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At least 865 records · Page 48Linked to original sources
PubMed2001

Comparative radiologic study of bone density and cortical thickness of donor bone used in mandibular reconstruction.

OBJECTIVE: The aim of this study was to compare the total cancellous bone density, bone-implant interface density, and cortical thickness of 6 donor bone types commonly used in oral and maxillofacial reconstruction. METHODS: A total of 120 bones from 20 Korean adults-including iliac bones, fibulas, cranial bones, scapulas, ribs, and clavicles-were selected. The implant recipient site was determined by the shape, contour, and anatomical limitations of the bones. The serial cross-sectional images of each bone were then acquired through computed tomography. Total cancellous bone density, bone-implant interface density around the imaginary implant fixture, and the cortical thickness along both sides of the imaginary fixture on each cross-sectional image were evaluated and compared. RESULTS: The cancellous bone density of each donor bone type had a statistically significant difference. The cranial bone showed the highest cancellous bone density, followed by the iliac bone, clavicle, scapula, rib, and fibula (P <.05). The bone-implant interface density of the cranial bone, clavicle, fibula, and scapula each belonged to the same Duncan's group, whereas the rib and iliac bone showed lower bone-implant interface density. In average cortical thickness, the scapula and fibula had a thicker cortex surrounding the imaginary implant than the other bones, and the rib had the thinnest cortex. CONCLUSION: Although more extensive testing is needed to explain the clinical implications of these results, the findings of this study may help clinicians choose the most appropriate donor bone.

Adult↗
PubMed1999

Anatomy of the scapulothoracic articulation.

Four fresh frozen human cadavers (eight extremities) consisting of the head, neck, thorax, and entire upper extremities were used for dissection of the scapulothoracic articulation. In each specimen, the spinal accessory nerve, all relevant muscle insertions, and bursae were identified and measured. The structures of the scapulothoracic articulation can be divided into superficial, intermediate, and deep layers. The superficial layer consists of the trapezius, latissimus dorsi, and an inconsistent bursa between the inferior angle of the scapula and the latissimus dorsi. The intermediate layer consists of the levator scapulae, rhomboid minor and major, spinal accessory nerve, and scapulotrapezial bursa located between the superomedial scapula and the overlying trapezius. In all specimens, the spinal accessory nerve traveled intimately along the wall of the scapulotrapezial bursa, an average of 2.7 cm lateral to the superomedial angle of the scapula. The deep layer consists of the serratus anterior, subscapularis, and two bursae: one between the serratus and the thorax, the scapulothoracic bursa; and one between the subscapularis and the serratus, the subscapularis bursa.

Accessory Nerve↗
PubMed2003

A neurovascular complication after scapulothoracic arthrodesis.

Facioscapulohumeral muscular dystrophy is a progressive disorder characterized by weakness in the muscles of the face, shoulder girdle and upper limbs, and variable lower extremity weakness. The muscles that stabilize the scapula are significantly weak, although the deltoid usually is preserved. With attempted shoulder abduction, the unstable scapula protrudes, elevates, and internally rotates. Scapulothoracic arthrodesis stabilizes the scapula and improves active range of motion and function of the shoulder. Appropriate scapular positioning on the chest wall has been described previously. The current authors review a neurovascular complication after scapulothoracic arthrodesis in which the scapula was positioned as described in the literature. Immediate repositioning resulted in an excellent long-term outcome. Previous recommendations as to scapular position must be taken simply as guidelines. Intraoperative monitoring of neurovascular function in the upper extremity should prevent this complication.

Adolescent↗
PubMed1994

The latissimus dorsi/scapular bone flap (the "latissimus/bone flap").

During the past 4 years, our trauma and reconstructive service has treated a number of patients with lower extremity trauma involving the loss of both soft tissue and significant segments of tibia. While there are many methods for reconstruction of such defects, we became interested in providing a one-stage reconstruction of both the soft tissues and the missing bone segments. Since our standard flap for lower extremity reconstruction is a latissimus dorsi flap, we became interested in transferring a portion of the lateral border of the scapula along with the latissimus muscle. We dissected 34 cadaver scapulas in order to verify the reliability of the blood supply to the lateral border of the scapula based on the thoracodorsal artery. We then performed 12 "latissimus/bone flaps" from 1988 to 1992. Prior to flap transfer, control of the wound was obtained with surgical debridement and aggressive wound management. The flap usually was performed 5 to 7 days after initial contact with the patient. The muscle was skin grafted. All patients reported are ambulating, with x-ray evidence of bony incorporation of the transferred bone segment into the tibia. We feel that inclusion of the lateral scapula bone with the latissimus dorsi is a useful adjunct in the management of lower extremity trauma.

