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Kumar PSS, Panwar R. Re: "Muscular Hemorrhages Around the Scapula Provide Insight on the Manner of Asphyxia's Study: Concerns and Considerations". Am J Forensic Med Pathol 2024; 45:186. [PMID: 37962926 DOI: 10.1097/paf.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
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Atalay HÖ, Atasoy D, Atasoy Ç. Superior scapular location: An overlooked albeit frequent finding in elastofibroma dorsi. Clin Imaging 2024; 109:110139. [PMID: 38574606 DOI: 10.1016/j.clinimag.2024.110139] [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: 12/05/2023] [Revised: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To explore the frequency of superior scapular elastofibroma dorsi in a large patient series with elastofibroma dorsi. METHODS 136 chest CTs from January 2016 to July 2022 reporting elastofibroma dorsi were retrospectively analyzed. Three radiologists assessed the number, size, and location of elastofibroma dorsi. Continuous variables underwent two-tailed t-tests with p < 0.05. Inter-observer agreement was assessed by using Cohen's Kappa values. RESULTS In 136 patients (mean age, 75.9 +/- 9.8 years; 117 female), 330 elastofibroma dorsi were found. Six (4.4 %) patients had single, 87 (64 %) double, 22 (16.2 %) triple and 21 (15.4 %) quadruple lesions. All single and double lesions were in the inferior scapular regions. 43 (31.6 %) patients had superior scapular lesions in addition to inferior scapular elastofibroma dorsi. Inferior scapular elastofibroma dorsi was significantly larger than superior scapular elastofibroma dorsi. The probability of a right superior lesion was significantly higher in patients with a larger right inferior lesion. Inter-observer agreement was very good for experienced radiologist (κ = 94.1) and good for other radiologists (κ = 79.4 and κ = 78). CONCLUSION In contrast to current belief, superior scapular elastofibroma dorsi accompanying the typical inferior scapular lesions is not uncommon and can even manifest bilaterally. To the best of our knowledge, this is the first case series reporting prevalence of quadruple elastofibroma dorsi.
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Affiliation(s)
- Hande Özen Atalay
- Radiology Department, Koc University Hospital, Davutpasa Caddesi No:4 Topkapi, Zeytinburnu, Istanbul, Turkey.
| | - Duygu Atasoy
- Radiology Department, Koc University Hospital, Davutpasa Caddesi No:4 Topkapi, Zeytinburnu, Istanbul, Turkey
| | - Çetin Atasoy
- Radiology Department, Koc University Hospital, Davutpasa Caddesi No:4 Topkapi, Zeytinburnu, Istanbul, Turkey.
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Lannes X, Goetti P, Boubat M, Eghbali P, Becce F, Farron A, Terrier A. Three-dimensional evaluation of the transverse rotator cuff muscle's resultant force angle in relation to scapulohumeral subluxation and glenoid vault morphology in nonpathological shoulders. J Shoulder Elbow Surg 2024; 33:1157-1168. [PMID: 37898420 DOI: 10.1016/j.jse.2023.09.031] [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] [Received: 04/16/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Static posterior subluxation of the humeral head (SPSH) results in glenohumeral osteoarthritis. Treatment strategies for SPSH with or without resulting osteoarthritis remain challenging. There is growing interest in evaluating the rotator cuff muscle volume, fatty infiltration, or forces in osteoarthritic shoulders with SPSH, mainly due to a possible transverse force imbalance. In nonpathological shoulders, the transverse angle of the rotator cuff muscle's resultant force may be associated with scapulohumeral alignment and glenoid vault morphology, despite an assumed transverse force balance. The purpose of this study was to assess the transverse rotator cuff muscle's resultant force angle (TRFA) and its relationship with the scapulohumeral subluxation index (SHSI) and selected glenoid vault parameters using computer modeling. METHODS Computed tomography scans of 55 trauma patients (age 31 ± 13 years, 36 males) with nonpathological shoulders were analyzed and all measurements performed in 3-dimension. We placed landmarks manually to determine the humeral head center and the rotator cuff tendon footprints. The contours of the rotator cuff muscle cross-sectional areas were automatically predicted in a plane perpendicular to the scapula. Each rotator cuff muscle was divided into virtual vector fibers with homogeneous density. The resultant force vector direction for each muscle, corresponding to the rotator cuff action line, was calculated by vectorially summing the normalized fiber vectors for each muscle, weighted by the muscle trophic ratio. The resultant force vector was projected on the axial plane, and its angle with the mediolateral scapular axis was used to determine TRFA. The SHSI according to Walch, glenoid version angle (GVA), glenoid anteroposterior offset angle (GOA), glenoid depth, glenoid width, and glenoid radius were also evaluated. RESULTS The mean values for TRFA, SHSI, GVA, GOA, glenoid depth, glenoid width, and glenoid radius were 7.4 ± 4.5°, 54.3 ± 4.8%, -4.1 ± 4.4°, 5.1 ± 10.8°, 3.3 ± 0.6 mm, 20 ± 2 mm, and 33.6 ± 4.6 mm, respectively. The TRFA correlated strongly with SHSI (R = 0.731, P < .001) and GVA (R = 0.716, P < .001) and moderately with GOA (R = 0.663, P < .001). The SHSI was strongly negatively correlated with GVA (R = -0.813, P < .001) and moderately with GOA (R = -0.552, P < .001). The GVA correlated strongly with GOA (R = 0.768, P < .001). In contrast, TRFA, SHSI, GVA, and GOA did not correlate with glenoid depth, width, or radius. CONCLUSION Despite an assumed balance in the transverse volume of the rotator cuff muscles in nonpathological shoulders, variations exist regarding the transverse resultant force depending on the SHSI, GVA, and GOA. In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset.
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Affiliation(s)
- Xavier Lannes
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Patrick Goetti
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthieu Boubat
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Pezhman Eghbali
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Terrier
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Farr S, Jauker F, Ganger R. Defining shoulder function and dysplasia in patients with longitudinal deficiencies of the upper limb. J Shoulder Elbow Surg 2024; 33:e21-e30. [PMID: 37379966 DOI: 10.1016/j.jse.2023.05.025] [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] [Received: 02/16/2023] [Revised: 05/05/2023] [Accepted: 05/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Phenotypic differences and functional limitations in children with congenital radial and ulnar longitudinal deficiencies (RLD/ULD) are well understood for the forearm and hand. However, anatomical features of shoulder elements in these pathologies have only been scarcely reported. Moreover, shoulder function has not been assessed in this patient population. Therefore, we aimed to define radiologic features and shoulder function of these patients at a large tertiary referral center. METHODS We prospectively enrolled all patients with RLD and ULD (minimum age: 7 years) for this study. Eighteen patients (12 RLD, 6 ULD) with a mean age of 17.9 years (range, 8.5-32.5) were evaluated using clinical examination (shoulder motion and stability), patient-reported outcome measures (Visual Analog Scale, Pediatric/Adolescent Shoulder Survey, Pediatric Outcomes Data Collection Instrument), and radiologic grading of shoulder dysplasia (including length and width discrepancy of the humerus, glenoid dysplasia in the anteroposterior and axial view [Waters classification], and scapular and acromioclavicular dysplasia assessment). Descriptive statistics and Spearman correlation analyses were performed. RESULTS Despite five (28%) cases having anterioposterior shoulder instability and five (28%) cases with decreased motion, outcome scores indicated an overall excellent function of the shoulder girdle, with mean Visual Analog Scale of 0.3 (range, 0-5), mean Pediatric/Adolescent Shoulder Survey of 97 (range, 75-100), and mean Pediatric Outcomes Data Collection Instrument Global Functioning Scale of 93 (range, 76-100). The humerus was, on average, 15 mm shorter (range, 0-75), and metaphyseal and diaphyseal diameters both reached 94% of the contralateral side. Glenoid dysplasia was detected in nine (50%) cases, with increased retroversion evident in 10 (56%) cases. However, scapular (n = 2) and acromioclavicular (n = 1) dysplasia were rare. Based on radiographic findings, a radiologic classification system for dysplasia types IA, IB, and II was developed. CONCLUSIONS Adolescent and adult patients with longitudinal deficiencies exhibit various mild-to-severe radiologic abnormalities around the shoulder girdle. Nevertheless, these findings did not seem to negatively affect shoulder function as the overall outcome scores were excellent.
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Affiliation(s)
- Sebastian Farr
- Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria; Vienna Private Hospital, Vienna, Austria.
| | - Fridolin Jauker
- Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
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Houdek MT, Elhassan BT, Moran SL, Wagner ER. Advances in Oncologic Shoulder Girdle Resection and Reconstruction. Instr Course Lect 2024; 73:359-368. [PMID: 38090909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The bony shoulder girdle consists of the clavicle, humerus, and scapula, which work synergistically to form a complex articulation that is essential for use of the upper extremity. The shoulder girdle is the most common location for primary and secondary bone tumors in the upper extremity, and following resection of these tumors, reconstruction of the upper extremity is challenging. Compared with those in the lower extremity, reconstructive techniques in the upper extremity have historically been unreliable and fraught with complications and poor functional outcomes. Newer reconstructive techniques using reverse total shoulder arthroplasty and functional muscle flaps have shown promise to improve outcomes while reducing complications for proximal humerus reconstructions. Despite these advancements, reconstruction following scapulectomy remains challenging and is still associated with more frequent complications and compromised function.
