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At least 73 records · Page 4Linked to original sources
PubMed2007

Partial scapulectomy for congenital elevation of the scapula.

We treated 26 patients with congenital elevation of the scapula by excising the superomedial part of the scapula. We also simultaneously resected the omovertebral bone when present. A modified inverted L-shape incision was used to release the contracted tissue around the medial edge of the scapula. We evaluated 28 shoulders (26 patients) at a minimum of 10 months followup (mean, 3.9 years; range, 10 months-7 years). The improvement rate for range of shoulder abduction was 59.11%. Eighteen shoulders with preoperative abduction less than 120 degrees achieved an average improvement of 52 degrees, whereas 10 shoulders with a preoperative abduction range greater than 120 degrees achieved an average improvement of 19 degrees. However, there was no difference in the improvement rate of the range of shoulder abduction between the two groups (60.94% versus 56%). Twenty-three shoulders (82.24%) attained various degrees of cosmetic improvement after the operation. There were no neurologic complications during or after surgery. No patients complained of scar problems. Excising the superomedial part of the scapula is a safe, simple operation for treating congenital elevation of the scapula.

Adolescent↗
PubMed2004

Development and experimental validation of a three-dimensional finite element model of the human scapula.

A new modelling approach, using a combination of shell and solid elements, has been adopted to develop a realistic three-dimensional finite element (FE) model of the human scapula. Shell elements were used to represent a part of the compact bone layer (i.e. the outer cortical layer) and the very thin and rather flat part of the scapula--infraspinous fossa and supraspinous fossa respectively. Solid elements were used to model the remaining part of the compact bone and the trabecular bone. The FE model results in proper element shapes without distortion. The geometry, material properties and thickness were taken from quantitative computed tomography (CT) data. A thorough experimental set-up for strain gauge measurement on a fresh bone serves as a reference to assess the accuracy of FE predictions. A fresh cadaveric scapula with 18 strain gauges fixed at various locations and orientations was loaded in a mechanical testing machine and supported at three locations by linkage mechanisms interconnected by ball joints. This new experimental set-up was developed to impose bending and deflection of the scapula in all directions unambiguously, in response to applied loads at various locations. The measured strains (experimental) were compared to numerical (FE) strains, corresponding to several load cases, to validate the proposed FE modelling approach. Linear regression analysis was used to assess the accuracy of the results. The percentage error in the regression slope varies between 9 and 23 per cent. It appears, as a whole, that the two variables (measured and calculated strains) strongly depend on each other with a confidence level of more than 95 per cent. Considering the complicated testing procedure on a fresh sample of scapula, the high correlation coefficients (0.89-0.97), the low standard errors (29-105 micro epsilon) and percentage errors in the regression slope, as compared to other studies, strongly suggest that the strains calculated by the FE model can be used as a valid predictor of the actual measured strain. The model is therefore an alternative to a rigorous three-dimensional model based on solid elements only, which might often be too expensive in terms of computing time.

Aged↗
PubMed2003

CT-based preoperative analysis of scapula morphology and glenohumeral joint geometry.

OBJECTIVE: To investigate the geometry of the glenohumeral joint using three-dimensional (3D) models; define landmarks, planes, angles and regions of interest; and analyze the exact morphology of the scapula. MATERIALS AND METHODS: We reconstructed 3D scapula models based on computed tomography (CT) data sets of 12 healthy controls. Three-dimensional models were reconstructed using the 3D Slicer2 (Surgical Planning Lab, Boston, MA), which provides interactive measurement. The 3D model and measuring tools can be freely shifted and rotated in all planes. RESULTS: The average length of the scapulas was 209.58 +/- 26.72 mm (left) and 223.68 +/- 47.74 mm (right); width was 124.03 +/- 13.28 mm (left) and 141.44 +/- 27.78 mm (right); and volume was 121.38 +/- 12.02 ml (left) and 130.24 +/- 20.86 ml (right). The glenoid dimensions were 34.34 +/- 5.62 mm (left) and 36.44 +/- 7.36 mm (right) (anteroposterior); and 49.16 +/- 7.68 mm (left), 51.46 +/- 10.07 mm (right) (superoinferior). For all average values, scapulas from male controls were significantly larger than those from females, and right sides were larger than left sides (p < 0.05). The glenoid version was nearly the same for male/female and left/right (left = 9.02 +/- 3.89 degrees retroversion; right = 8.26 +/- 3.72 degrees retroversion) (p > or = 0.05). CONCLUSION: The 3D measurement of scapula morphology compared with geometry of the glenohumeral joint leads to a more precise planning of shoulder surgery. As new shoulder prostheses are intended to reconstruct the normal anatomy as closely as possible, such exact 3D measurements may be used for optimization.

