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Lesser ER, Kim CY, Kikuchi K, Anadkat S, Iwanaga J, Tubbs RS. Novel Muscle in Infraspinous Fossa. Cureus 2024; 16:e56100. [PMID: 38618436 PMCID: PMC11013571 DOI: 10.7759/cureus.56100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
The infraspinatus muscle (IS) makes a minor contribution to lateral rotation of the arm but mainly serves to stabilize the glenohumeral (GH) joint as part of the rotator cuff. Although reports of variations in the rotator cuff muscles have been documented previously, specific discussions of IS variants are lacking. In this report, we present a novel case of an accessory muscle in the infraspinous fossa and its relationship to the IS, which was normally located. We describe the observed physical features of the muscles and their innervation patterns.
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Affiliation(s)
- Emma R Lesser
- Department of Neurosurgery, Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
| | - Chung Yoh Kim
- Department of Neurosurgery, Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
| | - Keishiro Kikuchi
- Department of Neurosurgery, Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Orthopaedics, Kurume University School of Medicine, Fukuoka, JPN
| | - Samir Anadkat
- Departments of Anatomy and Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
- Department of Neurosurgery, Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
- Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
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McCarthy A, O'Neill B. COVID-19 Vaccines and Axillary Nerve Dysfunction: A Case Report. Cureus 2023; 15:e49269. [PMID: 38143650 PMCID: PMC10746867 DOI: 10.7759/cureus.49269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
COVID-19 resulted in a worldwide pandemic and the rapid introduction of vaccines in an attempt to mitigate it. Neuritis and neuropathy after intramuscular injection had been previously seen with influenza vaccines and appear to be a side effect of the COVID-19 vaccine as well. In the following report, we present the case of a 43-year-old female who developed axillary nerve symptoms after administration of the COVID-19 vaccine and her subsequent recovery.
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Affiliation(s)
- Andrea McCarthy
- Trauma and Orthopedic Surgery, St. James's Hospital, Dublin, IRL
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Kurtoglu A, Ciftci R, Car B, Konar N. Investigation of Deltoid Muscle Activation From Different Angles in Body Building Athletes. Sisli Etfal Hastan Tip Bul 2023; 57:410-415. [PMID: 37900328 PMCID: PMC10600597 DOI: 10.14744/semb.2023.09522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/07/2023] [Accepted: 05/19/2023] [Indexed: 10/31/2023]
Abstract
Objectives It is known that bodybuilders suffer from shoulder injuries frequently. Therefore, it is important to determine the most appropriate form of movement during shoulder exercises. For this reason, this study was carried out to determine the most accurate form of movement by examining the deltoid muscle activation of bodybuilders from different angles. Methods The survey model, one of the quantitative research techniques, was used in this study. 53 athletes (44 men, 9 women) with an age of 25.77±9.13 years, height of 177.07±8.40 cm, body weight of 78.06±14.16 kg, and body mass index of 24.78±3.43 kg/m2 who regularly attended bodybuilding gyms were included in the study. The deltoid activations of the participants was measured, while the glenohumeral joint is at 90°, the cubital joint is in abduction at 180°, 150° and 120°. surface electromyography (sEMG) biofeedback was determined using the Neurotrac Myoplus Pro device. Joint angles were determined with a goniometer. Statistical analyses of the study were performed using the SPSS 25 package program. It was found that the data were normally distributed and the Repeated measures Anova test was applied for comparisons. Results As a result of statistical analysis, in male participants, mean deltoid sEMG values and maximum voluntary contraction (MVC [%]) significantly decreased with decreasing angle size (p<0.05). In female participants, the average sEMG and MVC (%) values did not change at different angles (p>0.05). Conclusion According to the research results, shoulder sEMG activations decrease in direct proportion to the angle in bodybuilders. When the glenohumeral joint is 90° and the cubital joint is 180°, the activation of the medial deltoid muscle is highest. It is suggested that bodybuilders should consider the results of our study when performing exercises to hypertrophy the deltoid muscle.
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Affiliation(s)
- Ahmet Kurtoglu
- Department of Coaching Education, Bandirma Onyedi Eylul University, Faculty of Sport Sciences, Balikesir, Türkiye
| | - Rukiye Ciftci
- Department of Anatomy, Bandirma Onyedi Eylul University, Faculty of Medicine, Balikesir, Türkiye
- Current affiliation: Department of Anatomy, Gaziantep Islam Science and Technology University Faculty of Medicine, Gaziantep, Türkiye
| | - Bekir Car
- Department of Coaching Education, Bandirma Onyedi Eylul University, Faculty of Sport Sciences, Balikesir, Türkiye
| | - Nurettin Konar
- Department of Coaching Education, Bandirma Onyedi Eylul University, Faculty of Sport Sciences, Balikesir, Türkiye
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Kim HT, Lee SH, Lee JK, Chung SW. Influence of Vitamin D Deficiency on the Expression of Genes and Proteins in Patients With Medium Rotator Cuff Tears. Am J Sports Med 2023; 51:2650-2658. [PMID: 37449678 DOI: 10.1177/03635465231184392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Whether vitamin D deficiency is related to rotator cuff muscle and tendon physiology is controversial. PURPOSE To assess the relationship between vitamin D deficiency and various gene expression patterns in patients with rotator cuff tears. STUDY DESIGN Controlled laboratory study. METHODS During arthroscopic surgery, samples from the supraspinatus muscle, deltoid muscle, and supraspinatus tendon were acquired from 12 patients with vitamin D deficiency (serum 25-hydroxyvitamin D concentration <20 ng/dL) and 12 patients with sufficient vitamin D levels (control group, serum 25-hydroxyvitamin D concentration ≥30 ng/dL) who were matched for age, sex, and tear size. Alterations in the expression of genes and proteins associated with myogenesis, muscle atrophy, adipogenesis, inflammation, and apoptosis, as well as in vitamin D receptor expression, were assessed using quantitative reverse transcription polymerase chain reaction, Western blotting, and immunohistochemistry and were compared between the 2 groups. RESULTS Vitamin D receptor gene expression in the deltoid muscle was significantly lower in the vitamin D deficiency group than in the control group (P = .043). Additionally, in the deltoid muscle, myoDgene expression levels were lower and atrogin levels were higher in the vitamin D deficiency group than in the control group (P = .034 and P = .011, respectively). However, in the supraspinatus muscle, no differences were observed between groups in the expression of myogenesis- or atrophy-related genes (all P > .05). The expression of inflammation-related genes (interleukin (IL)-1β and IL-6) was significantly higher in the vitamin D deficiency group, in both the deltoid and supraspinatus muscles (all P < .05). The supraspinatus tendon tissue did not show any significant differences in any gene expression evaluated (all P > .05). A correlation between gene and protein expression was observed for atrogin and IL-1β in the deltoid muscle (P = .019 and P = .037, respectively) and for IL-6 in the supraspinatus muscle (P = .044). CONCLUSION Vitamin D deficiency was not associated with the expression of myogenesis-related or muscle atrophy-related genes in the supraspinatus muscle of patients with rotator cuff tears, unlike in the deltoid muscle; rather, vitamin D deficiency was associated with increased proinflammatory cytokine expression. CLINICAL RELEVANCE In patients with rotator cuff tears, vitamin D deficiency was observed to be associated with increased levels of proinflammatory cytokines in the rotator cuff muscles, without significant changes in gene expression related to myogenesis or muscle atrophy.
