients was 43 years (range 20 to 67 years), and there were six male and five female patients. All patients had a minimum of 5 years of follow-up. There was a median follow-up of 79 months (range 61 to 128 months). The VAS pain score (range 0 to 10, higher scores represent more pain; MCID = 2), SST score (range 0 to 12, higher scores represent less pain and better shoulder function; MCID = 2.3), and SANE score (range 0 to 100, higher scores represent better shoulder function; MCID = 28) were recorded before surgery and at the most recent follow-up. We compared scores from before surgery with those taken at the most recent follow-up and ascertained the proportion of patients whose improvement exceeded the MCID. The number of patients achieving fusion (as confirmed by a CT image), complications, and reoperations was recorded via a record review as well as direct patient query by telephone. RESULTS The median VAS pain score improved from 7 (range 3 to 10) preoperatively to 3 (range 2 to 5) at the latest follow-up (p < 0.001). The median SANE score improved from 30 (range 0 to 60) preoperatively to 65 (range 40 to 85) at the latest follow-up (p < 0.001). The median SST score improved from 0 (range 0 to 9) to 8 (range 5 to 10) at the latest follow-up (p < 0.001). Ten of 11 patients had improvements exceeding the MCID for VAS, six of 11 had improvements for SANE scores, and nine of 11 had improvements for SST. Preoperative to postoperative improvements in these components of the SST were seen (responses of "yes"): comfort at rest (three of 11 improved to 11 of 11; p < 0.001), sleep comfortably (three of 11 improved to 11 of 11; p < 0.001), place coin on shelf (two of 11 improved to 10 of 11; p < 0.001), lift 1 pound above shoulder (two of 11 improved to eight of 11; p = 0.03), and carry 20 pounds with the arm at side (one of 11 improved to nine of 11; p < 0.001). All 11 patients had successful fusion noted on CT images. There were three complications (progression of glenohumeral arthritis, broken wires, and perioperative chest tube placement) and one reoperation for progression of glenohumeral arthritis with subsequent total shoulder arthroplasty. CONCLUSION Patients with recalcitrant symptomatic scapular winging often undergo an exhaustive course of clinical examinations, diagnostic tests, physical therapy, and multiple surgical procedures. Those with brachial plexus palsy with involvement of multiple nerves may continue to have symptoms despite nonoperative management and subsequent soft tissue tendon transfers. Scapulothoracic fusion could be considered for patients with persistent pain and decreased function because of recalcitrant scapular winging who are either not candidates for the procedure or have persistent symptoms despite prior soft tissue procedures. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Behnam Sharareh
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jason E. Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Frederick A. Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Winston J. Warme
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
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Çalışkan E, Gedik CC, Eren İ. Letter to the Editor: Total Hip Arthroplasty in a Patient With Facioscapulohumeral Dystrophy. Arthroplast Today 2023; 22:101173. [PMID: 37521738 PMCID: PMC10374855 DOI: 10.1016/j.artd.2023.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
| | - Cemil Cihad Gedik
- Corresponding author. Koc University School of Medicine, Rumelifeneri Yolu, Istanbul 34450, Turkey. Tel.: +90 5075348511.
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Gürkan Y, Sincer Y, Manici M, Gedik CC, Eren İ, Demirhan M. Erector Spinae Plane Block for Scapulothoracic Arthrodesis for Facioscapulohumeral Dystrophy Patients: A Case Series. A A Pract 2023; 17:e01662. [PMID: 36779875 DOI: 10.1213/xaa.0000000000001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Facioscapulohumeral dystrophy (FSHD) typically affects the periscapular muscles, resulting in scapular winging. Scapulothoracic arthrodesis (STA) stabilizes the scapula to provide better movement for these patients. Analgesia regimen for FSHD patients who received a single-shot erector spinae plane block (ESPB) and a catheter at the area were retrospectively analyzed in this study. Patients were asked to rate their pain postoperatively and only 5 of 10 patients needed rescue analgesic. No complications occurred. Our experience suggests that continuous ESPB may be helpful for providing analgesia in FSHD patients undergoing STA.
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Affiliation(s)
- Yavuz Gürkan
- From the Departments of Anesthesiology and Reanimation
| | | | - Mete Manici
- From the Departments of Anesthesiology and Reanimation
| | - Cemil Cihad Gedik
- Orthopedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
| | - İlker Eren
- Orthopedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
| | - Mehmet Demirhan
- Orthopedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
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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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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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Abstract
This update begins with muscle manifestations of coronavirus 2019. They may include myalgias and elevations in serum creatine kinase. It is unknown whether there is direct muscle invasion and how often the critically ill have muscle sequelae. Regarding autoimmune myopathies, a retrospective study of statin-induced necrotizing myopathy is covered. A relatively large proportion of patients had normal strength at presentation. Examples of dermatomyositis associated with immune checkpoint inhibitors are provided including one with cytokine storm. A report of juvenile dermatomyositis with severe abdominal complications is noteworthy. Two articles address unusual associations with inclusion body myositis, namely, spinocerebellar ataxias and granuloma myositis. In the category of muscular dystrophies, a relatively large single center study of the outcome of scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy is discussed and a article on anoctaminopathies with pauci- or asymptomatic hyperCKemia.
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Eren İ, Şar C, Demirhan M. Letter to the Editor Regarding “Non-Union After Multiple Lumbar Fusion Surgeries in a Patient with Facioscapulohumeral Muscular Dystrophy: A Case Report”. World Neurosurg 2020; 141:527. [DOI: 10.1016/j.wneu.2020.05.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
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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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Abstract
Skeletal muscle fibres are multinucleated cells that contain postmitotic nuclei (i.e. they are no longer able to divide) and perform muscle contraction. They are formed by fusion of muscle precursor cells, and grow into elongating myofibres by the addition of further precursor cells, called satellite cells, which are also responsible for regeneration following injury. Skeletal muscle regeneration occurs in most muscular dystrophies in response to necrosis of muscle fibres. However, the complex environment within dystrophic skeletal muscle, which includes inflammatory cells, fibroblasts and fibro-adipogenic cells, together with the genetic background of the in vivo model and the muscle being studied, complicates the interpretation of laboratory studies on muscular dystrophies. Many genes are expressed in satellite cells and in other tissues, which makes it difficult to determine the molecular cause of various types of muscular dystrophies. Here, and in the accompanying poster, we discuss our current knowledge of the cellular mechanisms that govern the growth and regeneration of skeletal muscle, and highlight the defects in satellite cell function that give rise to muscular dystrophies. Summary: The mechanisms of skeletal muscle development, growth and regeneration are described. We discuss whether these processes are dysregulated in inherited muscle diseases and identify pathways that may represent therapeutic targets.
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Affiliation(s)
- Jennifer Morgan
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK .,National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London WC1N 1EH, UK
| | - Terence Partridge
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.,National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London WC1N 1EH, UK.,Center for Genetic Medicine Research, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, USA
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