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PubMed1995

[Distribution of hematopoietic and fatty bone marrow in the proximal humerus and scapula: magnetic resonance tomography and macroscopic anatomy].

PURPOSE: To establish the distribution pattern of haematopoietic and fatty bone marrow on MRI of the proximal humerus and the scapula in correlation with age, gender and nutritive factors. MATERIAL AND METHODS: 32 shoulder MR examinations (T1-weighted spin-echo and opposed-phase gradient-echo sequences) from 24 patients and 8 volunteers were analysed retrospectively. The amount of haematopoietic bone marrow within the proximal humerus and scapula was classified into four groups and was correlated with age (H-test), gender (chi 2-Test), and thickness of subcutaneous fat (H-test). The marrow distribution within 10 scapulae of cadavers over 60 years of age at death was studied. RESULTS: With increasing age, the amount of haematopoietic bone marrow in the proximal humeral metaphysis tends to decrease from lateral towards medial (H-test, p = 0.3). Diaphysis and epiphysis did not show haematopoietic marrow. The amount of haematopoietic bone marrow within the paraglenoid region of the scapula also revealed a decrease with increasing age (H-test, p = 0.003). Females had higher amounts of haematopoietic marrow than males (chi 2-test, p = 0.03). The thickness of subcutaneous fat was independent of the marrow distribution. CONCLUSION: The amount of haematopoietic bone-marrow of the shoulder girdle decreases with increasing age. The knowledge of marrow distribution patterns based upon these changes is important for shoulder MRI interpretation to prevent confusion with infiltrative disease.

Age Factors↗
PubMedDate not supplied

[Results of shoulder hemiarthroplasty in patients with acute and old fractures of the proximal humerus].

STUDY-DESIGN: We report on a prospective study of 22 patients after shoulder hemiarthroplasty in acute and old proximal humerus fractures. METHOD: Nine patients with an acute and 13 with an old humerus fracture, in whom a hemiarthroplasty was performed have been evaluated clinically using the Constant score as well as radiologically on average 22 months postoperatively. RESULTS: The mean Constant score improved on 28 points (27 to 55). The improvement was especially distinct in the group with acute fractures. Sixteen of the twenty examined patients were painfree. Two patients reported sleeping disturbances due to pain. The ROM was improved, especially in forward elevation and abduction. In two patients with an old fracture the results were less satisfying. Major complications could not be observed. In five cases X-ray revealed an atrophy of the fixated fragments. Dislocations did not occur. Radiological changes of the glenoid, already seen preoperatively became more obvious. Some humeral components, inserted without cement, showed "densification lines". There were no clinical signs of loosening. CONCLUSION: By performing hemiarthroplasty pain relief can be achieved, especially in old fractures. The postoperatively achieved joint function mainly depends on the type of fracture as well as ist age. In cases with a destroyed glenoid we now prefer to perform a total arthroplasty. In our opinion, general cement use for shaft fixation is not necessary.

Adult↗
PubMedDate not supplied

[Humerus lengthening in a unilateral technique: case report].

Surgical lengthening of the humerus is indicated for cosmetic and functional reasons. The discrepancy should exceed 4 cm. Complications (review of literature) and our own experience regarding lengthening of extremities indicate that surgical lengthening of the humerus is technically feasible and reasonably safe. It appears to have fewer risks and complications than surgical lengthening of the femur or the tibia; even though radial nerve paralysis is an important complication.

Bone Lengthening↗
PubMedDate not supplied

[Biomechanical principles in diarthroses and synarthroses. II: The humerus articulation as a ball-and-socket joint].

The shoulder joint does not represent a simple ball-and-socket joint with three degrees of freedom unlike widely believed. Series of X-ray pictures show that in abduction the momentary rotational axis does not meet the center of the humerus. Morphological measurements yield the result that the radius of curvature of the cavitas is slightly greater (2 mm) than the humeral one. This physiological incongruity of the articulating surfaces is functionally necessary. Thus, the shoulder joint represents a force-locked dimeric ball-and-socket joint. In abduction e.g. the humerus simultaneously rotates around the humeral center and around the cavitas center in opposite direction. The resultant momentary rotational axis is therefore shifted towards the scapula as in vivo measurements confirm. Fundamental kinematical and statical properties of the joint are derived which explain substantial experimental finding in literature.

Biomechanical Phenomena↗
PubMed1980

[Solitary bone cysts with expansion throughout the complete humerus (author's transl)].

The paper contains two case reports of solitary bone cysts of the humerus, which expanded throughout the complete bone from the upper end to the lower. This unusual size was seen in a 12 year old boy after subtotal resection of an active cyst at the age of 6 years, with recurrence of the cyst. In the other case an 18 year old female patient felt pain in her left arm after sports. The X-ray picture showed a cystic transformation of the complete humerus. The histodiagnosis of the disease was made by multiple, repeated biopsy. Other cystic bone lesions, which are important concerning differential diagnosis, were excluded by detailed examination. No further pathological findings were made in both cases.