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Van der Woude HJ, Flipsen M, Welsink C, Van der Zwan AL, Ham SJ. Is total-body MRI useful as a screening tool to rule out malignant progression in patients with multiple osteochondromas? Results in a single-center cohort of 319 adult patients. Skeletal Radiol 2024; 53:141-150. [PMID: 37338590 DOI: 10.1007/s00256-023-04389-2] [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] [Received: 01/29/2023] [Revised: 06/11/2023] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To evaluate the results of total-body (TB) MRI used as a screening tool for assessment or exclusion of malignant transformation in patients with hereditary multiple osteochondromas (HMO). PATIENTS AND METHODS In a single-institute cohort of MO patients, 366 TB-MRI examinations, including T1-weighted and STIR images, were performed for screening and follow-up purposes to rule out the malignant transformation, and retrospectively analyzed. In each patient, the presence and location of osteochondromas in the axial and appendicular bones were recorded. Forty-seven patients underwent a second TB surveillance in this period. STIR sequences were used to identify sites of increased signal intensity that could represent suspicious thickened cartilage caps or indeterminate reactive changes related to osteochondromas. RESULTS In 82% of patients, one or more OC locations were determined in one or more flat bones. In 366 exams, nine OC (2,5 %) with suspicious imaging features were identified. These proved to be peripheral chondrosarcomas after targeted MRI and resection were performed. All nine malignant lesions were in flat bones (pelvis 5, ribs 3, scapula 1). Three of these patients were 19 years of age. In 12 patients who had peripheral or intraosseous low-grade chondrosarcoma in their history, before their first TB-MRI, no new lesions were identified. Twenty-three additional TB-MRI exams, demonstrating focal high T2 signal intensity, also gave rise to performing additional targeted MRI. One OC of the distal femur was excised and appeared benign. No suspicious cartilage caps were depicted on the remaining 22 targeted MRI exams but instead increased T2 signal was clarified by reactive changes (frictional bursitis, soft tissue edema) in close relation with benign osteochondromas. No malignant lesions were found in 47 patients who had a second TB surveillance (mean interval between exams 3.2 years, range 2-5 years). CONCLUSION TB-MRI can identify malignant transformation of osteochondromas in HMO patients. All peripheral chondrosarcomas occurred in flat bones (ribs, scapula, pelvis) in our study. TB-MRI might assist in triage between higher risk patients with a high burden of OC, including the location of OC in main flat bones vs lower risk patients without OC of the flat bones.
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Affiliation(s)
- Henk-Jan Van der Woude
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, P.O Box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Mark Flipsen
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Chantal Welsink
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Arnard L Van der Zwan
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - S John Ham
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Smolle MA, Niethard M, Schrader C, Bergovec M, Tunn PU, Friesenbichler J, Scheipl S, Leithner A. Clinical and functional outcome after partial or total claviculectomy without reconstruction for oncologic causes. J Shoulder Elbow Surg 2023; 32:1967-1971. [PMID: 37044301 DOI: 10.1016/j.jse.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/16/2022] [Revised: 02/19/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND To achieve clear margins in rare malignant clavicular neoplasms, claviculectomy may become necessary. This study aimed to review clinical, functional, and oncologic outcomes following partial or total claviculectomy without reconstruction. METHODS This study retrospectively included 15 patients from 2 tertiary sarcoma centers (mean age, 42.6 ± 20.3 years; 66.7% male patients). The median length of clinical and oncologic follow-up was 48.0 months (interquartile range [IQR], 24.0-83.5 months). Functional follow-up (Musculoskeletal Tumor Society score and QuickDASH score [short version of the Disabilities of the Arm, Shoulder and Hand questionnaire]) was available in 9 patients at a median of 36.0 months (IQR, 20.0-100.0 months). RESULTS Of the 15 patients, 7 underwent total claviculectomy; 5, partial lateral claviculectomy; and 3, partial medial claviculectomy. No postoperative complications emerged. The median Musculoskeletal Tumor Society and QuickDASH scores at latest follow-up amounted to 26.0 points (IQR, 24.0-29.0 points) and 18.0 points (IQR, 11.0-22.0 points), respectively. Notably, scores tended to be lower in patients who underwent total claviculectomy (n = 2) in comparison to partial claviculectomy (n = 7). CONCLUSION Satisfactory clinical and functional results can be achieved following partial or total claviculectomy without reconstruction, with a low complication rate and acceptable mid- to long-term function.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Maya Niethard
- Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Berlin, Germany; Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, Clinic and Outpatient Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Christian Schrader
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Per-Ulf Tunn
- Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Susanne Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
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Hargiss JB, Labott JR, Broida SE, Rose PS, Barlow JD, Houdek MT. Outcome of Scapular Ewing Sarcoma. Anticancer Res 2022; 42:3869-3872. [PMID: 35896233 DOI: 10.21873/anticanres.15879] [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: 06/19/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Ewing sarcoma is a common primary bone tumor, often located in the distal femur or pelvis. Although the scapula is a flat bone similar to the pelvis, scapular Ewing sarcoma is rare. The aim of this study was to review our institution's experience with the management of scapular Ewing sarcomas. PATIENTS AND METHODS We reviewed 9 patients with an Ewing sarcoma of the scapula, which included 5 males and 4 females with a mean age of 19±6 years. All patients were treated with chemotherapy and local control. Local control included surgical resection (n=7) and definitive radiotherapy (n=2). Mean follow-up was 6 years. RESULTS Prior to induction chemotherapy, the mean tumor size and volume were 10±2 cm and 181±112 cm3, respectively. Following induction chemotherapy, there was a reduction in the mean tumor size (6±3, p=0.02) and volume (20±12 cm3, p<0.01). The mean tumor necrosis in patients undergoing resection was 72±23%. The median survival was 30-months, and the 5-year disease specific survival was 38%. At most recent follow-up, the mean Musculoskeletal Tumor Society Score was 79±14%. CONCLUSION Scapular Ewing sarcoma is a rare, aggressive tumor. Even with chemotherapy and local control with surgery or definitive radiotherapy, patient survival is poor.
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Affiliation(s)
- John B Hargiss
- Alix School of Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Samuel E Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | | | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.
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Al-Redouan A, Hudak R, Nanka O, Kachlik D. The morphological stenosis pattern of the suprascapular notch is revealed yielding higher incidence in the discrete type and elucidating the inevitability of osteoplasty in horizontally oriented stenosis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2272-2280. [PMID: 32712687 DOI: 10.1007/s00167-020-06168-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To identify the morphological patterns of suprascapular notch stenosis. METHODS Suprascapular notch space capacity was assessed by morphometric analysis of 333 dry scapulae. Suprascapular notch parameters-superior transverse distance, middle width, depth, medial border length and lateral border length-were measured. The probable suprascapular notch stenosis was referenced by (1) comparing each obtained parameter measurement to the range of the suprascapular nerve diameter, and (2) quantifying the reduced parameters. Finally, the morphological pattern was determined based on the collective reduction of the parameters and their alignments. RESULTS Five types of suprascapular notch based on depth to superior transverse distance ratio were identified and assessed. Type-I showed low incidence of stenosis (6/333) and low frequency within type (6/28) with potential risk of horizontal compression. Type-II showed relatively low incidence of stenosis (9/333) and low frequency within type (9/50) with undetermined pattern. Type-III showed relatively higher incidence of stenosis (47/333) but low frequency within type (47/158) with potential risk of vertical compression. Type-IV (foramen) showed low incidence of stenosis (6/333) and relatively lower frequency within type (6/26) with potential risk of encircled compression. Finally, type-V (discrete) showed relatively high incidence of stenosis (40/333) and high frequency within type (40/71) with potential risk of vertical compression. The suprascapular notch was found to be stenosed beyond its capacity to accommodate the suprascapular nerve in 49/333. Type-V is at most risk followed by Type-III. CONCLUSIONS Suprascapular notch stenosis takes three morphological patterns: horizontal, vertical or mixed. An osteoplasty of suprascapular notch margins may be required beside the common surgical approach of the superior transverse scapular ligamentectomy.
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Affiliation(s)
- Azzat Al-Redouan
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic.
| | - Radovan Hudak
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
- Department of Orthopaedics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ondrej Nanka
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
- Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
- College of Polytechnics, Jihlava, Czech Republic
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Abstract
ABSTRACT Muscular hemorrhages around the scapula that are caused by upper extremity motion are rarely reported in cases other than drowning. We examined differences in the frequency of muscular hemorrhages around the scapula and stratified them by the cause of death. Muscular hemorrhages were mostly noted in cases of drowning (118/185, 63.8%), followed by cases of asphyxia (23/44, 52.3%). In addition, muscular hemorrhages around the scapula were found in cases of ligature strangulation (8/11, 72.7%), manual strangulation (2/3, 66.7%), choking (11/14, 78.6%), and traumatic asphyxia (2/2, 100%). Muscular hemorrhages were not found in cases of hanging or environmental suffocation, possibly because of the short time interval preceding the loss of consciousness. The distribution of muscular hemorrhages was similar in choking and drowning cases. Muscular hemorrhages due to strangulation were mainly unilateral, whereas those due to choking and drowning were mainly bilateral. During all types of asphyxia, muscular hemorrhages around the scapula were considered to be the result of conscious, active upper extremity motion. Because the frequency and laterality of muscular hemorrhages around the scapula differed based on the type of asphyxia, our findings provide insights into the manner of asphyxia that could be used to aid in the identification of homicidal hangings.