Computer Simulation↗
PubMed2003

[Scapulae alatae--angels' wings. A study of 64 patients treated with braces and physical therapy at the Viberg's hospital].

INTRODUCTION: Scapula winging is characterized by a paresis/paralysis of either m. serratus anterior innervated by n. thoracis longus or m. trapezius innervated by n. accesorius. This investigation reveals the results after bracing and muscle training in patients suffering from scapula winging. MATERIAL AND METHODS: A prospective, consecutive series consisting of 64 patients, 43 males and 21 females with a mean age of 37.8 years (15-75 years), were treated with bracing and muscle training in 1998-2001. Prior to the treatment of bracing all patients suffered from shoulder pain, shoulder fatigue and limited range of motion as well as cosmetic complaints, 28 patients had shoulder pain. RESULTS: At the time of the investigation all 64 patients had stopped using the brace after an average of 11 months (3-29 months). A total of 61 patients had returned to their previous work and sports activities. By the time of the one year follow-up control 18 (50%) patients had gained normal shoulder functions and had no complaints and no visible scapula winging. Ten (32%) had minor disability and two (6%) had major disability. Two patients had relapse of their scapula winging. (Both patients had formerly had normal ENG/EMG). DISCUSSION: We find that the combination of bracing and muscle training is successful in treating scapula winging. Electroneurography (ENG)/electromyography (EMG) was routinely performed but did not show any prognostic value for the treatment in our investigation.

Adolescent↗
PubMed2006

Anatomical basics and variations of the scapula in Turkish adults.

OBJECTIVE: To analyze the anatomical basis of the scapula, acromion, os acromiale, coracoid process, coraco-acromial arch, and glenoid cavity in Turkish adults. METHODS: We performed the study at the Faculty of Medicine, Akdeniz University, Turkey between January 2004 and December 2005. A total of 90 dry bones of the scapula from human cadavers were randomly selected. The length, width, and anterior thickness of the acromion and the acromial facet of the acromioclavicular joint were measured with an electronic caliber and was examined visually. For the radiological evaluation, the posterior anterior and the lateral shoulder radiographs of 90 consecutive adult patients with normal findings were used. These films were evaluated and grouped according to the acromial arch morphology. RESULTS: The distribution of the acromial morphologic types according to slope was type I (flat) 10%, type II (curved) 73%, type III (hooked) 17%. Type I was seen in 11%, type II 66%, type III 23% of the specimens. The morphological shape of the tip of the acromion was 31% cobra shaped, 13% square shaped, and 56% intermediate type. The scapulas, coracoid process and the coraco acromial arch were measured. In 72% of the specimen, the glenoid notch of the scapulas were absent and oval shaped, whereas in 28% the notch was well expressed and the glenoid cavity was pear shaped. The mean vertical length of the glenoid cavity was 36.3 +/- 3 mm, and the mean transverse length was 24.6 +/- 2.5 mm. Os acromiale is a rare anatomical condition. Its incidence has been documented in radiographic and anatomical studies to be between 1-15%. The presence of os acromiale was 1% in shoulder radiographs (os pre-acromiale), and in dry bones (os meta-acromiale) CONCLUSION: We reported the exact morphological measurements of the bone structures of the scapula in Turkish adult population. Our results present an instructive figures of anatomical preparations and radiological cases that can be used to make a more precise radiological and a differential diagnoses.

Acromion↗
PubMed1989

Treatment of painful scapulothoracic crepitus by resection of the superomedial angle of the scapula. A report of three cases.