Adolescent↗
PubMed2001

Ratio of nuchal thickness to humerus length for Down syndrome detection.

OBJECTIVE: Ultrasonographic biometry markers are now being used clinically to adjust Down syndrome risk. The limitations are that the definitions of "abnormal" measurements used are arbitrary, thus reducing screening performance, and also that patient-specific Down syndrome risks cannot be calculated. We report a new ultrasonographic algorithm that is sensitive for Down syndrome detection and that estimates individual risk. STUDY DESIGN: Overall in fetal populations with Down syndrome the humerus length is decreased, whereas the nuchal thickness is increased relative to that of a normal population. The nuchal thickness/humerus length ratio therefore shows an even greater increase and magnifies the separation between Down syndrome and healthy groups. Prospective data were collected in midtrimester amniocentesis cases. A regression equation for the median nuchal thickness/humerus length ratio based on biparietal partial diameter was generated. The Down syndrome likelihood ratio, or the odds on the basis of the nuchal thickness/humerus length ratio (multiples of the median), was multiplied by the age-related risk to give the posterior Down syndrome risk. Charts for rapid estimation of individual Down syndrome risk on the basis of maternal age and the nuchal thickness/humerus length ratio were constructed. RESULTS: There were 94 cases of Down syndrome and 4700 cases in which the karyotype was normal. The mean (+/-SD) gestational age of the study population was 16.1 +/- 1.6 weeks. Thirty-three fetuses with Down syndrome and 68 karyotypically normal fetuses had gross anomalies. The equation for the expected median nuchal thickness/humerus length ratio was as follows: 10e(1.7163 - 0.0292) x BPD + 0.0003 x BPD2, where BPD is the biparietal diameter. In the overall study population the nuchal thickness/humerus length ratio and maternal age had a 79.8% detection rate at a 22.1% false-positive rate, compared with maternal age plus humerus length (sensitivity, 55.1%) or maternal age plus nuchal thickness (sensitivity, 66.7%) at the same false-positive rate. For women > or =35 years old the values were 80% and 22.0%, respectively. CONCLUSIONS: We report an ultrasonographic biometry algorithm that, in combination with maternal age, detects 79.6% of Down syndrome cases in a high-risk group. Individual Down syndrome risk can be quickly calculated at the bedside and made available to women who desire this information before making a decision on amniocentesis. On the basis of published standards, ultrasonographic biometry as described would be a cost-effective alternative to amniocentesis in this high-risk group.

Algorithms↗
PubMed1996

Posterior approaches to the humerus: when should you worry about the radial nerve?

We used the olecranon osteotomy approach to the humerus on 75 cadaver arms and measured where the radial nerve pierced the intermuscular septum to determine the risk to that nerve during elevation of the triceps. We found the nerve an average of 10.0 cm from the distal articular surface in men and 9.4 cm in women; however, some cadavers had nerves as close as 7.5 cm. The humerus was also approached via a triceps split and the nerve located at the spiral groove. The distance from the articular surface to the nerve averaged 15.8 cm in men and 15.2 cm in women, with the minimum distance being 13 cm in one woman. When dissection beyond 7.5 cm laterally or 13.0 cm posteriorly is required, care should be taken to isolate and protect the radial nerve.

Body Height↗
PubMed1998

Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation.

A case of a posttraumatic humeral shaft nonunion, after intramedullary stabilization with a Seidel nail, is presented. Severe osteoporosis, an oligotrophic nonunion, subclinical infection, and adhesive capsulitis of the glenohumeral joint were present. Due to the subclinical infection and severe osteoporosis, other major invasive therapeutic options such as intramedullary nailing or compression plating and bone grafting were not applicable. Nonoperative treatment was also not indicated secondary to the pain and disability present. External fixation with the Ilizarov hybrid fixator seemed to offer a minimally invasive treatment modality without the need of additional bone grafting. After fourteen weeks of "callus massage," consisting of closed alternating compression and distraction with an Ilizarov hybrid fixator, osseous consolidation was achieved. Eight months after Ilizarov treatment the patient had returned to work as a mechanic. At the one-year follow-up examination, the patient presented pain free and with near normal shoulder and elbow motion, with stable osseous consolidation of the humerus. In some cases of nonunion of the humerus shaft, when standard treatment options are not recommended, external fixation with an Ilizarov hybrid fixator may offer a salvage procedure with a successful clinical outcome.

External Fixators↗
PubMed2005

Vascularized free fibula transfer for oncologic reconstruction of the humerus.