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Affiliation(s)
| | - Maki Ohtani
- Department of Forensic Sciences, Graduate School of Medicine, Akita University, Akita, Japan
| | - Sohtaro Mimasaka
- Department of Forensic Sciences, Graduate School of Medicine, Akita University, Akita, Japan
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Giles JW, Brodén C, Tempelaere C, Emery RJH, Rodriguez y Baena F. Development and ex-vivo assessment of a novel patient specific guide and instrumentation system for minimally invasive total shoulder arthroplasty. PLoS One 2021; 16:e0251880. [PMID: 34019573 PMCID: PMC8139503 DOI: 10.1371/journal.pone.0251880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To develop and assess a novel guidance technique and instrumentation system for minimally invasive short-stemmed total shoulder arthroplasty that will help to reduce the complications associated with traditional open replacement such as poor muscle healing and neurovascular injury. We have answered key questions about the developed system including (1) can novel patient-specific guides be accurately registered and used within a minimally invasive environment?; (2) can accuracy similar to traditional techniques be achieved? Methods A novel intra-articular patient-specific guide was developed for use with a new minimally invasive posterior surgical approach that guides bone preparation without requiring muscle resection or joint dislocation. Additionally, a novel set of instruments were developed to enable bone preparation within the minimally invasive environment. The full procedure was evaluated in six cadaveric shoulders, using digitizations to assess accuracy of each step. Results Patient-specific guide registration accuracy in 3D translation was 2.2±1.2mm (RMSE±1 SD; p = 0.007) for the humeral component and 2.7±0.7mm (p<0.001) for the scapula component. Final implantation accuracy was 2.9±3.0mm (p = 0.066) in translation and 5.7–6.8±2.2–4.0° (0.001<p<0.009) across the humerus implants’ three rotations. Similarly, the glenoid component’s implantation accuracy was 3.0±1.7mm (p = 0.008) in translation and 2.3–4.3±2.2–4.4° (0.008<p<0.09) in rotation. Conclusion This system achieves minimally invasive shoulder replacement with accuracy similar to traditional open techniques while avoiding common causes of complications. Significance This novel technique could lead to a paradigm shift in shoulder arthroplasty for patients with moderate arthritis, which could significantly improve rehabilitation and functional outcomes.
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Affiliation(s)
- Joshua W. Giles
- Department of Mechanical Engineering, University of Victoria, Victoria, British Columbia, Canada
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
- * E-mail: (JWG); (FRB)
| | - Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Christine Tempelaere
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Roger J. H. Emery
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Gerber N, Fawcett K, Bittman M, Beiner J. Osteomyelitis in an Unusual Location With an Atypical Presentation: A Case Report and Review of the Literature of Scapular Osteomyelitis in Pediatric Patients. Pediatr Emerg Care 2021; 37:e149-e151. [PMID: 33651767 DOI: 10.1097/pec.0000000000002362] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Bacterial osteomyelitis of the scapula is rare in pediatric patients. When it occurs, it usually affects young infants and patients often exhibit fever and functional limitation of the extremity. We present a case of a 12-year-old boy with subacute bacterial scapular osteomyelitis and a normal physical examination. The patient was briefly treated with intravenous antibiotics and then transitioned to oral antibiotics to complete a 4-week course for methicillin-sensitive Staphylococcus aureus osteomyelitis.
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Affiliation(s)
| | | | - Mark Bittman
- Radiology, NYU School of Medicine, New York City, NY
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Park JH, Jung HW, Jang WY. The usefulness of a three-dimensional printed segmental scapula prosthesis for recovering shoulder function in a patient with scapula chondrosarcoma: A case report. Medicine (Baltimore) 2021; 100:e24817. [PMID: 33663101 PMCID: PMC7909143 DOI: 10.1097/md.0000000000024817] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Localized chondrosarcoma of the scapula has a favorable long-term survival outcome. Therefore, recovery of shoulder function after surgery is important in middle-aged patients. Currently, three-dimensional (3-D) printing implants can be applied for personalized limb salvage surgery. PATIENT CONCERNS A 41-year-old woman with a palpable scapular area presented with shoulder pain for 3 months, which was aggravated during shoulder exercise. DIAGNOSES Chondrosarcoma at left scapular (Malawer S1, Enniking II B, and grade II chondrosarcoma). INTERVENTIONS Wide excision for a localized chondrosarcoma at the infrascapular lesion was performed and the resected muscles around the scapula were repaired with a 3-D printed segmental scapula prosthesis for recovery of shoulder function. OUTCOMES The affected shoulder achieved satisfactory function after operation using the 3-D printed segmental scapula prosthesis at 1 year 6 months after the operation. LESSONS The 3-D printed segmental scapula prosthesis is a useful method for shoulder functional recovery in patients with scapula chondrosarcoma.
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Affiliation(s)
- Jong Hoon Park
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Woo Young Jang
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine
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Al Dandan O, Hassan A, Al Muhaish M, AlMatrouk J, Almuhanna H, Hegazi T. Concomitant bilateral elastofibroma in the infrascapular and gluteal regions: a report of a rare case. BMC Musculoskelet Disord 2020; 21:16. [PMID: 31914985 PMCID: PMC6950919 DOI: 10.1186/s12891-020-3037-7] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elastofibroma is a benign soft tissue tumor characterized by the presence of elastic fibers in a stroma of collagen and mature adipose tissue. It is reported to have a prevalence of 2.73%, as shown by a study through computed tomography (CT) images. However, multiple elastofibromas are uncommon. CASE PRESENTATION We report a case of concomitant bilateral elastofibroma in the infrascapular and gluteal regions. A 63-year-old male patient presented with a 6-month history of gradually increasing painless swellings in the upper back. On physical examination, firm, painless bilateral infrascapular masses were identified; these masses were more noticeable on forward arm flexion. Contrast-enhanced computed tomography showed well-defined bilateral infrascapular masses deep to the serratus anterior muscles as well as poorly defined bilateral gluteal masses with attenuation similar to that of the adjacent skeletal muscle. Magnetic resonance imaging revealed heterogenous masses with internal fatty streaks, consistent with elastofibroma. The histopathological diagnosis of elastofibroma was established based on the results of image-guided core-needle biopsy. The patient underwent surgical excision of both infrascapular elastofibromas with no post-operative complications. As the gluteal masses were incidental, surgical management was not warranted. CONCLUSION The presence of multiple elastofibromas is unusual. This report describes a rare case of multiple elastofibromas and its typical imaging features, and alerts us that elastofibromas are not exclusive to the periscapular region.
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Affiliation(s)
- Omran Al Dandan
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Ali Hassan
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Mona Al Muhaish
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Jumanah AlMatrouk
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Haidar Almuhanna
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Tarek Hegazi
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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Jacxsens M, Elhabian SY, Brady SE, Chalmers PN, Tashjian RZ, Henninger HB. Coracoacromial morphology: a contributor to recurrent traumatic anterior glenohumeral instability? J Shoulder Elbow Surg 2019; 28:1316-1325.e1. [PMID: 30928394 PMCID: PMC6591074 DOI: 10.1016/j.jse.2019.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although scapular morphology contributes to glenohumeral osteoarthritis and rotator cuff disease, its role in traumatic glenohumeral instability remains unknown. We hypothesized that coracoacromial and glenoid morphology would differ between healthy subjects and patients with recurrent traumatic anterior shoulder instability. METHODS Computed tomography scans of 31 cadaveric control scapulae and 54 scapulae of patients with recurrent traumatic anterior shoulder instability and Hill-Sachs lesions were 3-dimensionally reconstructed. Statistical shape modeling identified the modes of variation between the scapulae of both groups. Corresponding measurements quantified these modes in relation to the glenoid center (linear offset measures), defined by the best-fit circle of the inferior glenoid, or the glenoid center plane (angles), which bisects the glenoid longitudinally. Distances were normalized for glenoid size. RESULTS Compared with controls, the unstable coracoids were shorter (P = .004), with a more superior and medial offset of the tip (mean difference [MD], 7 and 3 mm, respectively; P < .001) and an origin closer to the 12-o'clock position (MD, 6°; P < .001). The unstable scapular spines originated closer to the 9-o'clock position (MD, 4°; P = .012), and the unstable acromions were more vertically oriented (MD, 6°; P < .001). The unstable glenoids had an increased height-width index (MD, 0.04; P = .021), had a flatter anterior-posterior radius of curvature (MD, 77 mm; P < .001), and were more anteriorly tilted (MD, 5°; P = .005). CONCLUSIONS Coracoacromial and glenoid anatomy differs between individuals with and without recurrent traumatic anterior shoulder instability. This pathologic anatomy is not addressed by current soft-tissue stabilization procedures and may contribute to instability recurrence.
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Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Shireen Y Elhabian
- Scientific Computing and Imaging Institute, School of Computing, University of Utah, Salt Lake City, UT, USA
| | - Sarah E Brady
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, School of Computing, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.
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Nishida N, Hayashi S, Kakizaki F, Koseki T, Kawata S, Sakabe K, Itoh M. Humeral Head Morphometry Can Predict the Presence of Subacromial Spurs: Measurements of Dried Bones from Human Shoulder Girdles. Tokai J Exp Clin Med 2019; 44:9-14. [PMID: 30963523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/25/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To clarify the relationship between the morphological characteristics of the bones of the shoulder girdle and the presence of subacromial spurs (SS). METHODS The bones of 36 cadaveric shoulder girdles were measured. After dividing the bone specimens into SS present and absent groups, various bone parameters between the two groups were statistically compared. Logistic regression analysis was conducted to assess the significance of each parameter as a predictor of SS formation. A receiver operating characteristic curve analysis was used to determine the cut-off point and to assess the sensitivity and specificity of the parameters showing significant differences. RESULTS SS were found in 16 scapulae. The values for five parameters of the examined shoulder girdles were significantly different between the two groups. The presence of SS depended on the humeral head ratio, which was calculated by dividing the length of the greater tubercle of the humerus by the length of the lesser tubercle. A cut-off value of 1.97 was suitable for discriminating between the presence and absence of SS (sensitivity, 75%; specificity, 80%). CONCLUSION The presence of SS is related to several morphological characteristics of the shoulder girdle and, the presence of SS can be predicted using humeral head morphometry.
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Affiliation(s)
| | - Shogo Hayashi
- Department of Anatomy, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan.