Adolescent↗
PubMed2006

Clinical signs of accessory nerve palsy.

BACKGROUND: Injury to the spinal accessory nerve causes paralysis of the trapezius muscle, which is a painful and disabling condition. Many injuries are iatrogenic. Diagnosis is often made after a long delay, suggesting that current clinical signs are inadequate. METHODS: Accessory nerve palsy is known to be a cause of winging of the scapula. Observation of six patients with accessory nerve palsy has shown that winging of the scapula is most prominent when the patient actively externally rotates the shoulder against resistance. RESULTS: This is in contrast to the other causes of winging of the scapula including long thoracic nerve palsy and muscular dystrophy, where the scapula is most prominent on flexion or abduction of the shoulder. CONCLUSION: We propose that the resisted active external rotation test should be regarded as the key clinical sign for accessory nerve palsy.

Accessory Nerve Diseases↗
PubMed2007

Scapular position in primates.

Scapular position affects shoulder mobility, which plays an important role in the upper limb adaptations in primates. However, currently available data on scapular position are unsatisfactory because of the failure to simultaneously consider the relative dimensions of all the three skeletal elements of the shoulder girdle, i.e. the clavicle, the scapula and the thorax. In the present study, the clavicular length and the scapular spine length were measured on preserved cadavers, and the dorsoventral thoracic diameter was measured on scaled radiographs of a wide range of primates, permitting a quantitative comparison of scapular position among primates. It was found that arboreal monkeys have a more dorsally situated scapula than terrestrial ones, but the same difference was not found between terrestrial and arboreal prosimians. Hominoids were found to have the most dorsally situated scapula. Contrary to the slow climbing theory of hominoid evolution, which tries to explain most postcranial specializations of hominoids as adaptations for slow climbing, the scapulae of slow-climbing lorines and Alouatta are much less dorsal than those of the hominoids.

Adaptation, Physiological↗
PubMedDate not supplied

Electromyographic analysis of the scapular muscles during a golf swing.

To describe the role of the scapular muscles in the golf swing, we studied 15 competitive male golfers. Four muscles were studied bilaterally using dynamic electromyography and cinematography. In the trailing arm, the levator scapulae elevates while the rhomboid muscles retract the scapula during takeaway; both then stabilize the scapula through the remainder of the swing. In the leading arm, these muscles retract the scapula during forward swing and acceleration. The trapezius muscle in the trailing arm also demonstrates high activity during takeaway to aid in scapular retraction. In the leading arm, trapezius activity is high in forward swing and through the remainder of the swing to promote scapular retraction. The serratus anterior muscle activity is high in the trailing arm during forward swing and through the remainder of the swing to maximize scapular protraction. In the leading arm, the serratus anterior muscle has constant activity through all phases of the swing, which may explain the clinical scenario of muscle fatigue in high demand golfers. The golf swing and uncoiling action requires that the scapular muscles work in synchrony to maximize swing arc and clubhead speed. This study demonstrates the importance of the scapular muscles in the golf swing and the need for specific strengthening exercises.

Adult↗
PubMed1998

Anatomy and histological characteristics of the spinoglenoid ligament.

The spinoglenoid (inferior transverse scapular) ligament, when present, is located at the spinoglenoid notch. The ligament originates on the spine of the scapula and inserts on the superior margin of the glenoid neck. Because of discrepancies in the literature, we sought to determine its prevalence and to define its histological characteristics. We dissected 112 shoulders of seventy-six cadavera and classified the ligament as absent or an insubstantial structure, a thin fibrous band (type I), or a distinct ligament (type II). We found no distinct ligamentous structure in twenty-two shoulders (20 percent), a type-I ligament in sixty-eight shoulders (61 percent), and a type-II ligament in twenty-two shoulders (20 percent). Overall, ninety (80 percent) of the shoulders had a fibrous band of tissue that, together with the spine of the scapula, formed a narrow fibro-osseous tunnel through which the suprascapular nerve traveled. The bone-spinoglenoid ligament-bone complexes from three specimens were analyzed histologically. There were two type-I ligaments and one type-II ligament; all three ligaments were composed of collagen fibers. One type-I ligament and the type-II ligament demonstrated Sharpey fibers at their origin on the spine of the scapula. The other type-I ligament attached to the spine of the scapula through the periosteum. All three ligaments inserted into the periosteum of the glenoid neck.