UNLABELLED: Reconstruction of the humerus after oncologic resection is challenging. Vascularized free-fibula transfer allows the potential for rapid autograft incorporation in areas compromised by radiation, chemotherapy, and resection. A retrospective case series of vascularized free-fibula transfers for humeral reconstructions is reported. Fifteen patients were identified; nine had surgery for glenohumeral arthrodesis (three primary fusions, six salvage/revision), four had surgery for intercalary defects (three primary reconstructions, one salvage), one patient had an onlay graft for a pathologic fracture in irradiated bone, and one patient had an osteoarticular graft. Average followup was 68 months. One patient died from disease 41 months after surgery. Oncologic outcome was excellent with no local recurrence and preservation of all limbs. There were an average of 0.8 major complications (requiring reoperation) and 0.5 minor complications per patient. The most frequent complication was fracture, occurring in six of 15 patients. All patients went on to bony union except two patients with glenohumeral arthrodesis with asymptomatic fibrous unions. Mean time to union was 12 months. Vascularized free fibula transfer provides an effective and successful means of limb-preserving reconstruction after oncologic resection of the humerus. Healing time may be prolonged, and refracture and other complications commonly are encountered. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Bone Neoplasms↗
PubMed2006

Focal fibrocartilaginous dysplasia in the humerus.

Focal fibrocartilaginous dysplasia is an uncommon, benign bone lesion that causes deformity of the long bones in young children. It has most commonly been encountered in the proximal tibia, and very rarely in the long bones of the upper limb, that is, the proximal humerus, distal radius, ulna and proximal phalanx. Only one case of focal fibrocartilaginous dysplasia of the proximal humerus has been reported previously. The present study reports two such additional cases that were diagnosed in late childhood. The clinical presentation and radiographic findings are described with an emphasis on the natural evolution of the disease. Limb-length discrepancy is anticipated in these children in the long-term follow-up and, therefore, surgical intervention should be considered in treatment.

Adolescent↗
PubMed2003

The zonal distributions of alkaline phosphatase, adenosine triphosphatase, laminin, fibronectin and chondroitin 4-sulphate in growing rat humerus proximal epiphyseal cartilage: a histochemical and an immunohistochemical study.

Although there are many studies about epiphyseal cartilage extracellular matrix (ECM) macromolecules in bone formation, studies of their distribution and role in the mineralization of these components in growing rat humerus proximal epiphyseal cartilage have not been sufficiently detailed. The aim of this study was to determine the distributions of alkaline phosphatase (ALP), adenosine triphosphatase (ATPase), laminin, fibronectin and chondroitin 4-sulphate in growing rat humerus proximal epiphyseal cartilage. The rats were killed by cervical dislocation, and the humeri were removed, sectioned (6 and 10 microm) on a cryotome or paraffin microtome, and stained using histochemical and immunohistochemical methods. ALP and ATPase were markedly observed in the hypertrophy and calcifying cartilage. In addition, ATPase was found to be very strongly positive in the tangential zone of articular cartilage. Results of immunohistochemical staining for laminin, fibronectin and chondroitin 4-sulphate showed that the immunostaining was the heaviest in the tangential zone of articular cartilage. In growing epiphyseal plates, there were differences in the density of these macromolecules of chondrocytes as a function of the maturation process. In conclusion, these ECM macromolecules of epiphyseal cartilage may regulate the cell-cell and cell-matrix interactions as well as the matrix calcification during the ossification of epiphyseal cartilage.

Adenosine Triphosphatases↗
PubMed2006

Absence of large-diameter sensory fibres in a nerve to the cat humerus.

A fine branch of the median nerve innervates the periosteum and medullary cavity of the cat humerus. After branching to innervate the periosteum on the medial surface of the humerus, the nerve enters and supplies the medullary cavity via a nutrient foramen, accompanied by a small artery and vein. The composition of the fibres in the nerve was examined using electron microscopy. Myelinated fibres with diameters of 0.8-6.6 microm and unmyelinated fibres with diameters of 0.1-1.4 microm were observed. These diameters indicate that afferent fibres of this nerve are confined within the Group III and IV categories, and may therefore be nociceptive or mechanoreceptive in function. In addition, autonomic efferent fibres may also be present in these fibre groups. As no fibre diameters greater than 7 microm were noted, it appears that Group I and II fibres are absent in this nerve. The fibre distribution suggests that the principal role of this nerve is to relay bone-related nociceptive or mechanoreceptive information to the central nervous system and to provide autonomic regulatory influences on the bone.

Animals↗
PubMed1996

Fracture of the humerus after cancellous bone graft harvesting in a dog.

A five-year-old male Shetland sheepdog underwent calcaneoquartal arthrodesis for instability of the proximal intertarsal joint. A cancellous bone graft was harvested from the proximal humerus and packed around the arthrodesis site. Twenty-four hours postoperatively the dog developed a non-weightbearing forelimb lameness. Clinical and radiographic examination revealed a fracture of the humerus through the hole used to obtain the graft. Surgical repair of the fracture led to an uneventful recovery.