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Affiliation(s)
- Hyun Tae Kim
- Research Institute of Medical Science, Konkuk University School of medicine, Seoul, Republic of Korea
| | - Su Hyun Lee
- Research Institute of Medical Science, Konkuk University School of medicine, Seoul, Republic of Korea
| | - Jeong Kun Lee
- Research Institute of Medical Science, Konkuk University School of medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Research Institute of Medical Science, Konkuk University School of medicine, Seoul, Republic of Korea
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Wang Z, Cui D, Long Y, Meng K, Zheng Z, Li C, Yang R, Hou J. [Effect of critical shoulder angle on deltoid muscle strength reduction in patients with rotator cuff tears]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:827-832. [PMID: 37460179 DOI: 10.7507/1002-1892.202303064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Objective To investigate the synergistic interaction between the deltoid muscle and the rotator cuff muscle group in patients with rotator cuff tears (RCT), as well as the impact of the critical shoulder angle (CSA) on deltoid muscle strength. Methods A retrospective analysis was conducted on clinical data from 42 RCT patients who met the selection criteria and were treated between March 2022 and March 2023. There were 13 males and 29 females, with an age range of 42-77 years (mean, 60.5 years). Preoperative visual analogue scale (VAS) score was 6.0±1.6. CSA measurements were obtained from standard anteroposterior X-ray films before operation, and patients were divided into two groups based on CSA measurements: CSA>35° group (group A) and CSA≤35° group (group B). Handheld dynamometry was used to measure the muscle strength of various muscle group in the shoulder (including the supraspinatus, infraspinatus, subscapularis, and anterior, middle, and posterior bundles of the deltoid). The muscle strength of the unaffected side was compared to the affected side, and muscle imbalance indices were calculated. Muscle imbalance indices between male and female patients, dominant and non-dominant sides, and groups A and B were compared. Pearson correlation analysis was used to examine the relationship between muscle imbalance indices and CSA as well as VAS scores. Results Muscle strength in all muscle groups on the affected side was significantly lower than on the unaffected side ( P<0.05). The muscle imbalance indices for the supraspinatus, subscapularis, infraspinatus, and anterior, middle, and posterior bundles of the deltoid were 14.8%±24.4%, 5.9%±9.7%, 7.2% (0, 9.1%), 17.2% (5.9%, 26.9%), 8.3%±21.3%, and 10.2% (2.8%, 15.4%), respectively. The muscle imbalance indices of the anterior bundle of the deltoid, supraspinatus, and infraspinatus were significantly lower in male patients compared to female patients ( P<0.05); however, there was no significant difference in muscle imbalance indices among other muscle groups between male and female patients or between the dominant and non-dominant sides ( P>0.05). There was a positive correlation between the muscle imbalance indices of infraspinatus and VAS score ( P<0.05), and a positive correlation between CSA and the muscle imbalance indices of middle bundle of deltoid ( P<0.05). There was no correlation between the muscle imbalance indices of other muscle groups and VAS score or CSA ( P>0.05). Preoperative CSA ranged from 17.6° to 39.4°, with a mean of 31.1°. There were 9 cases in group A and 33 cases in group B. The muscle imbalance indices of the anterior bundle of the deltoid was significantly lower in group A compared to group B ( P<0.05), while there was no significant difference in muscle imbalance indices among other muscle groups between group A and group B ( P>0.05). Conclusion Patients with RCT have a phenomenon of deltoid muscle strength reduction, which is more pronounced in the population with a larger CSA.