Adolescent↗
PubMed1999

Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement.

STUDY DESIGN: Nonrandomized 2 group post-test only. OBJECTIVE: To compare scapular position and orientation between subjects with and without impingement syndrome. BACKGROUND: Abnormal scapular motion is commonly believed to be a contributing factor to shoulder impingement syndrome. METHODS AND MEASURES: Twenty nonimpaired subjects with a mean age of 34.3 (+/- 7.5 years) and 17 patients with impingement syndrome with a mean age of 45.8 (+/- 11.0) participated. A 3-dimensional electromechanical digitizer was used to measure scapular position and orientation in 3 planes. Measurements were taken with the arm at the side, elevated in the scapular plane to horizontal, and at maximum elevation. One-way analysis of variance was used to compare nonimpaired subjects to the impingement group and the symptomatic and asymptomatic sides within the impingement group. Five scapular kinematic variables were assessed at each arm position. Orientation was described by posterior tilting angle, upward rotation angle, and internal rotation angle. Position was described by medial-lateral position and superior-inferior position and determined by the distance from the scapula centroid to the seventh cervical vertebra (C7). RESULTS: During scapular plane elevation of the arm, the scapula showed a general pattern of increasing posterior-tilt angle, increasing upward-rotation angle, and decreasing internal-rotation angle in both impingement and nonimpaired groups. Also, the scapula moved to a more superior position and a slightly more medial position with increasing arm elevation. Compared to nonimpaired subjects (34.6 degrees +/- 9.7), those with impingement demonstrated a significantly lower posterior tilting angle of the scapula in the sagittal plane (25.1 degrees +/- 9.1). Subjects with impingement also demonstrated higher superior-inferior scapular position with maximal arm elevation (5.2 cm +/- 1.6 below the first thoracic vertebrae) compared to nonimpaired subjects (7.5 cm +/- 1.5). CONCLUSIONS: These results suggest that altered scapular kinematics may be an important aspect of the impingement syndrome.

Adult↗
PubMed1999

Current role of scapulectomy.

Tumors of the scapula are an unusual clinical challenge. Partial or complete resection of the scapula, with its attached musculoaponeurotic tissue, is a seldom used technique for the treatment of primary bone and soft tissue tumors, as well as selected metastatic involvement of the scapula. Scapulectomy may allow wide margins of resection without amputation. The purpose of this study is to review our recent experience with scapulectomy. This study describes the recent experience with scapulectomy by the Section of Surgical Oncology and the Department of Orthopedics at Louisiana State Medical Center (New Orleans, LA). Between 1994 and 1998, 12 patients (between 16 and 79 years of age) underwent a resection of the scapula. Eleven of these patients had soft tissue tumors; one had a metastasis from a thyroid carcinoma. Six of these patients underwent a scapulectomy as a primary treatment, five for recurrence. Six patients also received postoperative radiation and/or chemotherapy. The follow-up ranged from 6 months to 4 years. There was no mortality or wound infection associated with scapulectomy. All patients had normal hand and wrist function after surgery. Three distant recurrences occurred, with no local or regional failures encountered during the follow-up period. Scapulectomy can result in excellent local tumor control. Whereas some loss of active shoulder motion may occur, hand, wrist and elbow function is preserved. Although maintenance of shoulder function should not take precedence over adequacy of resection, scapulectomy remains an excellent procedure for malignant disease that preserves hand, wrist, and elbow function.

Adolescent↗
PubMedDate not supplied

Using scapular measurements in regression formulae for the estimation of stature.