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Abstract
RATIONALE Chondrosarcoma is a malignant mesenchymal tumor originating from cartilage. The pelvis, ribs, femur, and humerus are the most frequently affected sites, and scapula involvement is relatively rare. The aim of the present study was to report a case of chondrosarcoma in the scapula. PATIENT CONCERNS A 42-year-old woman presented with a 3-month history of a painful mass in the right scapula. DIAGNOSES AND INTERVENTION The patient underwent tumor resection. The post-operative pathological diagnosis was scapula chondrosarcoma. OUTCOMES Following resection, the patient continued to receive routine follow-up care. There was no recurrence or tumor metastasis at a follow-up of 5 years. CONCLUSIONS Surgery remains the primary therapy for chondrosarcoma. One of the greatest challenges in the management of chondrosarcoma is to accurately assess tumor grade before surgical intervention. Chemotherapy and radiotherapy have been applied without success. Chemo- and radioresistance have been examined beyond classic phenotypic properties to identify more efficient therapeutic strategies. Therefore, development of future novel therapies is contingent upon elucidating the molecular mechanisms of chondrosarcoma.
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Affiliation(s)
- Shuai Qiang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Xin-Nan Ma
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Hong-Wei Wang
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Song-Cen Lv
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
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Janssens LAA, Verheijen IKA, Serangeli J, van Kolfschoten T. Shoulder osteoarthritis in a European saber-toothed cat (Homotherium latidens) from the Lower Palaeolithic site of Schöningen (Germany). Int J Paleopathol 2019; 24:279-285. [PMID: 30777196 DOI: 10.1016/j.ijpp.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 06/09/2023]
Abstract
Evaluation of a right ventral scapula fragment from a mature Homotherium latidens from Schöningen, Germany (337-300 ka before present - MIS 9) revealed lesions consisting of an osteophyte at the caudal border of the glenoid cavity, and a large, multilobular, cystic feature in the medio-caudal glenoid cavity. Based on the type of lesions, their localization, their severity, and exclusion of several nutritional and other etiologies such as immune mediated disease, joint infection (septic arthritis), and joint tumors, we conclude that the lesion was caused by trauma or age-related shoulder osteoarthritis (or possibly both). We cannot speculate whether the condition was symptomatic, but if it was, the animal must have functioned well enough to hunt or scavenge, since it survived a significant period of lesion development.
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Affiliation(s)
- Luc A A Janssens
- Faculty of Archaeology, Leiden University, Einsteinweg 2, 2333 CC Leiden, The Netherlands; Evidensia Clinic for Referral Surgery of Companion Animals, Eerste Zeine 112, 5144AM, Waalwijk, The Netherlands; Faculty of Archaeology, Ghent University, Sint-Pietersnieuwstraat, 9000 Ghent, Belgium.
| | - Ivo K A Verheijen
- Faculty of Archaeology, Leiden University, Einsteinweg 2, 2333 CC Leiden, The Netherlands; Universität Tübingen/Senckenberg HEP, paläon 1, 38364 Schöningen, Germany
| | - Jordi Serangeli
- Universität Tübingen/Senckenberg HEP, paläon 1, 38364 Schöningen, Germany
| | - Thijs van Kolfschoten
- Faculty of Archaeology, Leiden University, Einsteinweg 2, 2333 CC Leiden, The Netherlands
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Savvidou OD, Zampeli F, Georgopoulos G, Dimopoulos L, Antoniadou T, Papanastassiou I, Papagelopoulos PJ. Total Scapulectomy and Shoulder Reconstruction Using a Scapular Prosthesis and Constrained Reverse Shoulder Arthroplasty. Orthopedics 2018; 41:e888-e893. [PMID: 30371919 DOI: 10.3928/01477447-20181023-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Malignant tumors of the scapula are rare, and limb salvage surgery after tumor resection is challenging. The authors present a series of 6 patients who were treated by total scapulectomy and reconstruction with a custom-made scapular prosthesis and a constrained reverse shoulder arthroplasty. Postoperative oncologic and functional outcomes were assessed. The mean follow-up was 37 months (range, 9-84 months). Clear surgical margins were achieved in all patients. At the last follow-up, 4 patients showed no evidence of disease and 2 had died of systemic metastatic disease. Although shoulder function was limited, all shoulders were painless and stable and the patients retained satisfactory hand, wrist, and elbow function. [Orthopedics. 2018; 41(6):e888-e893.].
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Abstract
RATIONALE Scapular winging is caused by neuromuscular dysfunction of shoulder stabilizer muscles. Clinically, a winged scapula can be easily diagnosed by typical physical findings. We report a case of atypical winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy, which has rarely been reported. PATIENT CONCERNS A 25-year-old right-handed male was admitted to the clinic due to right arm weakness for 1 year. On physical examination, right winged scapula with medially rotated inferior angle was observed on flexion. DIAGNOSES Under the diagnostic impression of a winged scapula due to long thoracic nerve injury based on physical examination, electrodiagnostic study was performed. However, the results showed right dorsal scapular neuropathy combined with suprascapular neuropathy. INTERVENTIONS Neck and right shoulder MRI were also performed to rule out other causes of winged scapula, but these showed only a partial thickness tear of the rotator cuff tendon. The patient received rehabilitation. OUTCOMES The symptoms have not improved. LESSONS In this case, combined suprascapular neuropathy might contribute to scapular winging and can confuse the diagnosis of winged scapula based on physical findings. This is the first report that indicates suprascapular neuropathy as a contributing factor of scapular winging.
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21
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Park I, Park CJ, Lee JH, Hyun HS, Park JY, Shin SJ. Clinical Outcomes and Recurrence Rates After Arthroscopic Stabilization Procedures in Young Patients With a Glenoid Bone Erosion: A Comparative Study Between Glenoid Erosion More and Less Than 20. Arthroscopy 2018; 34:2287-2293. [PMID: 29804952 DOI: 10.1016/j.arthro.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and recurrence rates of arthroscopic stabilization procedures in young patients who had recurrent anterior shoulder instability with a glenoid bone erosion more than 20%, and to compare with those in patients with a glenoid bone erosion less than 20%. METHODS A total of 161 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability with anterior glenoid bone erosions and at least 2 years of follow-up were included. Patients were divided into 2 groups based on the glenoid defect size (group I [32 patients]: erosion >20%, group II [129 patients]: erosion <20%). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Rowe score, and sports/recreation activity level between the 2 groups. Postoperative complications including instability recurrence were documented. RESULTS The mean glenoid defect size was 22.1 ± 2.1% in group I, and 12.2 ± 3.7% in group II. In group I, clinical outcomes were significantly improved after operation (ASES score: 57.9 ± 14.3 at initial, 88.9 ± 6.2 at the last visit, P = .001; Rowe score: 42.1 ± 15.6 at initial, 87.4 ± 7.6 at the last visit, P = .001). These results were inferior to the clinical outcomes of patients in group II (ASES score: 91.5 ± 12.7, P < .001; Rowe score: 89.3 ± 12.4, P = .01). Postoperative recurrences occurred in 5 patients (15.6%) in group I, whereas patients in group II showed 5.4% of recurrence rate (P = .05). Competent recoveries to sports/recreation activity were achieved in 84.4% of patients in group I. CONCLUSIONS Arthroscopic stabilization procedures for recurrent anterior shoulder instability in young patients with glenoid bone erosions more than 20% showed satisfactory clinical outcomes and recurrence rate, although these results were inferior to those of patients with glenoid erosions less than 20%. Arthroscopic stabilization procedures can be applied as the primary treatment of recurrent anterior shoulder instability with a large glenoid bone erosion for functional restoration and return to previous sports activity level. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Chan-Jae Park
- Department of Orthopedic Surgery, Bumin Haeundae Hospital, Busan, Republic of Korea
| | - Jae-Hoo Lee
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Hwan-Sub Hyun
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Park
- Center for Shoulder, Elbow and Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
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Roche CP, Stroud NJ, Palomino P, Flurin PH, Wright TW, Zuckerman JD, DiPaola MJ. The Impact of Anterior Glenoid Defects on Reverse Shoulder Glenoid Fixation in a Composite Scapula Model. Bull Hosp Jt Dis (2013) 2018; 76:116-122. [PMID: 29799371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Achieving glenoid fixation with anterior bone loss can be challenging. Limited guidelines have been established for critical defect sizes that can be treated without supplemental bone graft when performing reverse shoulder arthroplasty. METHODS We quantified the impact of two sizes of anterior glenoid defects on glenoid baseplate fixation in a composite scapula using the ASTM F 2028-14 reverse shoulder glenoid loosening test method. RESULTS All glenoid baseplates remained well-fixed after cyclic loading in composite scapula without a defect and in scapula with an 8.5 mm anterior glenoid defect; however, one of seven baseplates loosened in a scapula with a 12.5 mm defect. No difference was observed between pre- and post-cyclic baseplate displacements in scapula with 8.5 mm or 12.5 mm defects or in the control group scapula. However, baseplate displacement in scapula with 12.5 mm anterior defects was significantly greater after cyclic loading than that of baseplates in 8.5 mm defects (superior-inferior displacement, p = 0.0004; anterior-posterior displacement, p < 0.0001), where baseplate displacement in 8.5 mm (superior- inferior displacement, p = 0.0003; anterior-posterior displacement, p = 0.0014) and 12.5 mm (superior-inferior displacement, p < 0.0001; anterior-posterior displacement, p < 0.0001) defects after cyclic loading was significantly greater than that of baseplates in scapula without a defect. DISCUSSION Adequate and stable fixation can be achieved in scapula with anterior glenoid defects of at least 8.5 mm in this biomechanical model using an established testing methodology; however, supplemental bone grafting should be utilized for anterior glenoid defects of 12.5 mm and larger using the reverse shoulder prosthesis tested in this study.