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Affiliation(s)
- Zhiling Wang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
| | - Dedong Cui
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
| | - Yi Long
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
| | - Ke Meng
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
| | - Zhenze Zheng
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
| | - Cheng Li
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
| | - Rui Yang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
| | - Jingyi Hou
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China
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Vaithinathan AG, Khonji L, Narayanan G. Necessitating evidence-based practice in COVID-19 intramuscular vaccination techniques (to aspirate or not) in the context of scientific/evidence uncertainty amidst the pandemic. J Evid Based Med 2023. [PMID: 37282781 DOI: 10.1111/jebm.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Asokan G Vaithinathan
- Allied Health Department, College of Health and Sport Sciences, Salmanya Medical Complex, University of Bahrain, Salmanya, Bahrain
| | - Leena Khonji
- Nursing Department, WHO Collaborating Center for Nursing Development, College of Health and Sport Sciences, Salmanya Medical Complex, University of Bahrain, Salmanya, Bahrain
| | - Gayathripriya Narayanan
- Nursing Department, WHO Collaborating Center for Nursing Development, College of Health and Sport Sciences, Salmanya Medical Complex, University of Bahrain, Salmanya, Bahrain
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Olewnik Ł, Zielinska N, Koptas K, Maślanka K, Ruzik K, Georgiev GP, Tubbs RS. Accessory part of the deltoid muscle. Folia Morphol (Warsz) 2023; 83:226-230. [PMID: 36967626 DOI: 10.5603/fm.a2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/29/2023]
Abstract
The shoulder and arm region has numerous morphological variations. The deltoid muscle usually consists of three parts: anterior, middle and posterior. This case report describes a very rare deltoid muscle variant, an addition to the spinal part that is attached proximally at the infraspinatus fascia and the spine of the scapula. The distal attachment transforms directly into the brachialis muscle. Additional parts can affect the biomechanics and function of the joints significantly.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Krzysztof Koptas
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Krystian Maślanka
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Georgi P Georgiev
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, Bulgaria
| | - Richard Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Department of Neurosurgery, Ochsner Medical Centre, New Orleans, Louisiana, United States
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Veen EJ, Smits EJ, Ker A, Whitehouse SL, Ziegenfuss BL, Pivonka P, Gupta A, Cutbush K. Anterior deltoid muscle reflection using a deltopectoral approach is safe and does not influence outcome of reverse shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:1135-1145. [PMID: 36849027 DOI: 10.1016/j.jse.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/06/2023] [Accepted: 01/22/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The deltopectoral approach is well accepted for shoulder arthroplasty procedures. The extended deltopectoral approach with detachment of the anterior deltoid from the clavicle allows increased joint exposure and can protect the anterior deltoid from traction injury. The efficacy of this extended approach has been demonstrated in anatomical total shoulder replacement surgery. However, this has not been shown in reverse shoulder arthroplasty (RSA). The primary aim of this study was to evaluate the safety of the extended deltopectoral approach in RSA. The secondary aim was to evaluate the performance of the deltoid reflection approach in terms of complications, surgical, functional and radiological outcomes up to 24 months post-surgery. METHODS A prospective non-randomized comparative study was performed between January 2012 and October 2020 including 77 patients in the deltoid reflection group and 73 patients in the comparative group. Decision for inclusion was based on patient and surgeon factors. Complications were recorded. Patients were followed up for at least 24 months to evaluate their shoulder function and ultrasound evaluation. Functional outcome measures included the Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder Elbow Surgeons score (ASES), pain intensity (VAS 0-100), range of motion (forward flexion (FF), abduction (AD), and external rotation (ER)). A regression analysis was performed to evaluate any factors of influence on the VAS. RESULTS There were no significant differences in the rate of complications between the two groups (14.5% in the deltoid reflection group and 13.8% in the comparative group, p=0.915). Ultrasound evaluation was available in 64 (83.1%) patients, and no proximal detachment was observed. In addition, there were no significant differences in functional outcome measures both preoperatively and at 24 months post-surgery between the groups on Mean VAS pain, OSS, DASH, ASES, FF, ABD, and ER. Adjustment for possible confounders in a regression model indicated that only prior surgery significantly influenced the VAS pain (p=0.031, 95%CI 0.574 - 11.67) after surgery. Deltoid reflection (p=0.068), age (p=0.466), sex (p=0.936), glenoid graft (p=0.091), prosthesis manufacturer (p=0.382) and preop VAS score (p=0.362) were not of influence. DISCUSSION Results of this study show an extended deltopectoral approach for RSA is safe. Selected reflection of the anterior deltoid muscle improved exposure and prevents anterior deltoid muscle injury followed by re-attachment. Patients had similar functional scores preop and at 24 months compared to a comparative group. Furthermore, ultrasound evaluation showed intact re-attachments.
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Affiliation(s)
- Egbert Jd Veen
- Brisbane Private Hospital, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Esther J Smits
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew Ker
- Brisbane Private Hospital, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Sarah L Whitehouse
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Brandon L Ziegenfuss
- Brisbane Private Hospital, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter Pivonka
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia
| | - Kenneth Cutbush
- Brisbane Private Hospital, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; The University of Queensland, Brisbane, QLD, Australia.
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Deshpande N, Stino AM, Smith BW, Little AA, Yang LJS, Park P, Saadeh YS. Defining postoperative C5 palsy and recovery: a systematic review. J Neurosurg Spine 2022; 38:457-464. [PMID: 36585862 DOI: 10.3171/2022.11.spine221067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/23/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Postoperative C5 palsy (C5P) is a well-recognized and often-delayed complication of cervical spine surgery. Most patients recover within 6 months of onset, but the prognosis of severe cases is poor. The clinical significance and natural history of mild versus severe C5P appear to differ substantially, but palsy severity and recovery have been poorly characterized in the literature. METHODS Owing to the varying prognoses and expanding treatment options such as nerve transfer surgery to reconstruct the C5 myotome, this systematic review attempted to describe how C5P severity is classified and how C5P and its recovery are defined, with the aim of proposing a postoperative C5P scale to support clinical decision-making. PubMed was searched for articles in English published since 2000 that offer a clear definition of postoperative C5P or its recovery. Only articles reporting exclusively on C5 palsy for patients undergoing surgery for degenerative disease were included. A single reviewer screened titles and abstracts and reviewed the full text of relevant articles, with consultation as needed from a second reviewer. Data collected included postoperative C5P definitions, classification of C5P severity, and definition and/or classification of C5P recovery. Qualitative analysis was performed. RESULTS Full-text reviews were conducted of 98 of 272 articles identified and screened, and 43 met the inclusion criteria. Postoperative C5P was most commonly defined as a reduction in deltoid muscle strength by ≥ 1 grade using manual muscle testing (MMT), with potential biceps involvement also noted by some studies. The few studies that stratified C5P on the basis of severity unanimously characterized severe C5P as MMT grade ≤ 2. Nine studies reported on C5P recovery. Deltoid muscle strength improvement of MMT grade 5 commonly defined complete recovery, with no MMT improvement considered partial recovery. CONCLUSIONS This review identified clear discrepancies in the definitions of C5P and its recovery, leading to heterogeneity in its evaluation and management. With the emergence of therapeutic procedures for severe C5P, standardization of the definitions of C5P and its recovery is critical. The authors propose MMT grades of 4, 3, and ≤ 2 to classify C5P as mild, moderate, and severe, respectively, and grades of 5, 4, and 3 to classify recovery as complete, sufficient, and useful, respectively.