Three healthy young male manual laborers developed painful unilateral scapulothoracic crepitus arising from the superomedial angle of the scapula. There was a history of trauma in two of the patients. Asymmetric prominence of the superomedial angle of the scapula was demonstrated by computed tomography (CT) scanning in two patients. All three patients were successfully treated by resection of the superomedial angle of the scapula. The resected tissue was histologically normal in each case. Painful scapulothoracic crepitus arising from the superomedial angle of the scapula is associated with local trauma, is best investigated with a CT scan, and if unresponsive to prolonged conservative measures, can be successfully treated by resection of the superomedial angle of the scapula.

Adult↗
PubMed1983

[Tilting angle of the scapula].

The shoulder joint has the most freedom of range of motion in the human body. This joint is composed of the gleno-humeral joint, the acromio-clavicular joint, the sterno-clavicular joint and the scapulo-thoracic articulation. The scapula has a very important role in the scapulo-humeral rhythm in the shoulder motions, but the scapular position could be identified from the two roentgenograms from different distances in the same direction. Three points of the scapula were chosen to decide the plane of the scapula as below: A: The intersection of the vertebral border and the scapular spine, B: The inferior angle, C: The tuberos, infraarticularis. The two roentgenograms were taken using the distances of one and two meters from the X-ray tube to the X-ray film. The X-ray was concentrated on the point A of the scapula. Points B and C on each roentgenogram were measured by X-Y coordinates. The lengths of AB, BC and CA and the scapular angles (the medially tilting angle, the downward tilting angle and the upward rotation angle) were calculated by using specific equations. The lengths of AB, BC and CA and the medially tilting angle of 16 scapulae (dry bones) were measured by using a caliper, and those were calculated by roentgenograms. Each measurement was almost accurate the length of AB, BC and CA; r equal 0.965, the medially tilting angle; r equal 0.928). Then the scapular angles of a human body determined from the roentgenographic examination in the standing position. Also the shoulder was loaded with five kg at the forearm and the length were reconfirmed. The results were as below: The medially tiling angles were 42.7 degrees +/- 1.3 degrees (n equal 50) in the resting position (R.P.) and 47.5 degrees +/- 2.0 degrees (n equal 23) in the five kg loaded position (5 L.P.) among the males. Those angles were 45.5 degrees +/- 2.6 degrees (n equal 19, R.P.) and 49.5 degrees +/- 2.1 degrees (n equal 13, 5 L.P.) among the females. The downward tilting angles were 8.5 degrees +/- 1.6 degrees (R.P.) and 7.8 degrees +/- 2.0 degrees (5 L.P.) among the males and were 7.7 degrees +/- 2.6 degrees (R.P.) and 5.1 degrees +/- 4.8 degrees (5 L.P.) among the females. The upward rotation angle was 8.7 degrees +/- 0.9 degrees (R.P.) and was 5.6 degrees +/- 1.5 degrees (5 L.P.) among the males, and was 6.6 degrees +/- 1.8 degrees (R.P.) and was 4.4 degrees +/- 2.6 degrees (5 L.P.) among the females.

Adult↗
PubMed1984

The winged scapula.

Twenty-five patients with 23 different types of winging of the scapula are described. A simple clinical and etiologic classification of the winged scapula is proposed based on the study of these patients in conjunction with a review of the literature. Winging of the scapula is either static or dynamic. Static winging is due to fixed deformity in the shoulder girdle, spine, or ribs. Dynamic winging is due to a neuromuscular disorder. The great variety of lesions that produce winging of the scapula may be classified anatomically into four types: Type I, nerve; Type II, muscle; Type III, bone; and Type IV, joint. Winging of the scapula is a surprisingly common physical sign, but because it is often asymptomatic it receives little attention. However, symptoms of pain, weakness, or cosmetic deformity may demand attention, and it is hoped that this classification will help in the diagnosis and assessment of these patients.

Adolescent↗
PubMed1996

Electromyography of levator scapulae: new findings allow tests of a head stabilization model.