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Abstract
RATIONALE The scapula is relatively rare site for osteochondroma. Scapula osteochondroma is usually asymptomatic, however it may present with features such as pseudowinging, snapping scapula, bursa formation, chronic pain, and cosmetic deformities. To our best knowledge, this is the first report in the English literature about osteochondroma of ventral scapula associated with chest pain due to rib cage compression. PATIENT CONCERNS A 14-year-old boy was transferred to the orthopedic clinic from thoracic surgery department with a complaint of intermittent, dull, and diffuse aching pain around left chest wall and back from the past 2 months. The patient was previously diagnosed with multiple osteochondromas on another side; proximal tibia and distal femur. DIAGNOSIS A radiopaque mass like lesion was observed on the scapula in the posteroanterior view of the chest, and compression of chest wall was also seen. In chest computed tomography (CT), pedunculated outgrowing bony mass was noted in the anterior aspect of the left scapular wing, which showed the continuity of bony cortex and medulla. This bony mass showed the mass effect on the left chest wall, causing left thoracic cavity deformity by making it narrower than the right INTERVENTIONS:: Surgery was performed under general anesthesia. After the surgery, the arm was immobilized by putting it in an abductor pillow brace for 3 weeks, and during that period pendulum exercise was permitted. OUTCOMES The patient's symptoms resolved in the immediate postoperative period. At 1 year's follow-up, the patient was symptom free and there was no evidence of recurrence of the tumor. LESSONS We recommend that in case of patients who have a history of osteochondroma and complaint of chest pain, surgeons should become suspicious of the presence of osteochondroma of the ventral scapula. In this situation, we recommend chest radiography, pulmonary function test, and chest CT for early detection and treatment.
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Affiliation(s)
- Dong-il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Jae-ho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Sakju-ro, Chuncheon-si, Gangwon-do
| | - In Ho Choi
- Department of Pathology, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Inje University, Jeo-dong, Jung-gu
| | - Jun Yong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
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Barsaoui M, Riahi H, Chelly Bouaziz M, Ladeb MF. Diagnostic features of elastofibroma dorsi: about 4 cases. Tunis Med 2018; 96:64-67. [PMID: 30324995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Elastofibromas are rare benign soft tissue tumors that are commonly located at the inferior pole of the scapula, typically in the right side, deep to the serratus anterior muscle. They occur mainly in elderly women and are usually asymptomatic. We present four cases of elastofibroma dorsi in which the clinical and ultrasound diagnosis was confirmed by CT and magnetic resonance imaging. The location of the lesions (bilateral in two cases) was typical, in the thoraco-scapular region. When the lesion show typical imaging features and produces no symptoms, as is usually the case; further investigations are probably unnecessary.
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Kim KH, Oh HH, Son DJ, Hong JY, Jeong YH, Jung JS, Yu HM, Myung DS, Cho SB, Lee WS, Kim JW, Joo YE. Scapular metastasis of hepatocellular carcinoma presenting as acute bleeding and hematoma: A case report of safe and effective treatment. Medicine (Baltimore) 2017; 96:e8736. [PMID: 29145320 PMCID: PMC5704865 DOI: 10.1097/md.0000000000008736] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The occurrence of bleeding and hematoma from bone metastasis of hepatocellular carcinoma (HCC) is extremely rare. PATIENT CONCERNS We present a case of scapular metastasis of HCC in a 69-year-old man who presented with acute bleeding and hematoma. DIAGNOSES Chest computed tomography showed a large hematoma within the right pectoral muscle of the right upper chest and an exophytic metastatic mass in the right scapula with bony destruction, which caused the intramuscular hematoma. The final diagnosis was scapular metastasis of HCC presenting as acute bleeding and hematoma. INTERVENTIONS Selective right subclavian angiography showed a hypervascular metastatic lesion in the right scapula. Subsequently, embolization of the tumoral feeding artery using a microcoil was performed and tumoral bleeding was stopped. OUTCOMES The patient was discharged on hospital day 14 without any complications. LESSONS Despite being extremely rare, the possibility of bleeding from bone metastasis of HCC needs to be considered. Transcatheter arterial embolization may be an effective means to treat bleeding from bone metastasis of HCC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jin-Woong Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
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Abstract
RATIONALE Malignant granular cell tumor is a kind of rare and highly aggressive malignant tumor that commonly occurs in lower extremity, trunk, and peritoneal cavity. Huge malignant granular cell tumor (MGCT) with suprascapular nerve and brachial plexus invasion was extremely rare. PATIENT CONCERNS We present a special case of a 48-year-old orthopedist who suffered from MGCT. The orthopedist had regarded that he suffered from scapulohumeral periarthritis. DIAGNOSES The disease was noticed until a painless mass on his right neck was discovered 9 months later. MRI result confirmed a large occupying in axillary fossa, supraclavicular and infraclavicular region. INTERVENTIONS During the operation, a tumor measuring 22 × 13 × 6 cm with suprascapular nerve and brachial plexus invasion was identified. The tumor was fractional resected carefully to maintain the integrity of nerves and vessels. Lymph nodes were simultaneously resected. OUTCOMES The motor function and sensation of the upper extremity were same to that of preoperation. The postoperative histological diagnosis was MGCT. At a 12-month follow-up, there was no recurrence of the tumor showed by MRI. LESSONS This study presents a rare case of large MGCT with suprascapular nerve and brachial plexus invasion that was successfully managed by surgery.
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Affiliation(s)
- Xiaotian Jia
- Department of Hand Surgery, Huashan Hospital, Fudan University
- Key Laboratory of Hand Reconstruction, Ministry of Health
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Chao Chen
- Department of Gynecology and Obstetrics, Putuo District Center Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University
- Key Laboratory of Hand Reconstruction, Ministry of Health
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Cong Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University
- Key Laboratory of Hand Reconstruction, Ministry of Health
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery
| | - Tadashi Kondo
- Division of Rare Cancer Research, National Cancer Center Research Institute, Tokyo, Japan
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Schmidt VJ, Wietbrock JO, Leibig N, Hernekamp JF, Henn D, Radu CA, Kneser U. Haemodynamically stimulated and in vivo generated axially vascularized soft-tissue free flaps for closure of complex defects: Evaluation in a small animal model. J Tissue Eng Regen Med 2017; 12:622-632. [PMID: 28509443 DOI: 10.1002/term.2477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/06/2016] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 12/25/2022]
Abstract
The arteriovenous (AV) loop model permits the creation of significant volumes of axially vascularized tissue that represents an alternative to conventional free flaps, circumventing their common limitations. However, such AV loop-based flaps have never before been examined in standardized animal models with respect to their suitability for reconstruction of critical bone-exposing defects. In the course of our preliminary studies, we implemented a novel defect model in rats that provides standardized and critical wound conditions and evaluated whether AV loop-generated flaps are suitable for free microsurgical transfer and closure of composite defects. We compared three groups of rodents with similar scapular defects: one received the AV flap, whereas controls were left to heal by secondary intention or with supplementary acellular matrix alone. To create the flaps, AV loops were placed into subcutaneous Teflon chambers filled with acellular matrix and transferred to the thigh region. Flap maturation was evaluated by histological analysis of angiogenesis and cell migration at days 14 and 28 after loop creation. Flap transfer to the scapular region and microsurgical anastomoses were performed after 14 days. Postoperative defect closure and perfusion were continually compared between groups. Within the AV flap chamber, the mean vessel number, cell count and the proportion of proliferating cells increased significantly over time. The novel defect model revealed that stable wound coverage with homogeneous vascular integration was achieved by AV loop-vascularized soft-tissue free flaps compared with controls. In summary, our study indicates for the first time that complex composite defects in rats can successfully be treated with AV loop-based free flaps.
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Affiliation(s)
- Volker J Schmidt
- Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Johanna O Wietbrock
- Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Nico Leibig
- Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Jochen F Hernekamp
- Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Dominic Henn
- Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Christian A Radu
- Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
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Christman-Skieller C, McIntyre LK, Plevin R, Friedrich JB, Smith DG. A Posterolateral Approach to the Scapula for Evacuation of a Subscapular Abscess: A Case Report. JBJS Case Connect 2017; 7:e57. [PMID: 29252887 DOI: 10.2106/jbjs.cc.16.00241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We present the case of a subscapular abscess that was drained via a posterolateral approach to the scapula. Complete evacuation of the abscess was achieved, and the incisions healed without difficulty. There were no immediate postoperative complications from this approach. CONCLUSION To our knowledge, a posterolateral approach for evacuating a subscapular abscess has not been described previously in the literature. Utilizing the internervous plane between the teres major and latissimus dorsi muscles, along with medial counterincisions, allows for safe drainage of this rare type of abscess.
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Affiliation(s)
- Claudia Christman-Skieller
- Department of Orthopaedics and Sports Medicine (C.C.-S. and D.G.S.), Division of Trauma, Burns, and Surgical Critical Care (L.K.M.), and Division of Plastic Surgery (J.B.F.), Department of Surgery, University of Washington, Seattle, Washington
| | - Lisa K McIntyre
- Department of Orthopaedics and Sports Medicine (C.C.-S. and D.G.S.), Division of Trauma, Burns, and Surgical Critical Care (L.K.M.), and Division of Plastic Surgery (J.B.F.), Department of Surgery, University of Washington, Seattle, Washington
| | - Rebecca Plevin
- Department of Surgery, University of California at San Francisco, San Francisco, California
| | - Jeffrey B Friedrich
- Department of Orthopaedics and Sports Medicine (C.C.-S. and D.G.S.), Division of Trauma, Burns, and Surgical Critical Care (L.K.M.), and Division of Plastic Surgery (J.B.F.), Department of Surgery, University of Washington, Seattle, Washington
| | - Douglas G Smith
- Department of Orthopaedics and Sports Medicine (C.C.-S. and D.G.S.), Division of Trauma, Burns, and Surgical Critical Care (L.K.M.), and Division of Plastic Surgery (J.B.F.), Department of Surgery, University of Washington, Seattle, Washington
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Carroll C, Bass B. Winging of the scapula diagnosed as Parsonage-Turner syndrome: a case report. US Army Med Dep J 2017:99-101. [PMID: 28853127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 24-year-old active duty female Soldier complained of right shoulder burning, stinging, electrical shock-like pain with radiation to the right hand after completing a ruck march. She also complained of swelling and feelings of her cold right hand. Examination showed a deficit in the deltoid, upper trapezius, supraspinatus, and also right winging of the scapula. She also exhibited weakness to right arm, weak right hand grip, and decreased sensation over the dorsal right hand. The right hand was also noticed to be colder to touch than the left one. She had tenderness to palpation over right paracervical muscles from C3 to C7. A previous magnetic resonance arthrogram of the right shoulder revealed no findings. The cervical magnetic resonance imagery showed mild disc protrusion at C5-C6 without spinal cord impingement. Based on the history and the physical findings, the patient was diagnosed with Parsonage-Turner syndrome.
