Contracture of the Deltoid Muscle: Sonographic Evaluation with MRI Correlation

Shoulder Tumor/Tumor-Like Lesions: What to Look for

This article discusses the most common tumor and tumor-like lesions arising at the shoulder. Osseous tumors of the shoulder rank second in incidence to those at the knee joint and include benign osteochondromas and myeloma or primary malignant lesions, such as osteosarcoma or chondrosarcomas. Soft tissue tumors are overwhelmingly benign, with lipomas predominating, although malignant lesions, such as liposarcomas, can occur. Numerous tumor-like lesions may arise from the joints or bursae, due to either underlying arthropathy and synovitis (eg, rheumatoid arthritis and amyloid) or related to conditions, including tenosynovial giant cell tumor and synovial osteochondromatosis.

MR Imaging of Atraumatic Muscle Disorders

Atraumatic disorders of skeletal muscles include congenital variants; inherited myopathies; acquired inflammatory, infectious, or ischemic disorders; neoplastic diseases; and conditions leading to muscle atrophy. These have overlapping appearances at magnetic resonance (MR) imaging and are challenging for the radiologist to differentiate. The authors organize muscle disorders into four MR imaging patterns: (a) abnormal anatomy with normal signal intensity, (b) edema/inflammation, (c) mass, and (d) atrophy, highlighting each of their key clinical and imaging findings. Anatomic muscle variants, while common, do not produce signal intensity alterations and therefore are easily overlooked. Muscle edema is the most common pattern but is nonspecific, with a broad differential diagnosis. Autoimmune, paraneoplastic, and drug-induced myositis tend to be symmetric, whereas infection, radiation-induced injury, and myonecrosis are focal asymmetric processes. Architectural distortion in the setting of muscle edema suggests one of these latter processes. Intramuscular masses include primary neoplasms, metastases, and several benign masslike lesions that simulate malignancy. Some lesions, such as lipomas, low-flow vascular malformations, fibromatoses, and subacute hematomas, are distinctive, but many intramuscular masses ultimately require a biopsy for definitive diagnosis. Atrophy is the irreversible end result of any muscle disease of sufficient severity and is the dominant finding in disorders such as the muscular dystrophies, denervation myopathy, and sarcopenia. This imaging-based classification, in correlation with clinical and laboratory data, will aid the radiologist in interpreting MR imaging findings in patients with atraumatic muscle disorders. ^©RSNA, 2018.

Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders

Background

This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs?

Methods

PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies.

Results

Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity.

Conclusions

Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1694-y) contains supplementary material, which is available to authorized users.

The deltoid, a forgotten muscle of the shoulder

The deltoid is a fascinating muscle with a significant role in shoulder function. It is comprised of three distinct portions (anterior or clavicular, middle or acromial, and posterior or spinal) and acts mainly as an abductor of the shoulder and stabilizer of the humeral head. Deltoid tears are not infrequently associated with large or massive rotator cuff tears and may further jeopardize shoulder function. A variety of other pathologies may affect the deltoid muscle including enthesitis, calcific tendinitis, myositis, infection, tumors, and chronic avulsion injury. Contracture of the deltoid following repeated intramuscular injections could present with progressive abduction deformity and winging of the scapula. The deltoid muscle and its innervating axillary nerve may be injured during shoulder surgery, which may have disastrous functional consequences. Axillary neuropathies leading to deltoid muscle dysfunction include traumatic injuries, quadrilateral space and Parsonage-Turner syndromes, and cause denervation of the deltoid muscle. Finally, abnormalities of the deltoid may originate from nearby pathologies of subdeltoid bursa, acromion, and distal clavicle.

Surgical results of concomitant treatment of deltoid contracture and rotator cuff tear

BACKGROUND

Contracture of the deltoid muscle is an uncommon disorder. The symptoms usually are nonspecific and the diagnosis may be missed, especially when combined with other shoulder disorders, such as rotator cuff lesions. Few reports have described the surgical treatment of combined deltoid contracture and a torn rotator cuff. The purpose of this study was to share our experiences in the diagnosis and treatment of patients, who sustained deltoid contracture combined with rotator cuff tearing.

MATERIALS AND METHODS

Between April 2001 and December 2006, 18 consecutive patients underwent concomitant treatment for distal release of deltoid contracture and repair of a torn rotator cuff. The mean age at operation was 55.1 years. There were eight female and ten male patients. The acromial type, winging angle of the scapula and thickest diameter of the deltoid fibrotic band were measured using preoperative magnetic resonance imaging studies. The abduction-contracture angle, extension-contracture angle, horizontal-adduction angle and Constant and Murley scores were measured preoperatively and at the latest follow-up.