Animals↗
PubMed1983

Osteonecrosis of the humerus related to pregnancy.

A case of osteonecrosis of the head of the humerus is described in which the only likely precipitant was pregnancy. The association of pregnancy and osteonecrosis is reviewed. This is the first reported case of osteonecrosis of the humerus alone associated with pregnancy.

Female↗
PubMed2006

When physiology becomes pathology: the role of magnetic resonance imaging in evaluating bone marrow oedema in the humerus in elite tennis players with an upper limb pain syndrome.

Upper limb stresses are well recognised in tennis, and the normal physiological responses of the humerus to externally applied forces are well defined. Changes to both the microscopic and macroscopic bony architecture are often not apparent on plain radiographs in the early stages of a stress reaction. Bone scintigraphy is more sensitive, but not very specific to subtle changes, as is computer aided tomography. Magnetic resonance imaging (MRI) scans are now used to assess many musculoskeletal injuries, and may allow earlier recognition of changes. This study reports on eight high level tennis players (seven professionals, one highly ranked amateur), who all presented during the course of the 2002 Australian Open and its lead up events. All had an upper limb pain syndrome centred around the elbow. Each underwent an MRI scan. A group of asymptomatic players also had scans of the same area to serve as controls. All symptomatic patients had various levels of bone marrow oedema in their distal humerus, some with periosteal reactions, although most without. No scans revealed a cortical breach. The management of these reactions is problematic in players on an international circuit, as review is sporadic and not always coordinated. The timetabling of international tournaments means it is difficult for top players to obtain adequate rest to avoid injury. Awareness of this early overuse reaction needs to be raised to allow preventive and therapeutic options to be considered to reduce the incidence of this humeral stress response producing an upper limb pain syndrome.

Adolescent↗
PubMed1993

Conversion of bone marrow in the humerus, sternum, and clavicle: changes with age on MR images.

To study the normal conversion of bone marrow in the humerus, sternum, and clavicle, 101 T1-weighted magnetic resonance (MR) studies obtained in 91 patients aged 2 days to 37 years were retrospectively evaluated. Conversion from hypointense (red) to hyperintense (yellow) bone marrow was assessed by comparison of signal intensity of the bone marrow with that of muscle and fat. Conversion began in the proximal humeral epiphysis (in 16 of 21 adequate studies [76%]), humeral diaphysis (17 of 30 adequate studies [57%]), and distal metaphysis (16 of 25 adequate studies [64%]) before age 1 year and was nearly complete in these regions (20 of 22 adequate studies [91%], 20 of 21 adequate studies [95%], and five of seven adequate studies [71%]) in examinations of children aged 1-5 years. In the proximal humeral metaphysis, conversion was seen in 21 of 22 adequate studies (95%) in children aged 1-5 years and was nearly complete in all by age 20 years. Conversion began in the sternum (six of six studies [100%] in children aged 6-10 years) and clavicle (six of eight studies [75%] in children aged 6-10 years) before age 11 years but was never complete. Bone marrow conversion in the humerus, sternum, and clavicle follows a well-defined pattern and is depicted earlier by MR imaging than one would expect on the basis of histologic data.

Adolescent↗
PubMed1976

Stature estimation from femur and humerus by regression and autometry.

Estimation of stature from a single extremity bone is a common forensic practice and many regression equations are given by various workers. In India, Pearson's formula is the most commonly used method to determine the height. These regression equations were subjected to verification on 194 (97 pairs) femora and 102 (51 pairs) humeri from India. It was seen that the Pearsonian formulae did not give exact results. The regression formulae differed statistically in both sexes in femur and humerus. These are calculated and given. This finding once again proves the necessity of having norms or formulae for the specific groups, when reliable results are required. In addition, the proportion between humerus length and femur length is also verified. This has evolutionary significance. In addition to the usual method as above, a method of the proportion these bones individually bear to the stature of the same person to which the bones belong is worked out both as a multiplication factor and percentage proportion to the body stature. It has been amply demonstrated and concluded that this method be called "autometry" and further that this seems to be more reliable method than the tedious yet variable and unreliable results the various formulae give. This autometry seems to have a consistency, being constant in both sexes and all races, thus evolving a "human race autometry".

Anthropometry↗
PubMedDate not supplied

Cortical desmoid-like lesion of the proximal humerus and its occurrence in gymnasts (ringman's shoulder lesion).

Eighteen gymnasts were interviewed and examined radiographically for a cortical irregularity of the proximal humerus simulating malignancy. Fifty percent of the gymnasts had the lesion which is considered to be a benign reactive lesion secondary to excessive forces at the pectoralis major insertion to the proximal humerus. All patients were asymptomatic. The lesion is probably unique to gymnasts, particularly those involved with strength moves.

Adult↗