There are very few papers in forensic literature in which scapular dimensions have been used for estimation of living stature. Allowing the forensic duty to estimate the living stature of skeletal remains, using intact or fragmented scapulae, the Authors have performed multiple regression analysis between the measurements taken from 80 scapula (40 male and 40 female) belonging to a skeletal collection with anthropometric known data. Seven parameters (max length, max breadth, max acrocoracoid distance, length of acromion, max length of coracoid, length of glenoid cavity, width of glenoid cavity) have been recorded. By statistical analysis multiple and linear regressions have been obtained. The results show that living stature may be determined by using regression formulae of single or associated parameters taken from whole or fragmented scapulae. In absence of intact or fragmented long limb bones, scapula sample can be reliably employed for the estimation of stature in forensic practice.

Body Height↗
PubMed1992

[Extended surgical indications in combined shoulder girdle fracture].

The combination of an ipsilateral clavicule and scapula fracture causes a double instability of the shoulder. In opposite to an isolated clavicule or scapula fracture this injury should be treated operatively. Diagnosis of the scapula fracture in polytrauma can be difficult. If there is a clinical or radiologic suspicion, the indication for a CT scan is given. Osteosynthesis with plates from separated approaches, first the scapula from dorsal then the calvicule from ventral has proven good. The nervus suprascapularis must be treated carefully and, if necessary, liberated from the fracture. The optimal treatment of this injury is not always possible in polytraumatised patient.

Clavicle↗
PubMed1995

Incidence of the coracoclavicular joint in South African populations.

The presence of a diarthrotic coracoclavicular joint, as represented by an articular facet on the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula, was investigated. The sample consisted of 60 white and 180 black South African (60 Sotho, 60 Xhosa and 60 Zulu) skeletons. Each group consisted of 30 male and 30 female skeletons. The presence of the articular facet was recorded as either bilateral, unilateral left or unilateral right. The effect of clavicular length, scapular size and first rib angle on the presence of the coracoclavicular joint was also investigated. The presence of the articular facet was noted in 23 (9.6%) of the 240 individuals studied. Of these 23 individuals, 6 (26.1%) were white and 17 (73.9%) were black. Males (56.5%) presented a higher incidence of this anomaly than females (43.5%). The articular facet occurred bilaterally in 47.9% (11/23), unilaterally on the left in 30.4% (7/23) and unilaterally on the right in 21.7% (5/23). Sexual, racial and tribal differences were not statistically significant. Individuals possessing the joint showed statistically significantly (P < 0.01) larger scapulae (increased border lengths and superior angles), longer clavicles and longer first ribs. No statistically significant differences in the first rib angles were observed between individuals who possessed the joint and those who did not, thus implying similar thoracic inlet size. It is proposed that the aforementioned morphometry of the scapulae, clavicles and first ribs may restrict associated movements of the scapulae, resulting in the development of the coracoclavicular joint.

Adult↗
PubMed1995

[Morphometry of the sub-acromial space and its clinical relevance].

Rupture of the rotator cuff is one of the commonest (30%) pathologic findings in elderly dissecting room subjects. Together with the degenerative tendopathy associated with increasing age, this is due to mechanical damage to the distal parts of the tendons or the soft tissues lying in the subacromial space between the acromion, coracoacromial ligament, coracoid process and humeral head. The object of this investigation was to examine the influence of the decisive metrical parameters of the subacromial space in the macerated scapula. For this purpose, defined distances and angles of 343 macerated human scapulae were measured by means of an image analysing system, and the results evaluated statistically. It was found that the size of the subacromial space depends, not only upon variations in the form of the acromion itself, but also upon the acromial and scapula-spine angles. Marked projection of the coracoid process, which is dependent upon both the angle between the long axis of the scapula and the root of the coracoid process and the coracoid angle, plays an important part in the development of the so-called subcoracoid impingement syndrome: a constriction of the subscapularis tendon between the coracoid process and the head of the humerus. A clinical assessment of the absolute size of the subacromial space should take into account the size of the body; but sex, age, and the side involved are of little significance.

Acromioclavicular Joint↗
PubMed2006

Botulinum toxin A for treating muscular contractures in cephalic tetanus.