RESULTS

There were nine complete rotator cuff tears and nine partial tears. At an average of 5 years and 3 months' follow-up, the mean abduction-contracture angle significantly improved from 27° to 0° (p<0.001), the mean extension-contracture angle improved from 13° to 0° (p<0.001), and, the mean horizontal-adduction angle improved from 8° to 44° (p<0.001). The mean Constant score also improved from 69 points to 95 points (p<0.001).

CONCLUSIONS

If a symptomatic torn rotator cuff and deltoid contracture co-exist, simultaneous operative treatment of both conditions is highly recommended.

Deltoid contracture mimicking shoulder dislocation in a 7-year-old boy

Contracture of the deltoid muscle, a relatively uncommon disorder in children, can be caused by repeated intramuscular injection, trauma, or congenital disease. The typical clinical manifestations of deltoid contracture (i.e., a palpable fibrous cord within the deltoid muscle, abduction contracture of the shoulder, winged scapula, and skin dimpling over the fibrous bands), however, may be atypical or even lacking, thus, leading to misdiagnosis. The procedure going from misdiagnosis to recognition of the correct diagnosis is reviewed in a 7-year-old boy with deltoid contracture.

Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study

HYPOTHESIS

A randomized, double-blind, placebo-controlled study of sodium hyaluronate (ARTZ Dispo) treatment was performed in 51 patients with rotator cuff lesions without complete tears. We hypothesized that ARTZ Dispo would render better results than the placebo.

MATERIALS AND METHODS

Twenty-five patients (ARTZ Dispo group) had injections of 25 mg/wk of sodium hyaluronate into the subacromial bursa for 5 consecutive weeks. Twenty-six patients (placebo group) were given 2.5 mL of normal saline solution with the same injection protocol as the ARTZ Dispo group. No significant difference in age, height, weight, gender, vocation, involved shoulder, duration of symptoms, baseline Constant score, or visual analog scale (VAS) score existed between the 2 groups.

RESULTS

The 2 groups did not significantly differ with regard to Constant scores, VAS scores, or global improvement assessments 1 week after injections. The ARTZ Dispo group had a better Constant score (P = .0095) and VAS score (P = .0018) than the placebo group 6 weeks after treatment. Patients in the placebo group were given 5 sodium hyaluronate injections, rather than placebo, after disclosure of the blind list, if they wished. Forty-one patients who underwent hyaluronate injection exhibited a significantly improved Constant score, from 64.0 +/- 11.7 at baseline to 88.9 +/- 10.4 (P < .0001), and a significantly improved VAS score, from 6.4 +/- 1.3 to 1.5 +/- 1.6 (P < .0001), at a mean follow-up of 33.1 months. No significant adverse effect was noted.

CONCLUSIONS

Subacromial injections of sodium hyaluronate are effective in treating rotator cuff lesions without complete tears.

Deltoid contracture: a case with multiple muscle contractures

Deltoid contracture is relatively uncommon. The literature consists primarily of case reports and few articles on large case series. The pathogenesis has been well studied. Muscle contractures can occur in the deltoid, biceps, triceps, gluteus and quadriceps muscles; however, cases of multiple muscle contractures are rare. We reported a patient with multiple contractures of the bilateral deltoid, bilateral gluteus, and bilateral quadriceps muscles, who had received repeated intramuscular injections during childhood and adulthood. The radiographic, including magnetic resonance imaging (MRI), features of the bone and joint abnormalities are presented. Some literatures reported that damage to the structures of the body due to intramuscular injection is related to the site of injection, age of the patient, and the volume, pH, chemical composition, and diffusional capacity of the injectate. Our patient had muscular contracture induced by needle injection regardless of her age, medication and injection site.

Coracoid transfer in Bristow-Latarjet procedure: does it modify the biceps muscle?

The aim of this study is to evaluate the size and morphologic patterns of the biceps muscle after coracoid transfer performed during the Bristow-Latarjet procedure to treat anterior shoulder instability. We analyzed retrospectively 26 patients, who underwent a Bristow-Latarjet procedure, and 23 volunteers (control group) with no shoulder disease. A US machine (ATL 5000 HDI, probe 4.2 MHz) was used to determine the biceps section area (BA) and biceps echogenicity (BE). The dominant and non-dominant limbs in both groups were compared. The coracoid transfer performed in the Bristow-Latarjet procedure to treat recurrent anterior shoulder instability does not modify the size and morphology of the biceps muscle.