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Affiliation(s)
| | - Amro M Stino
- 2Neurology, University of Michigan, Ann Arbor, Michigan; and
| | - Brandon W Smith
- 3Department of Neurologic Surgery, Duke University, Durham, North Carolina
| | - Ann A Little
- 2Neurology, University of Michigan, Ann Arbor, Michigan; and
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Gómez M, Casado A, de Diego M, Pastor JF, Potau JM. Anatomical and molecular analyses of the deltoid muscle in chimpanzees (Pan troglodytes) and modern humans (Homo sapiens): Similarities and differences due to the uses of the upper extremity. Am J Primatol 2022; 84:e23390. [PMID: 35561001 DOI: 10.1002/ajp.23390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/22/2022] [Accepted: 04/25/2022] [Indexed: 11/12/2022]
Abstract
In the deltoid muscles of Pan troglodytes and Homo sapiens, we have analyzed the muscle architecture and the expression of the myosin heavy chain (MHC) isoforms. Our aim was to identify differences between the two species that could be related to their different uses of the upper limb. The deltoid muscle of six adult Pan troglodytes and six adult Homo sapiens were dissected. The muscle fascicle length (MFL) and the physiological cross-sectional area (PCSA) of each muscle were calculated in absolute and normalized values. The expression pattern of the MHC-I, MHC-IIa and MHC-IIx isoforms was analyzed in the same muscles by real-time polymerase chain reaction. Only the acromial deltoid (AD) presented significant architectural differences between the two species, with higher MFL values in humans and higher PCSA values in chimpanzees. No significant differences in the expression pattern of the MHC isoforms were identified. The higher PCSA values in the AD of Pan troglodytes indicate a greater capacity of force generation in chimpanzees than in humans, which may be related to a greater use of the upper limb in locomotion, specifically in arboreal locomotion like vertical climbing. The functional differences between chimpanzees and humans in the deltoid muscle are more related to muscle architecture than to a differential expression of MHC isoforms.
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Affiliation(s)
- Mónica Gómez
- Department of Surgery and Surgical Specializations, Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - Aroa Casado
- Department of Surgery and Surgical Specializations, Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.,Institut d'Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona, Barcelona, Spain
| | - Marina de Diego
- Department of Surgery and Surgical Specializations, Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | | | - Josep Maria Potau
- Department of Surgery and Surgical Specializations, Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.,Institut d'Arqueologia de la Universitat de Barcelona (IAUB), Faculty of Geography and History, University of Barcelona, Barcelona, Spain
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Koyasu S, Nakamoto Y. 111In-Pentetreotide Uptake Due to COVID-19 Vaccination. Clin Nucl Med 2022; 47:271-272. [PMID: 34619700 PMCID: PMC8820749 DOI: 10.1097/rlu.0000000000003935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 72-year-old woman was referred for whole-body 111In-pentetreotide scintigraphy with SPECT/CT. There was increased uptake of lymphadenopathy in the left axilla and left deltoid muscle. The patient's history revealed that the patient received the first dose of the COVID-19 vaccine 3 days before the 111In-pentetreotide scintigraphy with SPECT/CT. This case demonstrates that the COVID-19 vaccine can cause 111In-pentetreotide uptake in the lymph nodes and the deltoid muscle.
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Shin SH, Park SJ, Yeoum SH, Youn CS, Park KY. Efficacy and safety of botulinum toxin injection in reducing deltoid muscle hypertrophy. Dermatol Ther 2021; 34:e15168. [PMID: 34676643 DOI: 10.1111/dth.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 09/28/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
With the increasing demand for body contouring, botulinum toxin (BTX) injection is being widely used off-label for muscular hypertrophy. However, to the best of our knowledge, no study has investigated the clinical efficacy of BTX type A (BTX-A) in deltoid muscle hypertrophy. This study was conducted to evaluate the efficacy and safety of intramuscular injection of BTX in reducing deltoid muscle hypertrophy. Overall, 10 patients with bilateral deltoid muscle hypertrophy were treated with an intramuscular injection of prabotulinum toxin A, with a total of 50 units [U] administered per patient. As measured by ultrasonography, the thickness of the deltoid muscles was significantly decreased at weeks 2 and 12. In addition, the clinical assessment score by blinded investigators was improved after the treatment; however, patients' satisfaction scores were relatively low. No major complications were reported. Therefore, intramuscular injection of BTX-A seems to be a candidate for novel treatment option for deltoid muscle hypertrophy. Further larger clinical studies are warranted to confirm the efficacy of BTX-A.
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Affiliation(s)
- Sun Hye Shin
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Su Jung Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | | | | | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
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13
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Ueda Y, Nimura A, Matsuki K, Yamaguchi K, Sugaya H, Akita K. Morphology of the Undersurface of the Anterolateral Acromion and Its Relationship to Surrounding Structures. Orthop J Sports Med 2021; 9:2325967120977485. [PMID: 33553456 PMCID: PMC7844461 DOI: 10.1177/2325967120977485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background: A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise correlations between the morphologic features underneath the acromion and the surrounding structures including the attachment of the coracoacromial ligament (CAL) and the origin of the deltoid middle head have not yet been determined in the absence of artifacts on the bony surface caused by dissection techniques. Moreover, anatomic findings in previous studies using only older-aged cadavers or dried bones may not reflect the morphologic features of younger and healthy specimens. Purpose: To characterize the anterolateral structures morphologically in the inferior aspect of the acromion, assess the relationships of these structures with surrounding structures without dissection artifacts on the bony surface, and verify the cadaveric data in the asymptomatic shoulders of living middle-aged patients. Study Design: Descriptive laboratory study. Methods: We initially analyzed the relationship between the morphology of the anterolateral structures and surrounding structures in 18 cadaveric shoulders (mean age, 81.8 years), 15 of which were subjected to macroscopic investigation of the CAL attachment and 3-dimensional micro—computed tomography investigation with radiopaque markers and 3 of which were subjected to histologic examination. We also analyzed the morphology underneath the anterolateral acromion in 24 asymptomatic shoulders of middle-aged patients (mean age, 54.8 years) to verify the cadaveric data. In both the cadaveric shoulders and the asymptomatic shoulders of live patients, the long axis, width, and height of the anterolateral prominence were measured by use of 3-dimensional CT imaging. Results: In cadavers, the anterolateral prominence underneath the acromion corresponded to the attachment of the CAL. Histologic evaluation revealed that the CAL was continuous to the deep layer of the deltoid middle head in the lateral acromion. The study in asymptomatic shoulders of middle-aged patients revealed bony prominences similar to those observed in cadavers. Conclusion: The anterolateral prominence, which corresponds to the attachment of the CAL below the acromion, may be a native structure below the acromion. Moreover, the CAL is continuous to the deep layer of the deltoid middle head in the lateral acromion.