OBJECTIVE: This study reports the use of botulinum toxin for treatment of muscle contractures in a patient with cephalic tetanus. METHOD: Case report. RESULTS: An 80-year-old woman was diagnosed with cephalic tetanus, with contractures of the masseter, sternocleidomastoid, trapezius, and levator scapulae muscles. After one month of conventional treatment good recovery was observed, but with persistence of the contractures of the sternocleidomastoid, trapezius and levator scapulae. These contractures were treated with botulinum toxin A (75IU in the right sternocleidomastoid, 25IU in the right trapezius; one month later 50IU in the left levator scapulae, 50IU in the right levator scapulae, 75IU in the left sternocleidomastoid; two months later 25IU in the left trapezius). Full recovery was observed. CONCLUSIONS: Local infiltration with botulinum toxin A appears to be an effective treatment for persistent muscle contracture in cephalic tetanus.

Aged, 80 and over↗
PubMed2005

Acromion-fixation of glenoid components in total shoulder arthroplasty.

Successful design of components for total shoulder arthroplasty has proven to be challenging. This is because of the difficulties in maintaining fixation of the component that inserts into the scapula; i.e., the glenoid component. Glenoid components that are fixated to both the glenoid and acromion (a long process extending medially on the dorsal aspect of the scapula) have the possible advantage of greater stability over those that are fixated to the glenoid alone. In this study, a finite element analysis is used to investigate whether or not acromion fixation is advantageous for glenoid components. Full muscle loading and joint reaction forces are included in the finite element model. Reflective photoelasticity of five scapulae is used to obtain experimental data to compare with results from the finite element analysis, and it confirms the structural behaviour of the finite element model. When implanted with an acromion-fixated prosthesis, it is found that high unphysiological stresses occur in the scapula bone, and that stresses in the fixation are not reduced. Very high stresses are predicted in that part of the prosthesis which connects the acromion to the glenoid. It is found that the very high stresses are partly in response to the muscle and joint reaction forces acting at the acromion. It is concluded that, because of the relatively high forces acting at the acromion, fixation to it may not be the way forward in glenoid component design.

Acromion↗
PubMed1997

Shoulder and forelimb orientations and loading in sitting cats: implications for head and shoulder movement.

A three-dimensional static analysis was carried out to characterize the effects of ground reaction forces propagated through different joints in the forelimb and shoulder of quietly sitting cats. Stereofluoroscopy, used to identify the orientations of bones, showed that the scapula is held in a parasagittal plane, with its vertebral border located dorsally to the spines of thoracic vertebrae. The forelimb is held with the elbow flexed. Loading on the elbow tended to flex and adduct the ulna, whereas loading on the glenohumeral joint tended to extend, adduct and internally rotate the humerus. Loading on the scapula was confined primarily to the sagittal plane and tended to rotate the vertebral border of the scapula caudally around the head of the humerus. This caudally-directed moment suggests that the static equilibrium of the feline scapula depends upon muscular forces directed cranially, presumably by way of attachments on the skull and cervical column. The differing arrangement of the shoulder-to-neck transition in cats and humans suggests caution in the use of feline models to represent some aspects of human head movement.

Animals↗
PubMed1998

Contracture of the deltoid muscle: imaging findings in 17 patients.

OBJECTIVE: A retrospective review of the MR images and radiographs of 26 shoulders in 17 patients suffering from contracture of the deltoid muscle was used to establish the characteristic imaging findings. MATERIALS AND METHODS: Deltoid muscle contractures in 26 shoulders in 17 patients encountered over a 4-year period are reported. The history of intramuscular injection and clinical symptoms and signs are detailed. Imaging studies including routine radiographs (24 shoulders), MR images (25 shoulders), and computed arthrotomograms (two shoulders) were reviewed. On MR images, the winging angle of the scapula (angle between the axis of the scapular body and the coronal plane of the chest) and the diameter of the lesion were measured and compared with data derived from 24 age-matched control subjects. RESULTS: Diagnostic MR features of deltoid muscle contracture include fibrotic cord in the deltoid muscle, especially its middle portion, extending from the superior acromial surface to the deltoid tuberosity, and winging of the scapula (increased winging angle of the scapula). Characteristic radiographic features include abduction contracture, winging of the scapula, lateral down-sloping of the acromial process, and a superior acromial enthesophyte. CONCLUSION: MR images are sensitive and accurate in the diagnosis of contracture of the deltoid muscles. Characteristic features also allow accurate routine diagnosis on radiographs.

Arm↗