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Echchaoui A, Sadrati Y, Elbir Y, Elktaibi A, Benyachou M, Mazouz SE, Gharib NE, Abbassi A. Proximal-type epithelioid sarcoma: a new case report and literature review. Pan Afr Med J 2016; 24:238. [PMID: 27800093 PMCID: PMC5075453 DOI: 10.11604/pamj.2016.24.238.8535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/02/2016] [Indexed: 12/01/2022] Open
Abstract
Proximal-type epithelioid sarcoma is a rare soft tissue neoplasm which arises from the more proximal part of body and occurs more often in young people; the definite diagnosis depends mainly on the pathological examination; early detection and complete excision remain the foundation of treatment. Due to its aggressive behavior, high capacity of recurrence and the great ability to metastasize, a careful clinical long-term monitoring is required. We report a new case of a 20 years old girl, presented with proximal-type epithelioid sarcoma in her right scapular region, confirmed by pathological examination and removed surgically without recurrence or metastasis at eighteen months of follow-up.
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Affiliation(s)
| | - Yassine Sadrati
- Department of Orthopaedic Surgery & Traumatology, Ibn Sina University Hospital, Rabat, Morocco
| | - Youssef Elbir
- Department of Orthopaedic Surgery & Traumatology, Ibn Sina University Hospital, Rabat, Morocco
| | | | - Malika Benyachou
- Department of Plastic Surgery and Burns, Avicenna University Hospital, Rabat, Morocco
| | - Samir El Mazouz
- Department of Plastic Surgery and Burns, Avicenna University Hospital, Rabat, Morocco
| | - Nour-Eddine Gharib
- Department of Plastic Surgery and Burns, Avicenna University Hospital, Rabat, Morocco
| | - Abdellah Abbassi
- Department of Plastic Surgery and Burns, Avicenna University Hospital, Rabat, Morocco
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Knowles NK, Carroll MJ, Keener JD, Ferreira LM, Athwal GS. A comparison of normal and osteoarthritic humeral head size and morphology. J Shoulder Elbow Surg 2016; 25:502-9. [PMID: 26597658 DOI: 10.1016/j.jse.2015.08.047] [Citation(s) in RCA: 22] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate and to compare the size and morphologic patterns among normal and osteoarthritic (OA) humeral heads. METHODS This comparative anatomic imaging study evaluated 150 humeral heads that were separated into 3 cohorts: normal, OA with symmetric glenoid erosion, and OA with asymmetric (type B2) glenoid erosion. Three-dimensional models were created of the humeral head from computed tomography data, and point coordinates were extracted for evaluation. Parameters measured were diameter (sphere fit and circle fit), chord distance (superoinferior and anteroposterior), and humeral head height. RESULTS The sphere-fit diameter of the humeral head for the entire OA cohort (100 patients; mean diameter, 59 ± 9 mm) was significantly greater (P < .001) than that of the normal cohort (50 patients; mean diameter, 49 ± 5 mm). Similarly, the humeral head circle-fit diameters in the superoinferior and anteroposterior planes were significantly greater (P < .001) in the combined OA cohorts (59 ± 9 mm and 56 ± 10 mm, respectively) compared with the normal cohort (51 ± 5 mm and 47 ± 5 mm, respectively). However, there were no significant differences (P ≥ .099) between the symmetric and asymmetric OA cohorts in sphere-fit or circle-fit diameters. The mean values of humeral head heights were not significantly different (P = .382) between cohorts, 19 ± 2 mm, 18 ± 2 mm, and 18 ± 2 mm for the normal, symmetric, and asymmetric cohorts, respectively. DISCUSSION Although OA humeral head morphology varies significantly from normal, it does not vary as a function of the Walch classification between symmetric and asymmetric glenoids. Understanding of the morphologic variability of the pathologic humeral head may provide insight into the pathoanatomy of osteoarthritis and the development of various erosion patterns.
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Affiliation(s)
- Nikolas K Knowles
- University of Western Ontario, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | | | - Jay D Keener
- Washington University/Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Louis M Ferreira
- University of Western Ontario, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada.
| | - George S Athwal
- University of Western Ontario, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada
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Walia P, Patel RM, Gottschalk L, Kuklis M, Jones MH, Fening SD, Miniaci A. The Reduction in Stability From Combined Humeral Head and Glenoid Bony Defects Is Influenced by Arm Position. Am J Sports Med 2016; 44:715-22. [PMID: 26792704 DOI: 10.1177/0363546515620588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 01/31/2023]
Abstract
BACKGROUND Combined defects of the glenoid and humeral head are often a cause for recurrent shoulder instability. PURPOSE/HYPOTHESIS The aim of this study was to evaluate the influence of combined bony lesions on shoulder instability through varying glenohumeral positions. The hypothesis was that instability due to combined defects would be magnified with increasing abduction and external rotation. STUDY DESIGN Controlled laboratory study. METHODS Eighteen cadaveric shoulders were tested. Experiments were performed at combinations of glenohumeral abduction angles of 20°, 40°, and 60° and external rotations of 0°, 40°, and 80°. The various glenoid defect sizes created were 10%, 20%, and 30% of the glenoid width. Four humeral head defects were created based on humeral head diameter (6%, 19%, 31%, and 44%). Each experiment consisted of translating the glenoid in a posterior direction to simulate an anterior dislocation under a 50-N load. The instability was measured as a percentage of intact translation (ie, loss in translational distance normalized to the no-defect condition). RESULTS At 20° of abduction, instability increased from 100% to 85%, 70%, and 43% with increasing glenoid defect sizes of 10%, 20% and 30%, respectively, with a 6% humeral head defect. However, at a functional arm position of apprehension, these values were significantly decreased (P < .05) for humeral head defect sizes of 19%, 31%, and 44%, with translation values of 49%, 27%, and 2%, respectively. CONCLUSION A humeral defect leads to rotational instability with the arm rotated into a functional position rather than a resting position. However, a significant glenoid defect can lead to loss of translation independent of changes in arm position. Combined defects as large as 44% of humeral head and 20% glenoid did not show instability at 20° of abduction and neutral position; however, defects as small as 19% humeral defect and 10% glenoid defect led to significant instability in the position of apprehension. CLINICAL RELEVANCE Instability at lower levels of abduction and external rotation clinically indicates larger bony defects and may need to be directly addressed, depending on the patient's age and function.
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Affiliation(s)
- Piyush Walia
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, Ohio, USA Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ronak M Patel
- Sports Performance Institute, Hinsdale Orthopaedic Associates, Westmont, Illinois, USA
| | - Lionel Gottschalk
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Kuklis
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen D Fening
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anthony Miniaci
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Dare D, Dines JS, Tebo C, Edwards TB, Craig EV, Dines DM. Scapular Notching. Instr Course Lect 2016; 65:145-156. [PMID: 27049187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Developed in 1985, the Grammont-style reverse total shoulder arthroplasty offered a biomechanical advantage for the deltoid muscle as well as predictably reduced pain and improved shoulder function in rotator cuff-deficient shoulders. Despite favorable outcomes, reverse total shoulder arthroplasty is associated with a unique set of complications, one of which is scapular notching. Scapular notching is believed to be a result of mechanical impingement of the humeral component on the lateral scapular pillar. Although it appears that scapular notching progresses with time, its effect on implant survivorship and clinical outcomes is unknown. Factors associated with scapular notching are categorized into several groups, including patient-specific risk factors, surgical approach and technique, and prosthetic design. Surgical strategies to reduce the rate of scapular notching include inferior positioning of the glenosphere, inferior tilting of the glenosphere, and increasing the size of the glenosphere. A lateralized center of rotation and a decreased humeral shaft-neck angle also decrease the incidence of scapular notching. As the indications for reverse total shoulder arthroplasty expand, it is important for orthopaedic surgeons to understand the etiology and incidence, predictive factors, and clinical relevance of scapular notching as well as strategies to avoid it.
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Affiliation(s)
- David Dare
- Orthopaedic Surgery Resident, Department of Academic Training, Hospital for Special Surgery, New York, New York
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Oleinikov BV, Knyazhishche AN, Oleinikov DB. [Myofascial meridional reflexotherapy of scapulohumeral periarthrosis in the course of the combined spa and health resort-based treatment]. Vopr Kurortol Fizioter Lech Fiz Kult 2015; 92:45-47. [PMID: 26841529 DOI: 10.17116/kurort2015645-47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors draw attention to the role of a whiplash injury in the pathogenesis of scapulohumeral periarthrosis (SHP). Peculiarities of the specific pathological biomechanical changes associated with this condition are described. The study included a group of 64 patients in whom the localization of the myofascial trigger points (MFTT) of the shortened muscles is described with reference to the differential techniques for soft-tissue manual therapy. Spatial emphasis is laid on the diagnostic dynamic ischemic compression of trigger points (TT) for their inactivation using the method proposed by J. Travel in the original modifications proposed by the authors of the present article. The results of the application of myofascial meridional reflexotherapy of scapulohumeral periarthrosis are presented and analysed in the context of the combined spa and health resort-based treatment.