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Affiliation(s)
- Yusuke Ueda
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.,Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keisuke Matsuki
- Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Campos YAC, Vianna JM, Guimarães MP, Oliveira JLD, Hernández-Mosqueira C, da Silva SF, Marchetti PH. Different Shoulder Exercises Affect the Activation of Deltoid Portions in Resistance-Trained Individuals. J Hum Kinet 2020; 75:5-14. [PMID: 33312291 DOI: 10.2478/hukin-2020-0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aims of this study were to compare muscle activity of the anterior deltoid, medial deltoid, and posterior deltoid in the bench press, dumbbell fly, shoulder press, and lateral raise exercises. Thirteen men experienced in strength training volunteered for the study. Muscle activation was recorded during maximum isometric voluntary contraction (MVIC) for data normalization, and during one set of 12 repetitions with the load of 60% 1RM in all exercises proposed. One-way repeated-measures ANOVA with Bonferroni’s posthoc was applied using a 5% significance level. For anterior deltoid, the shoulder press (33.3% MVIC) presented a significantly higher level of activation when compared to other exercises. Also, no significant difference was found between the bench press (21.4% MVIC), lateral raise (21.2% MVIC), and dumbbell fly (18.8% MVIC). For the medial deltoid, the lateral raise (30.3% MVIC) and shoulder press (27.9% MVIC) presented a significantly higher level of activity than the bench press (5% MVIC) and dumbbell fly (3.4% MVIC). Besides, no significant difference was found between the bench press and the dumbbell fly. For the posterior deltoid, the lateral raise (24% MVIC) presented a significantly higher level of activation when compared to other exercises. For the posterior deltoid portion, the shoulder press (11.4% MVIC) was significantly more active than the bench press (3.5% MVIC) and dumbbell fly (2.5% MVIC). Moreover, no significant difference was found between the bench press and the dumbbell fly. In conclusion, the shoulder press and lateral raise exercises showed a higher level of muscle activation in the anterior deltoid and medial deltoid when compared to the bench press and dumbbell fly exercises.
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15
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Hamada S, Nishida Y, Takanari K, Ota T, Urakawa H, Ikuta K, Sakai T, Tsukushi S, Kamei Y, Ishiguro N. Functional evaluation following deltoid muscle resection in patients with soft tissue sarcoma. Jpn J Clin Oncol 2020; 50:772-778. [PMID: 32249309 DOI: 10.1093/jjco/hyaa039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The present study aimed to determine functional outcomes in patients undergoing deltoid muscle resection for soft tissue sarcoma. METHODS Between 2002 and 2014, 18 patients with soft tissue sarcoma of the shoulder who underwent wide resection including the deltoid muscle, and were followed up for more than 12 months, were retrospectively included in the study. In all, 11 patients were male and 7 were female. The median age was 59 years, median follow-up duration was 37 months. The extent of resection of deltoid muscle, with or without rotator cuff damage, reconstruction methods, adjuvant therapy, oncological outcomes, and the International Society of Limb Salvage (ISOLS) score as functional outcomes were analyzed. RESULTS Six patients underwent total resection, and twelve underwent partial resections of deltoid muscle. The rotator cuff was resected in four patients. Soft tissue reconstruction was performed in 17 patients using a pedicled latissimus dorsi muscle flap. Two local recurrences and three distant metastases occurred during follow-up. Median overall survival was 72 months. The mean ISOLS score was 25.0 points (±4.6points). Univariate analysis revealed that there was no significant difference in ISOLS score regarding the extent of deltoid muscle resection. Multivariate analysis identified only combined resection of the rotator cuff as a significant prognostic factor for poor functional outcomes (P < 0.001). CONCLUSIONS The extent of resection of the deltoid muscle might not affect the functional outcomes determined by ISOLS score. If the rotator cuff is resected concurrently, satisfactory functional outcomes might not be obtained.
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Affiliation(s)
- Shunsuke Hamada
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Takehiro Ota
- Department of Orthopedic Surgery, Nagoya Memorial Hospital, Nagoya, Japan
| | - Hiroshi Urakawa
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Kunihiro Ikuta
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan.,Department of Genome Medical Center, Nagoya University Hospital, Nagoya, Japan
| | - Tomohisa Sakai
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Satoshi Tsukushi
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
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Abstract
Background The ball impact position during spiking in volleyball may influence the pattern of activation of shoulder girdle muscles and, therefore, could be a significant risk factor for shoulder injury. Methods Activation of 10 muscles in the dominant shoulder was evaluated using surface electromyography (EMG) in 11 male volleyball players, during spiking in a static standing position, with the goal being to precisely control the specified ball impact positions, without a run-up or ball setting. The following 4 ball impact positions were evaluated: standard, posterior, medial, and lateral. The EMG amplitude, normalized to the maximal voluntary isometric contraction of the respective muscles, was compared for each phase of the spiking movement between the standard position and the other 3 different impact positions, using the Dunnett test. Results The following between-position differences were noted for the deltoid muscle: increased activation of the anterior deltoid during the acceleration phase for the posterior position (P = .041), increase in the posterior deltoid during the acceleration phase for the lateral position (P = .04), and increase in the middle deltoid during the deceleration phase for the lateral position (P = .005). Conclusion A posterior or lateral shift in the position of ball impact may cause an increase in the activity of the deltoid muscle that would cause a decrease in the centripetal force of the humeral head through the acceleration and deceleration phases. As such, neuromuscular exercises, combined with strengthening of the rotator cuff muscle, might reduce the risk of shoulder injury during performance of the volleyball spiking movement.