OBJECTIVE: Understanding the recruitment patterns of shoulder girdle prime-mover muscles will allow meaningful exploration of non-prime-mover neck muscle activity during arm and shoulder efforts. This study identifies exercises that isolate recruitment of levator scapulae from recruitment of upper trapezius. The exercises will be used for electromyographic experiments in which the head stabilizing roles of other neck muscles will be explored. DESIGN: Right levator scapulae and upper trapezius were electromyographically monitored with indwelling, fine-wire, bipolar electrodes. Subjects performed isometric arm exercises and movements of the upper limb, shoulder and head. SETTING: Electromyography facilities of the department of Anatomical Sciences of the State University of New York at Stony Brook were used. PARTICIPANTS: Six adult subjects participated; one had reduced shoulder girdle mobility and a history of multiple shoulder separations. MAIN OUTCOME MEASURES: Raw electromyographic data were scored visually on a scale from 0 to 4, with 4 being the signal observed in a maximal voluntary contraction. RESULTS: All subjects recruited levator scapulae alone during arm extension. Only the subject with reduced shoulder mobility recruited levator scapulae during scapular plane arm elevation and arm abduction. CONCLUSIONS: The levator scapulae torque to be counteracted in arm extension produces ipsilateral rotation, lateral flexion and extension of the neck; trapezius rotates the head contralaterally during scapular plane arm elevation. These distinct and relatively simple cases (one shoulder girdle prime-mover affecting head posture at a time) are appropriate exercises for experimental exploration of the recruitment patterns of potential head stabilizers during arm/shoulder efforts.

Adult↗
PubMed1997

Dynamic stability of the scapula.

SUMMARY. The ability to position and control movements of the scapula is essential for optimal upper limb function. The inability to achieve this stable base frequently accompanies the development of shoulder and upper limb pain and pathology. Unlike other joints the bony, capsular and ligamentous constraints are minimal at the scapulothoracic 'joint' so stability is dependant on active control. Clinically, it is noted that patients presenting with shoulder and arm symptoms demonstrate poor dynamic scapula control. Scapula setting is an exercise taught by physiotherapists to correct movement dysfunction associated with abnormal scapula positioning and dynamic control. Addressing the dynamic stabilization of the scapula is an essential part of the management of neuromusculoskeletal dysfunction of the shoulder girdle and an appropriate rehabilitation programme is necessary if this issue is to be addressed. Copyright 1997 Harcourt Publishers Ltd.

Journal Article↗
PubMed2005

Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula.

In a cadaveric instability model that leaves all muscles intact initially, we studied anteroinferior glenohumeral dislocation behavior after section of the ligaments on the humeral side of the joint. In this study, the latissimus dorsi seemed to play a role when complete section did not result in a locked anteroinferior dislocation. We therefore initiated a study to test the hypothesis that the latissimus dorsi may, in certain circumstances, depending on variations in its anatomy, influence dislocation behavior. Here, in Part I, we present the results of the anatomic study of latissimus dorsi and its tendons. The anatomy of the latissimus dorsi pertaining to the scapula and humerus was studied in 100 cadaver specimens. The distance between the uppermost part of the tendon of both the latissimus dorsi and the teres major and the edge of the articular cartilage of the humeral head (tendon-cartilage distance, TCD) as well as the width and length of the tendons were measured. Furthermore, the relationship between latissimus dorsi and the inferior angle of the scapula was studied. The tendon of the latissimus dorsi inserted at a variable distance from the cartilage of the humeral head: the TCD ranged from 12.6 to 31.6 mm (mean 21.06 mm+/-5.11 mm). The latissimus dorsi can have muscular fibers arising from the inferior angle of the scapula (type 1 scapular connection, 43%). Alternatively, there may be only a few fibrous strands between the muscle and the scapula or there may be an intervening bursa (type 2 scapular connection, 57%). This variability in the morphology of the latissimus dorsi may be a factor explaining the differences observed in a study of humerus-based sequential cutting of the glenohumeral capsule. This possibility is explored in Part II of the study. The latissimus dorsi may also complete the tendinous protection of the humeral side of the capsule generally provided by the rotator cuff.

Cadaver↗
PubMed2005

Chondrosarcoma of the scapula: long-term oncologic outcome.