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Affiliation(s)
- B V Oleinikov
- Federal state government facility 'Sochinsky Spa and Health Resort Complex', Russian Ministry of Defense, Sochi, Russian Federation, 354054
| | - A N Knyazhishche
- Federal state government facility 'Sochinsky Spa and Health Resort Complex', Russian Ministry of Defense, Sochi, Russian Federation, 354054
| | - D B Oleinikov
- Federal state government facility 'Sochinsky Spa and Health Resort Complex', Russian Ministry of Defense, Sochi, Russian Federation, 354054
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Ibrahim EF, Forrest NP, Forester A. Bilateral weighted radiographs are required for accurate classification of acromioclavicular separation: an observational study of 59 cases. Injury 2015; 46:1900-5. [PMID: 26194267 DOI: 10.1016/j.injury.2015.06.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 01/10/2015] [Revised: 06/06/2015] [Accepted: 06/10/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Misinterpretation of the Rockwood classification system for acromioclavicular joint (ACJ) separations has resulted in a trend towards using unilateral radiographs for grading. Further, the use of weighted views to 'unmask' a grade III injury has fallen out of favour. Recent evidence suggests that many radiographic grade III injuries represent only a partial injury to the stabilising ligaments. This study aimed to determine (1) whether accurate classification is possible on unilateral radiographs and (2) the efficacy of weighted bilateral radiographs in unmasking higher-grade injuries. METHODS Complete bilateral non-weighted and weighted sets of radiographs for patients presenting with an acromioclavicular separation over a 10-year period were analysed retrospectively, and they were graded I-VI according to Rockwood's criteria. Comparison was made between grading based on (1) a single antero-posterior (AP) view of the injured side, (2) bilateral non-weighted views and (3) bilateral weighted views. Radiographic measurements for cases that changed grade after weighted views were statistically compared to see if this could have been predicted beforehand. RESULTS Fifty-nine sets of radiographs on 59 patients (48 male, mean age of 33 years) were included. Compared with unilateral radiographs, non-weighted bilateral comparison films resulted in a grade change for 44 patients (74.5%). Twenty-eight of 56 patients initially graded as I, II or III were upgraded to grade V and two of three initial grade V patients were downgraded to grade III. The addition of a weighted view further upgraded 10 patients to grade V. No grade II injury was changed to grade III and no injury of any severity was downgraded by a weighted view. Grade III injuries upgraded on weighted views had a significantly greater baseline median percentage coracoclavicular distance increase than those that were not upgraded (80.7% vs. 55.4%, p=0.015). However, no cut-off point for this value could be identified to predict an upgrade. CONCLUSIONS The accurate classification of ACJ separation requires weighted bilateral comparative views. Attempts to predict grade on a single AP radiograph result in a gross underestimation of severity. The value of bilateral weighted views is to 'unmask' a grade V injury, and it is recommended as a first-line investigation.
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Affiliation(s)
- E F Ibrahim
- Department of Trauma and Orthopaedics, Charing Cross Hospital, London, UK.
| | - N P Forrest
- Department of Trauma and Orthopaedics, Charing Cross Hospital, London, UK
| | - A Forester
- Department of Trauma and Orthopaedics, Charing Cross Hospital, London, UK
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Lädermann A, Gueorguiev B, Charbonnier C, Stimec BV, Fasel JHD, Zderic I, Hagen J, Walch G. Scapular Notching on Kinematic Simulated Range of Motion After Reverse Shoulder Arthroplasty Is Not the Result of Impingement in Adduction. Medicine (Baltimore) 2015; 94:e1615. [PMID: 26402829 PMCID: PMC4635769 DOI: 10.1097/md.0000000000001615] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Impingement after reverse shoulder arthroplasty (RSA) is believed to occur from repetitive contact in adduction between the humeral component and the inferior scapular pillar. The primary purpose of this biomechanical study was to confirm the presence of different types of impingement and to examine which daily-life movements are responsible for them. A secondary aim was to provide recommendations on the type of components that would best minimize notching and loss of range of motion (ROM). The study included 12 fresh frozen shoulder specimens; each had a computed tomography (CT) image of the entire scapula and humerus in order to acquire topological information of the bones before RSA implantation. Cyclic tests were run postimplantation with 3 shoulders in each modalities. To quantify bone loss due to impingement, 3-dimensional anatomical models of the scapula were reconstructed from the CT scans and compared to their intact states. We found 8 bony impingements in 7 specimens: 2 at the lateral acromion, 1 at the inferior acromion, 4 scapular notching, and 1 with the glenoid resulting to wear at the 3:00 to 6:00 clock-face position. Impingements occurred in all kinds of tested motions, except for the internal/external rotation at 90° of abduction. The 3 specimens tested in abduction/adduction presented bone loss on the acromion side only. Scapular notching was noted in flexion/extension and in internal/external rotation at 0° of abduction. The humeral polyethylene liner was worn in 2 specimens--1 at the 6:00 to 8:00 clock-face position during internal/external rotation at 0° of abduction and 1 at the 4:00 clock-face position during flexion/extension. The present study revealed that 2 types of impingement interactions coexist and correspond to a frank abutment or lead to a scapular notching (friction-type impingement). Scapular notching seems to be caused by more movements or combination of movements than previously considered, and in particular by movements of flexion/extension and internal/external rotation with the arm at the side. Polyethylene cups with a notch between 3 and 9 o'clock and lower neck-shaft angle (145° or 135°) may play an important role in postoperative ROM limiting scapular notching.
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Affiliation(s)
- Alexandre Lädermann
- From the Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin (AL); Faculty of Medicine, University of Geneva (AL); Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva (AL); AO Research Institute Davos, Davos (BG, IZ, JH); Artanim Foundation, Medical Research Department (CC); Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland (BVS, JHF); and Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital GDS, Lyon, France (GW)
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Edelstein AI, Linn RL, Fritsch MK, Sagan M. Osteochondroma With Contiguous Bronchogenic Cyst of the Scapula. Am J Orthop (Belle Mead NJ) 2015; 44:E355-E357. [PMID: 26372765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Osteochondroma is a benign bone tumor composed of a bony protrusion with an overlying cartilage cap. Osteochondromas arise in the scapula in 3% to 5% of cases, making them the most common benign bone tumor in this location. Scapular osteochondromas cause various pathologies of the shoulder girdle, including snapping scapula syndrome, chest wall deformity, shoulder impingement, and bursa formation. Bronchogenic cyst is an exceedingly rare finding in the periscapular area. It is a congenital cystic mass lined by tracheobronchial structures and respiratory epithelium. To our knowledge, there are no reports of a contiguous osteochondroma and bronchogenic cyst. A 12-month-old boy presented with an incidentally noted mass on the spine of the scapula, which drained scant, clear fluid through an adjacent pinprick-sized hole. Imaging revealed an exostosis with an adjacent cystic mass. The mass and cyst were excised en bloc, and histopathologic examination confirmed the diagnosis of osteochondroma with contiguous bronchogenic cyst. In this case, we present the report of a novel dual lesion.
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Affiliation(s)
- Adam I Edelstein
- Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL.
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Inarejos Clemente EJ, Vilanova JC, Riaza Martin L, Guirao-Marín S. A primary inflammatory myofibroblastic tumor of the scapula in a child: imaging findings. Skeletal Radiol 2015; 44:733-7. [PMID: 25307049 DOI: 10.1007/s00256-014-2023-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/18/2014] [Accepted: 09/28/2014] [Indexed: 02/02/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor characterized by inflammatory cell infiltration and differentiated myofibroblastic spindle cells. IMT was first described in the lung and retroperitoneum. Occurrence in bone has been well described in the maxilla and occasionally in the long bones in the adult population. We present a unique case of IMT arising primarily from the scapula in an 8-year-old patient, not described previously in the pediatric or adult literature. Imaging demonstrated an ill-defined and aggressive osteolytic lesion with cortical bone destruction associated with an important soft tissue component that extended into the adjacent muscles. Histologically, the tumor was composed of spindle and polygonal cells distributed in an inflammatory background with different proportions of plasma cells, lymphocytes, eosinophils and neutrophils. The absence of cellular atypia helped to differentiate this entity from malignant spindle cell tumors, and imaging could differentiate the tumor from the nontumoral inflammatory reaction.
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Altan E, Ozbaydar MU, Tonbul M, Yalcin L. Comparison of two different measurement methods to determine glenoid bone defects: area or width? J Shoulder Elbow Surg 2014; 23:1215-22. [PMID: 24581417 DOI: 10.1016/j.jse.2013.11.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 09/20/2013] [Revised: 11/15/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compared two different techniques that have been used to measure the glenoids of patients with recurrent anterior shoulder dislocation. METHODS We analyzed 36 patients who had received arthroscopic Bankart repair for anterior shoulder instability. Retrospectively, 3-dimensional computed tomography images of both shoulders were available for these patients. Two measurement methods were compared to determine the glenoid defects. One of these techniques is based on linear measurement, previously defined as the glenoid index. The other method is based on surface area measurement. Subsequently, 3 more diameters and the average values obtained from these diameters were compared with the surface measurement method. Pearson correlation coefficient (r) was assessed to determine the relationship. RESULTS There was an almost perfect relationship between measurement methods when the defect area was less than 6% of the inferior glenoid circle (r, 0.915; P < .001). This relation decreased and the difference became more pronounced (r, 0.343; P = .657) when the bone loss exceeded 14% of the inferior glenoid circle. The highest correlations with the actual defects were the average values obtained from 4 different diameters (r, 0.964; P < .001) and the 4-o'clock position of the single diameter measurements (r, 0.860; P = .001). In addition, 11 patients had crescent-like defects, demonstrating a relatively low correlation between the measurement methods (r, 0.679; P = .021). CONCLUSION Although the best correlation was achieved from average values obtained from different diameter positions, in practical use, we advise a linear measurement to estimate the glenoid bone loss at the 4-o'clock position to achieve a high correlation between the measurement techniques.