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Affiliation(s)
- Kazutomo Miura
- Department of Rehabilitation Medicine, Hirosaki University, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University, Hirosaki, Japan
| | - Masakazu Kogawa
- Department of Rehabilitation Medicine, Hirosaki University, Hirosaki, Japan
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17
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Rienmüller A, Maffiuletti NA, Schwyzer HK, Eggspühler A. Shoulder Muscle Strength and Neuromuscular Activation 2 Years after Reverse Shoulder Prosthesis-An Experimental Case Control Study. J Clin Med 2020; 9:jcm9020365. [PMID: 32013074 PMCID: PMC7073832 DOI: 10.3390/jcm9020365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Although reverse shoulder arthroplasty (RSA) has shown successful postoperative outcomes, little is known about compensatory activation patterns of remaining shoulder muscles following RSA. The purpose of this experimental case control series was to investigate shoulder muscle strength and neuromuscular activation of deltoid and teres minor muscles 2 years after RSA. Humerus lengthening, center-of-rotation medialization, maximal voluntary strength, and electromyographic (EMG) activity were compared between the operated and the non-operated side of 13 patients (mean age: 73 years). Shoulder muscle strength was significantly lower on the operated side for external rotation (−54%), internal rotation (−20%), and adduction (−13%). Agonist deltoid EMG activity was lower on the operated side for shoulder flexion, extension, and internal and external rotation (p < 0.05). Antagonist deltoid coactivation was higher on the operated side for external rotation (p < 0.001). Large correlation coefficients were observed between shoulder adductor strength asymmetry and both center-of-rotation medialization (r = −0.73) and humerus lengthening (r = 0.71). Shoulder abduction strength and neuromuscular activation were well preserved 2 years after RSA, while persistent strength and activation deficits were observed for shoulder adduction and internal and external rotation. Additional studies are required to elucidate shoulder neuromuscular activation patterns before and after RSA to support decision making for surgical, implant design, and rehabilitation choices.
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Affiliation(s)
- Anna Rienmüller
- Department of Orthopedic and Trauma Surgery, Medical University Vienna, AT-1090 Vienna, Austria
- Correspondence:
| | | | - Hans-Kaspar Schwyzer
- Department of Orthopedic Surgery, Schulthess Clinic, CH-8008 Zurich, Switzerland;
| | - Andreas Eggspühler
- Department of Neurology, Schulthess Clinic, CH-8008 Zurich, Switzerland;
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18
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Adamonis S, Enodien B, Taha‐Mehlitz S, Maurer A, Taha A. Intramuscular myxoma of the deltoid muscle in a swimmer: A rare case report and literature review. Clin Case Rep 2019; 7:2398-2401. [PMID: 31893067 PMCID: PMC6935645 DOI: 10.1002/ccr3.2483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/04/2019] [Accepted: 08/27/2019] [Indexed: 11/05/2022] Open
Abstract
Intramuscular myxoma (IM) is a rare mesenchymal neoplasm with the incidence of one per 1 000 000 people and is reported greater among women. Our case reports an IM of a deltoid muscle in a young man. Differential diagnosis with sarcoma is important. Surgery is the treatment of choice usually without recurrence.
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Affiliation(s)
- Saulius Adamonis
- Clinic for General and Visceral SurgerySpital EinsiedelnEinsiedelnSwitzerland
| | - Bassey Enodien
- Department of General SurgeryGZO Spital WetzikonWetzikonSwitzerland
| | | | - Andreas Maurer
- Department of Orthopedics and Trauma SurgeryRheinfelden HospitalRheinfeldenSwitzerland
| | - Anas Taha
- Department of Visceral and Thoracic SurgeryCantonal Hospital of WinterthurWinterthurSwitzerland
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19
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Meisterhans M, Bouaicha S, Meyer DC. Posterior and inferior glenosphere position in reverse total shoulder arthroplasty supports deltoid efficiency for shoulder flexion and elevation. J Shoulder Elbow Surg 2019; 28:1515-1522. [PMID: 30929955 DOI: 10.1016/j.jse.2018.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND For humeral flexion and elevation, most relevant for daily activities with reverse total shoulder arthroplasty, the anterior and lateral deltoid muscles are most important. However, how this direction of movement is best supported with the glenosphere position is not fully understood. We hypothesized that both inferior positioning and posterior positioning of the glenosphere may best support this direction of movement. METHODS A validated, anatomic biomechanical shoulder model was modified to host a reverse shoulder prosthesis. The glenoid baseplate was altered to allow inferior, lateral, and posterior center-of-rotation (COR) offsets. An optical tracking system was used to track the excursion of ropes simulating portions of various shoulder muscles during humeral abduction, elevation, and flexion. RESULTS The inferior COR offset resulted in a significant increase in the deltoid moment arm in all 3 planes of motion. The lateral COR offset showed a significantly lower posterior deltoid moment arm during humeral abduction and a significantly lower lateral deltoid moment arm during humeral elevation. The posterior offset showed significantly larger anterior and lateral deltoid moment arms during humeral flexion. DISCUSSION AND CONCLUSION Owing to the oblique direction of the deltoid muscle across the shoulder joint, an inferior offset of the COR in reverse total shoulder arthroplasty increases the deltoid moment arm during abduction, elevation, and flexion, whereas it mainly supports humeral flexion at a posterior offset. For humeral elevation and flexion, favorable positioning of the glenosphere may, therefore, be defined by a more inferior and posterior placement compared with the non-offset position.