BACKGROUND: Chondrosarcoma is the second most common primary sarcoma of bone. It often develops within flat bones, such as the pelvis, ribs, and scapula. In the current study, the authors reviewed the surgical experience and long-term oncologic outcomes of patients with chondrosarcoma arising in the scapula. METHODS: The medical records of 29 consecutive patients with chondrosarcoma of the scapula were reviewed. The patients were treated between 1954 and 1994. All patients had localized disease at the time of presentation. The tumors were classified histologically as Grade 1 (10 patients), Grade 2 (10 patients), Grade 3 (7 patients), dedifferentiated (1 patient), and mesenchymal (1 patient) (using the criteria of Evans et al.). The mean maximal dimension of the tumors was 11 cm. Twenty-five patients underwent limb-sparing surgical resection and 4 patients underwent forequarter amputations. The median follow-up was 13 years (range, 1-35 years). RESULTS: At last follow-up, 22 patients (76%) were free of disease and 7 patients (24%) had died of their disease. Local recurrence occurred in 4 patients at 7 months, 16 months, 40 months, and 43 months, respectively. The local recurrence-free survival rate was 86% at 5 years, 10 years, and 20 years. Disease-specific survival was 83% at 5 years, 74% at 10 years, and 74% at 20 years. Patients who had low-grade chondrosarcomas had better survival compared with patients who had high-grade chondrosarcomas (P = 0.07). CONCLUSIONS: Patients who had localized chondrosarcoma of the scapula had a favorable long-term outcome, most likely due to the unique anatomic features that improved the likelihood of achieving wide surgical margins with limb-sparing surgery, despite the frequent presentation of locally advanced disease.

Adolescent↗
PubMed2004

Modularity and integration in the hominoid scapula.

In this paper, several hypotheses of morphological integration within the hominoid (ape) scapula are tested. In particular, whether the scapula represents a set of developmental tissues sharing tight correlations between constituent parts (i.e., highly integrated) or is more modularly organized (i.e., covariation is greater within regions than between) is tested. Whether the patterns of integration in the scapula have changed over phylogenetic time or in response to selective forces is also examined. Results from two different analyses (matrix correlations and edge deviance) indicate traits comprising the blade and acromion, and to a weaker degree the glenoid, correlate highly with each other. The coracoid exhibits more independence from other parts of the scapula, perhaps reflecting its distinct evolutionary developmental history. Overall, similarity in species-specific patterns of correlation was high between all taxa. Correlation matrix similarity was significantly correlated with functional similarity and morphological distance, but not with phylogenetic distance. These results are congruent with other studies of integration that suggest correlation patterns remain stable over evolutionary time. There are changes associated with phylogeny, but the tight link between functional similarity and phylogenetic distance at this level of comparison presents possible challenges to interpretation. Overall similarities in the pattern of integration in all taxa might be better interpreted as relative strengthening or weakening of trait correlations rather than broadscale changes in the pattern of relationship between developmental regions. Larger sample sizes with greater taxonomic/functional breadth, and finer scale analyses of patterns of correlation are needed to test these hypotheses further.

Animals↗
PubMed1989

Giant cell tumor of the scapula. A review of 13 cases.

This study reviews the demographic, radiologic, and histologic characteristics of 13 cases of an important primary skeletal neoplasm, giant cell tumor of bone, occurring in an uncommon location, the scapula. That eight of 13 patients presented prior to 20 years of age contrasts significantly with the typical age distribution (between 20-40 years) encountered in giant cell tumors arising in long bones. As it does elsewhere in the skeleton, giant cell tumor of the scapula frequently demonstrates cystic and/or telangiectatic components on histologic examination. The radiologic appearances of giant cell tumor in the scapula and in more typical locations are similar and include: (1) well-defined (geographic) margins, occasionally with a delicate sclerotic rim, (2) prominent trabeculations, (3) "expanded" bone contour, (4) frequent extension to the subchondral plate, and (5) absence of internal mineralization. Tumor sites within the scapula included: coracoid process, acromion, and body (three cases each); glenoid (two cases); and superior and inferior angles (one case each).

Adolescent↗
PubMed2004

Intrinsic cartilage-forming potential of dermomyotomal cells requires ectodermal signals for the development of the scapula blade.