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Affiliation(s)
- Egemen Altan
- Orthopaedics and Traumatology Department, Selcuk University Medical Faculty, Konya, Turkey.
| | | | - Murat Tonbul
- Orthopaedics and Traumatology Department, Namik Kemal University, Tekirdag, Turkey
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Chang F, Liu GY, Zhang Q, Lin G, Huang H, Duan DS, Wang JC. Malawer limb salvage surgery for the treatment of scapular chondrosarcoma. World J Surg Oncol 2014; 12:196. [PMID: 24976133 PMCID: PMC4090394 DOI: 10.1186/1477-7819-12-196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
Chondrosarcoma is a common malignant bone tumor, which accounts for 20% of all malignant bone tumors. It often occurs in the long bones, but the incidence of scapular chondrosarcoma is rare. Here, we describe a case of a large chondrosarcoma occurring in the scapula which was treated with Malawer limb salvage surgery. The patient retained considerable limb function after complete removal of the tumor tissue as assessed at the follow-up visit two years and ten months following surgery.
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Affiliation(s)
- Fei Chang
- Department of Orthopedic Surgery, the second hospital of Jilin University, Changchun, China
- Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guang-Yao Liu
- Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qiao Zhang
- Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Gang Lin
- Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hong Huang
- Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - De-Sheng Duan
- Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jin-Cheng Wang
- Department of Orthopedic Surgery, the second hospital of Jilin University, Changchun, China
- Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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Zhao Y, Fang W, Yan A, Wang G, Liu CY. [Discussion on relationship between soft tissue tension and cervical physiological curvature change of patients with scapular muscle fasciitis]. Zhongguo Gu Shang 2014; 27:376-378. [PMID: 25167665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To discuss the relative association of soft tissue tension and cervical physiological curvature chang in patients with scapula muscle fasciitis. METHODS From February 2012 to December 2012,29 patients with scapula muscle fasciitis were investigated. There were 10 males and 19 females with an average age of 27.77 years old (ranged from 22 to 40 years old). Routine AP and lateral cervical X-rays were done in all patients. Cervical lordosis was measured according to Borden's method and the pain point tension was measured by soft tissue tension meter. Finally,perform statistic analysis to bove data. RESULTS Lateral X-rays showed 9 cases were normal cervical lordosis, 18 cases were cervical lordosis decreased, 2 cases were cervical lordosis increased. The regression equation of cerical lordosis changes D(Y) and soft tissue tension displacement D0.5 kg (X) was Y = -15.069 + 3.673X. CONCLUSION There is linear relationship between soft tissue tension and cervical physiological curvature change. With the soft tissue tension increases, the cervical lordosis trend to decrease.
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Daghfous A, Bouzaidi K, Affes M, Ben Rhouma N, Rezgui Marhoul L. Dorsal elastofibroma: usefulness of MRI imaging. Tunis Med 2014; 92:354-355. [PMID: 25504394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Rahman N, Siddiqui YS. Winging of the scapula. Saudi Med J 2014; 35:409-410. [PMID: 24749141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Nusra Rahman
- Department of Anatomy, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Tambasco D, Seccia A, Cimino A, Seccia A. Elastofibroma: management and surgical outcome. Ann Ital Chir 2014; 85:S2239253X14021434. [PMID: 25689890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Elastofibroma is a benign slow-growing neoplasm of soft tissues, originally defined Elastofibroma dorsi because of the typical localization in the connective tissue placed between the bottom corner of the scapula and the chest wall. From 1990 to 2013 at our center, 115 patients underwent elestofibroma surgical removal, including 2 bilateral and one relapsed. For all the patients ultrasound preoperative examination was requested, sometimes with a diagnosis of lipoma or fibrolipoma because of the rarity of this type of lesion and therefore the lack of experience of the radiologists. In all 115 patients the lesion was detected and removed, only in 7 cases it was necessary, intraoperatively, to mobilize the upper limb and shoulder in order to better visualize the lesion. On the operating table the lesion was situated below the muscle planes and looks like a solid mass, oval, with a pole firmly attached to the periosteum of the ribs and intercostal ligaments, with net margins and a diameter of 5-10 cm. The sides not attached to the chest wall were in continuity with the adipose tissue. The cutting surface was pink-graysh, with fibrous appearance. Foci of cystic degeneration interspersed with islands of fat that are vaguely reminiscent of the fibrolipoma could be found. The treatment of choice is the surgical excision and subsequent histological examination solve the diagnostic dilemma. If the removal is radical, it is definitve because the lesion has no tendency to relapse.
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Zhang C, Wang S, Ren G, Tuo Z, Yu J, Wang J, An L, Ma J, Zhao L. [Primary study on tissue engineered periosteum osteogenesis to repair scapula defect in vivo in allogenic rabbit]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:384-388. [PMID: 24844025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the feasibility of tissue engineered periosteum (TEP) constructed by porcine small intestinal submucosa (SIS) and bone marrow mesenchymal stem cells (BMSCs) of rabbit to repair the large irregular bone defects in allogenic rabbits. METHODS The BMSCs were cultivated from the bone marrow of New Zealand white rabbits (aged, 2 weeks-1 month). SIS was fabricated by porcine proximal jejunum. The TEP constructed by SIS scaffold and BMSCs was prepared in vitro. Eighteen 6-month-old New Zealand white rabbits whose scapula was incompletely resected to establish one side large irregular bone defects (3 cm x 3 cm) model. The bone defects were repaired with TEP (experimental group, n = 9) and SIS (control group, n = 9), respectively. At 8 weeks after operation, the rabbits were sacrificed, and the implants were harvested. The general condition of the rabbits was observed; X-ray radiography and score according to Lane-Sandhu criteria, and histological examination (HE staining and Masson staining) were performed. RESULTS After operation, all animals had normal behavior and diet; the incision healed normally. The X-ray results showed new bone formation with normal bone density in the defect area of experimental group; but no bone formation was observed in control group. The X-ray score was 6.67 +/- 0.32 in experimental group and was 0.32 +/- 0.04 in control group, showing significant difference (t = 19.871, P = 0.001). The general observation of the specimens showed bone healing at both ends of the defect, and the defect was filled by new bone in experimental group; no new bone formed in the control group. The histological staining showed new bone tissue where there were a lot of new vessels and medullary cavity, and no macrophages or lymphocytes infiltration was observed in the defect area of experimental group; only some connective tissue was found in the control group. CONCLUSION TEP constructed by porcine SIS and BMSCs of rabbit can form new bone in allogenic rabbit and has the feasibility to repair the large irregular bone defects.
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Shadymov AB, Shepelev OA. [On the possibility to reconstruct the initial position of the body of a victim from the configuration of wound canals in the scapular region]. Sud Med Ekspert 2014; 57:57-60. [PMID: 25269174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of the present study was to estimate the influence of the position of an upper extremity on the formation of wound canals resulting from the injury to the scapular region and the chest. The secondary objective was to substantiate the possibility of the detection of the position of the upper extremity at the time of wound infliction. A few series of experiments were carried out with the differently positioned upper extremities. They allowed to determine: 1) the degree of tissue displacement in the scapular and thoracic regions, 2) disjunctive (discontinuous) dislocation of the wound canal, and 3) the possibility to detect the relative position of the upper extremity at the time of wound infliction in the scapular region.
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Herget GW, Otto C, Kurz P, Uhl M, Adler CP, Südkamp NP, Hauschild O. Epithelioid osteosarcoma of the scapula. Acta Chir Orthop Traumatol Cech 2014; 81:288-291. [PMID: 25137500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Epithelioid and epithelial neoplasms of bone are rare. They include different epithelioid variants of vascular lesions, osteoblastoma, chondroblastoma and most importantly metastatic carcinoma. Up to now, only few cases of epithelioid osteosarcoma were described. In this case the authors report a 53-year-old patient presented with a medical history of chronic shoulder pain for 3 years. Magnetic resonance imaging (MRI and computed tomography (CT) showed a destructive, partially calcified osseous lesion of the scapula with expansion into the surrounding soft tissue, suggestive of a primary bone tumor. Histologically, the tumor consisted of epithelioid cells with expression of cytokeratine and the lesion was primarily diagnosed as metastatic carcinoma. With regard to the MRI morphology untypical for metastatic disease the histopathologic slides were re-evaluated and detection of tumor osteoid led to the diagnosis of epithelioid osteosarcoma. Chemotherapy was initiated, however follow-up imaging studies showed rapidly progressive disease of both primary tumor and lung metastases. In conclusion, epithelioid neoplasms of the bone are extremetumourly rare and must be distinguished from metastatic carcinoma. Despite the presence of cytokeratine positive cells a thorough histological evaluation is mandatory and osteoid detection is essential in order to establish the correct diagnosis and further treatment. Key words: osteosarcoma, epithelioid, aneurysmal bone cyst, chondrosarcoma, pathology, immunohistochemistry.
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Affiliation(s)
- G W Herget
- Clinic of Orthopaedics and Traumatology, University Medical Centre Freiburg, Freiburg, Germany
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Peña-Irún Á, González-Santamaría AR. [Winged scapula caused by a long thoracic nerve lesion]. Rev Clin Esp 2013; 214:e25. [PMID: 24209982 DOI: 10.1016/j.rce.2013.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Á Peña-Irún
- Centro de Salud El Sardinero, Santander, Cantabria, España.
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Kano WT, Rahal SC, Mesquita LDR, Agostinho FS, de Faria LG. Gait analysis in a cat with scapular luxation and contralateral forelimb amputation. Can Vet J 2013; 54:990-991. [PMID: 24155423 PMCID: PMC3781435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This report describes the use of a pressure-sensitive walkway to evaluate an uncommon case of a cat with dorsal luxation of the left scapula and an amputated right forelimb. The findings suggest that limb amputation induced load redistribution mostly to the contralateral forelimb despite the scapular luxation.
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Affiliation(s)
| | - Sheila C Rahal
- Address all correspondence to Dr. Sheila C. Rahal; e-mail:
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Erdoğan Ç, Alkan H, Kilinçer A, Değirmenci E, Oğuzhanoğlu A. Winging scapula due to demyelinating polyneuropathy. Acta Neurol Belg 2013; 113:347-9. [PMID: 23055111 DOI: 10.1007/s13760-012-0136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 09/12/2012] [Indexed: 11/28/2022]
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