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Affiliation(s)
| | - Samy Bouaicha
- Department of Shoulder and Elbow Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Dominik C Meyer
- Department of Shoulder and Elbow Surgery, Balgrist University Hospital, Zurich, Switzerland
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20
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Renner T, Sollmann N, Trepte-Freisleder F, Albers L, Mathonia NM, Bonfert MV, König H, Klose B, Krieg SM, Heinen F, Gerstl L, Landgraf MN. Repetitive Peripheral Magnetic Stimulation (rPMS) in Subjects With Migraine-Setup Presentation and Effects on Skeletal Musculature. Front Neurol 2019; 10:738. [PMID: 31379706 PMCID: PMC6646581 DOI: 10.3389/fneur.2019.00738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/24/2019] [Indexed: 01/03/2023] Open
Abstract
Purpose: Repetitive peripheral magnetic stimulation (rPMS) has been successfully applied recently in migraineurs to alleviate migraine symptoms. Symptom relief has been achieved by stimulating myofascial trigger points (mTrPs) of the trapezius muscles, which are considered part of the trigemino-cervical complex (TCC). However, effects on musculature have not been assessed in detail, and the specificity of effects to muscles considered part of the TCC yet has to be elucidated. Against this background, this study presents the setup of rPMS in migraine and evaluates effects on skeletal musculature. Materials and Methods: Thirty-seven adults (mean age: 25.0 ± 4.1 years, 36 females) suffering from migraine and presenting mTrPs according to physical examination underwent rPMS either to mTrPs in the trapezius muscles (considered part of the TCC; n = 19) or deltoid muscles (considered not part of the TCC; n = 18) during six sessions over the course of 2 weeks. Standardized questionnaires were filled in to assess any adverse events and experience with rPMS as well as satisfaction and benefits from stimulation. Algometry was performed to evaluate changes in pressure pain thresholds (PPTs). Results: All stimulation sessions were successfully performed without adverse events, with 84.2% of subjects of the trapezius group and 94.4% of subjects of the deltoid group describing rPMS as comfortable (p = 0.736). Muscular pain or tension improved in 73.7% of subjects of the trapezius group and in 61.1% of subjects of the deltoid group (p = 0.077). PPTs of the trapezius muscles clearly increased from the first to the last stimulation sessions-regardless of the stimulated muscle (rPMS to the trapezius or deltoid muscles). However, depending on the examined muscles the increase of PPTs differed significantly (subjects with stimulation of trapezius muscles: p = 0.021; subjects with stimulation of deltoid muscles: p = 0.080). Conclusion: rPMS is a comfortable method in migraineurs that can improve local muscular pain or tension. Furthermore, it is able to increase directly and indirectly the PPTs of the trapezius muscles (considered part of the TCC) when applied over mTrPs, supporting the role of the TCC in migraineurs.
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Affiliation(s)
- Tabea Renner
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Florian Trepte-Freisleder
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lucia Albers
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nina M Mathonia
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Helene König
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Birgit Klose
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU-University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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21
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Bergquist R, Iversen VM, Mork PJ, Fimland MS. Muscle Activity in Upper-Body Single-Joint Resistance Exercises with Elastic Resistance Bands vs. Free Weights. J Hum Kinet 2018; 61:5-13. [PMID: 29599855 PMCID: PMC5873332 DOI: 10.1515/hukin-2017-0137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Elastic resistance bands require little space, are light and portable, but their efficacy has not yet been established for several resistance exercises. The main objective of this study was to compare the muscle activation levels induced by elastic resistance bands versus conventional resistance training equipment (dumbbells) in the upper-body resistance exercises flyes and reverse flyes. The level of muscle activation was measured with surface electromyography in 29 men and women in a cross-over design where resistance loadings with elastic resistance bands and dumbbells were matched using 10-repetition maximum loadings. Elastic resistance bands induced slightly lower muscle activity in the muscles most people aim to activate during flyes and reverse flies, namely pectoralis major and deltoideus posterior, respectively. However, elastic resistance bands increased the muscle activation level substantially in perceived ancillary muscles, that is deltoideus anterior in flyes, and deltoideus medius and trapezius descendens in reverse flyes, possibly due to elastic bands being a more unstable resistance modality. Overall, the results show that elastic resistance bands can be considered a feasible alternative to dumbbells in flyes and reverse flyes.
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Affiliation(s)
- Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Ronny Bergquist NTNU, Fakultet for medisin og helsevitenskap, PB 8905, 7491 TRONDHEIM Phone: 0047 72571259
| | - Vegard Moe Iversen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Paul J Mork
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Steiro Fimland
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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22
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Nakajima Y, Mukai K, Takaoka K, Hirose T, Morishita K, Yamamoto T, Yoshida Y, Urai T, Nakatani T. Establishing a new appropriate intramuscular injection site in the deltoid muscle. Hum Vaccin Immunother 2017; 13:2123-2129. [PMID: 28604191 PMCID: PMC5612213 DOI: 10.1080/21645515.2017.1334747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It is becoming increasingly important for clinicians to identify a safer intramuscular (IM) injection site in the deltoid muscle because of possible complications following the vaccine administration of IM injections. We herein examined 4 original IM sites located on the perpendicular line through the mid-acromion to establish a safer IM injection site. Thirty healthy volunteers participated in this study and the distances from our 4 IM sites to some anatomical landmarks on their left arms were measured. Ultrasonography (US) was also performed to measure the thickness of the deltoid muscle and identify the posterior circumflex humeral artery (PCHA) along the course of the axillary nerve. Subcutaneous thickness was measured using 2 methods: measuring the skin thickness with caliper after pinching the skin, and with US. The results obtained revealed that the intersection between the anteroposterior axillary line (the line between the upper end of the anterior axillary line and the upper end of the posterior axillary line) and the perpendicular line from the mid-acromion was the most appropriate site for IM injections because it was distant from the axillary nerve, PCHA, and subdeltoid/subacromial brusa. At this site, depth of needle insertions was 5 mm greater than the subcutaneous thickness at a 90° angle, which was sufficient to penetrate subcutaneous tissue in both sexes. Subcutaneous thickness can be assessed with almost the same accuracy by US or measuring with calipers after pinching the skin. The results of the present study support the improved vaccine practice for safer IM injections.