The avian scapula has a dual origin. The cranial part derives from the somatopleure of the forelimb field, while the caudal part, the scapula blade, originates from the dermomyotomes of the cervicothoracic transition zone. Thus, these dermomyotomes have, in addition to the well-known myogenic, angiogenic, and dermogenic potential, the ability to form cartilage. The scapula blade is therefore a derivative of dermomyotomal chondrogenesis. Although the mechanisms that direct the sclerotomal chondrogenesis are beginning to be understood, little is known about dermomyotomal chondrogenesis. Here, we address the mechanisms that control dermomyotomal cells to become chondrocytes. After heterotopic transplantation of dorsal epithelial somite halves from the scapula-forming level to the cervical level, the grafted tissue retains the capability to form cartilage, indicating that the dermomyotomal chondrogenic potential must be specified during anterior-to-posterior regionalization of the paraxial mesoderm. Furthermore, we show that signals from the ectoderm are required, allowing dermomyotome cells to express markers associated with the chondrogenic lineage.

Animals↗
PubMed2004

Load transfer across the scapula during humeral abduction.

Stress analysis in the individual parts of the scapula under normal physiological conditions is necessary to understand the load transfer mechanism, its relation with morphology of bone and to analyse the deviations in stress patterns due to implantation of the glenoid. The purpose of this study was to obtain stress distribution in the scapula during abduction of the arm and to obtain a qualitative estimate of the function of coracoacromial ligament. An accurate three-dimensional (3D) finite element (FE) model of the natural scapula has been developed for this purpose, using computed tomography data and shell-solid modelling approach. The model was experimentally validated. A musculoskeletal shoulder model of forces that calculates all muscle, ligament and joint reaction forces, in six load cases (30-180 degrees) during unloaded humeral abduction was used as applied loading conditions for the 3D FE model. High tensile and compressive stresses (15-60 MPa) were generated in the thick bony ridges of the scapula, like the scapular spine, lateral border, glenoid and acromion. High compressive stresses (45-58 MPa) were evoked in the glenoid and at the connection of glenoid-scapular spine-infraspinous fossa. The stresses in the infraspinous fossa and supraspinous fossa were low (0.05-15 MPa). These results indicated that the transfer of major muscle and joint reaction take place predominantly through the thick bony ridges, whereas the fossa area act more as attachment sites of large muscles. During humeral abduction, coracoacromial ligament was stretched, and presumably will be under tension.

Biomechanical Phenomena↗
PubMed2005

Influence of glenohumeral mismatch on bone strains and implant displacements in implanted glenoïds. An in vitro experimental study on cadaveric scapulae.

In shoulder arthroplasty, there is no consensus about the ideal mismatch between a prosthetic humeral head and a glenoïd component. Thus, investigations into mismatch effects from a biomechanical point of view can be useful. The aim of this in vitro study was to help us understand mismatch influence on bone strains, translational forces in the joint and implant/bone displacements in implanted scapulae. Five fresh cadaveric scapulae were implanted with a cemented keeled polyethylene implant. The lower part of the scapulae was embedded and the loadings were carried out using five metallic spheres simulating mismatches of 0, 2, 4, 5 and 6 mm. Loadings included a constant compressive preload of 392N and an anterior, posterior, inferior and superior translation of 2.5 mm. We measured the transversal force necessary to produce the imposed translation, the strains at six locations around the peripheral cortex of the glenoïd using strain gages and the relative implant/bone displacements using CCD cameras. Generally, the increase of mismatch reduced the translational forces, the strains around the glenoïd and, except for the anterior loading, the relative implant/bone displacements. Few and even no significant differences were observed when the mismatch varied from 0 to 2 mm; the number of significant differences increased when the mismatch varied from 0 to 4mm and from 0 to 5 mm; the results obtained for a 0-6 mm variation in mismatch were comparable to those obtained for a 0-5 mm variation. This study underlines that the mismatch has a significant effect on bone strains, relative implant/bone displacements and induced translational forces when a compressive preload and imposed translations were applied on implanted scapulae.

Aged↗
PubMed2004

Spontaneous fracture of the lower angle of scapula. Possible role of cough.

We report a case of a fracture of the inferior angle of the scapula related to prolonged cough, without triggering trauma, sport, or occupational activity. Bone insufficiency was present in this patient. Stress fractures of the scapula are rare; the fatigue type is the most frequent, associated with sports or occupational activity. We do not find any published case report about scapula stress fracture related to cough, until rib fractures are frequent in this situation. Repetitive muscular activity of the serratus anterior and major rhomboid on the inferior angle of the scapula during cough may explain this avulsion fracture.

Cough↗