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Affiliation(s)
- Yukari Nakajima
- a Graduate Course of Nursing Science, Division of Health Sciences , Graduate School of Medical Sciences, Kanazawa University , Kanazawa , Japan
| | - Kanae Mukai
- b Institute of Medical, Pharmaceutical and Health Sciences , Kanazawa University , Kanazawa , Japan
| | - Kana Takaoka
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Toshiko Hirose
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Keiko Morishita
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Takuya Yamamoto
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Yuka Yoshida
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Tamae Urai
- a Graduate Course of Nursing Science, Division of Health Sciences , Graduate School of Medical Sciences, Kanazawa University , Kanazawa , Japan
| | - Toshio Nakatani
- b Institute of Medical, Pharmaceutical and Health Sciences , Kanazawa University , Kanazawa , Japan
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23
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Walker DR, Kinney AL, Wright TW, Banks SA. How sensitive is the deltoid moment arm to humeral offset changes with reverse total shoulder arthroplasty? J Shoulder Elbow Surg 2016; 25:998-1004. [PMID: 26810015 DOI: 10.1016/j.jse.2015.10.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/24/2015] [Accepted: 10/24/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty commonly treats cuff-deficient or osteoarthritic shoulders not amenable to rotator cuff repair. This study investigates deltoid moment arm sensitivity to variations in the joint center and humeral offset of 3 representative reverse total shoulder arthroplasty subjects. We hypothesized that a superior joint implant placement may exist, indicated by muscle moment arms, compared with the current actual surgical implant configuration. METHODS Moment arms for the anterior, lateral, and posterior aspects of the deltoid muscle were determined for 1521 perturbations of the humeral offset location away from the surgical placement in a subject-specific musculoskeletal model with motion defined by subject-specific in vivo abduction kinematics. The humeral offset was varied from its surgical position ±4 mm in the anterior/posterior direction, ±12 mm in the medial/lateral direction, and -10 to 14 mm in the superior/inferior direction. RESULTS The anterior deltoid moment arm varied in humeral offset and center of rotation up to 20 mm, primarily in the medial/lateral and superior/inferior directions. The lateral deltoid moment arm varied in humeral offset up to 20 mm, primarily in the medial/lateral and anterior/posterior directions. The posterior deltoid moment arm varied up to 15 mm, primarily in early abduction, and was most sensitive to humeral offset changes in the superior/inferior direction. DISCUSSION High variations in muscle moment arms were found for all 3 deltoid components, presenting an opportunity to dramatically change the deltoid moment arms through surgical placement of the reverse shoulder components and by varying the overall offset of the humerus. LEVEL OF EVIDENCE Basic Science Study; Computer Modeling.
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Affiliation(s)
- David R Walker
- Department of Mechanical Engineering, University of Florida, Gainesville, FL, USA
| | - Allison L Kinney
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, FL, USA.
| | - Scott A Banks
- Department of Mechanical Engineering, University of Florida, Gainesville, FL, USA
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Cook IF. Best vaccination practice and medically attended injection site events following deltoid intramuscular injection. Hum Vaccin Immunother 2015; 11:1184-91. [PMID: 25868476 PMCID: PMC4514326 DOI: 10.1080/21645515.2015.1017694] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/25/2015] [Accepted: 02/06/2015] [Indexed: 11/10/2022] Open
Abstract
Analysis of medically attended injection site events data provides a vehicle to appreciate the inadequacies of vaccination practice for deltoid intramuscular injection and to develop best practice procedures. These data can be divided into 3 groups; nerve palsies, musculoskeletal injuries and cutaneous reactions and reflect inappropriate site of injection, needle over or under penetration, local sepsis and vascular complications. The aim of this review is to formulate best vaccination practice procedures for deltoid intramuscular injection of vaccines through the collation and analysis of medically attended injection site events.
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Affiliation(s)
- Ian F Cook
- University of Newcastle; Newcastle, New South Wales, Australia
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Abstract
A hydatid cyst is a zoonotic infection which may affect any organ and tissue, particularly the liver and the lung. Primary muscular hydatid cysts comprise less than 0.7-3% of the cases. The hydatid cysts must be kept in mind to avoid a diagnostic puncture in cystic lesions to avoid the spreading of the disease. In this case report, we present an exceptionally rare case with an unusual localization of a primary hydatid cyst in the left deltoid muscle.
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Affiliation(s)
- Serdar Yilmaz
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Murat Gulcek
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yunus Demirtas
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Sualp Turan
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Mimata Y, Nishida J, Gotoh M, Akasaka T, Shimamura T. Limb function after excision of a deltoid muscle sarcoma. J Shoulder Elbow Surg 2013; 22:e1-5. [PMID: 23937929 DOI: 10.1016/j.jse.2013.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 05/14/2013] [Accepted: 05/18/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Limb function after excision of deltoid muscle sarcomas has not been thoroughly investigated, although a large defect of soft tissue often causes some degree of dysfunction after wide excision. We formulated a hypothesis that the limb functional results depend on the volume of the excised deltoid muscle and examined the clinical outcomes in patients with a sarcoma in the deltoid muscle treated by surgical resection. METHODS The clinical outcomes of 8 patients with a malignant soft tissue tumor in the deltoid muscle were retrospectively reviewed. The following items were evaluated: type of excision of the deltoid muscle, including total excision, subtotal excision, and partial excision; surgical margins; reconstruction procedure used; postoperative complications; local recurrence; metastasis; survival; and functional results (determined by the Musculoskeletal Tumor Society scoring system). RESULTS After surgical resection, reconstruction in 6 of 8 patients was performed by pedicled latissimus dorsi musculocutaneous or muscle flap or pedicled trapezius musculocutaneous flap. Two patients did not undergo reconstruction because skin closure was possible. The partial excision group had a Musculoskeletal Tumor Society score of 100.0%, and the subtotal excision case and the total excision group had scores of 76.6% and 82.2%, respectively. None of the patients has demonstrated any evidence of local recurrence. CONCLUSION We conclude that the functional results may depend on the volume of the excised deltoid muscle. Latissimus dorsi and trapezius musculocutaneous flaps were found to be useful for covering a defect of the deltoid muscle, although these flaps did not contribute to function of the shoulder.
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Affiliation(s)
- Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Prefectural Ninohe Hospital, Horino, Ninohe, 028-6193 Japan
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27
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Abstract
An unusual anatomic variation of the deltoid muscle was found in a 45-year-old female cadaver during dissection of the right upper extremity. The posterior fibers of the right deltoid muscle were enclosed in a distinct fascial sheet and the deltoid muscle was seen to arise from the middle 1/3 of the medial border of the scapula. There was no accompanying vascular or neural anomaly of the deltoid muscle. To the best of our knowledge, unilateral posterior separation of the deltoid muscle with a distinct fascia has not been described previously. While dissecting deltoid, posterior deltoid, or scapular flaps, the surgeon needs to look out for this variation because it may cause confusion.
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Affiliation(s)
- Haldun O Kamburoğlu
- Department of Plastic Reconstructive and Hand Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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