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At least 883 records · Page 49Linked to original sources
PubMed1999

Spinal accessory nerve injury.

Injury to the spinal accessory nerve can lead to dysfunction of the trapezius. The trapezius is a major scapular stabilizer and is composed of three functional components. It contributes to scapulothoracic rhythm by elevating, rotating, and retracting the scapula. The superficial course of the spinal accessory nerve in the posterior cervical triangle makes it susceptible to injury. Iatrogenic injury to the nerve after a surgical procedure is one of the most common causes of trapezius palsy. Dysfunction of the trapezius can be a painful and disabling condition. The shoulder droops as the scapula is translated laterally and rotated downward. Patients present with an asymmetric neckline, a drooping shoulder, winging of the scapula, and weakness of forward elevation. Evaluation should include a complete electrodiagnostic examination. If diagnosed within 1 year of the injury, microsurgical reconstruction of the nerve should be considered. Conservative treatment of chronic trapezius paralysis is appropriate for older patients who are sendentary. Active and healthy patients in whom 1 year of conservative treatment has failed are candidates for surgical reconstruction. Studies have shown the Eden-Lange procedure, in which the insertions of the levator scapulae, rhomboideus minor, and rhomboideus major muscles are transferred, relieves pain, corrects deformity, and improves function in patients with irreparable injury to the spinal accessory nerve.

Accessory Nerve↗
PubMed1976

Normal and abnormal motion of the shoulder.

The roentgenographic parameters of motion in normal and abnormal shoulders, including the movement of the scapula, arm angle, glenohumeral angle, scapulothoracic angle, excursion of the humeral head, and instant center of motion for abduction in the plane of the scapula, were determined in twelve normal subjects and fifteen patients. The scapula rotated externally with abduction. The ratio of glenohumeral to scapulothoracic movement was 5:4 after about 30 degrees of abduction. The center of rotation of the glenohumeral joint for abduction in the plane of the scapula was located within six millimeters of the geometric center of the humeral ball. The average excursion of the humeral ball on the face of the glenoid in the superoinferior plane between each 30-degree arc of motion was less than 1.5 millimeters in normal subjects. Significant previous injury resulting in abnormal mechanics of the shoulder joint was associated with abnormal values for excursion of the instant center and of the humeral head. An abnormal glenohumeral-to-scapulothoracic ratio was associated with significant pain in the shoulder. The fact that these various parameters were sensitive indicators of normal and abnormal motion raises the possibility of diagnostic clinical application.

Adult↗
PubMed1994

Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants.

OBJECTIVE: To identify donor sites from which vascularized bone may be harvested capable of accepting osseointegrated implants of the minimum dimensions required to ensure long-term implant stability. DESIGN: An anatomic study of the most commonly employed donor sites for vascularized bone in oromandibular reconstruction was conducted on 28 cadavers. SETTING: Academic tertiary referral center. PARTICIPANTS: Twenty-eight freshly embalmed, adult white cadavers (16 male, 12 female) were dissected. INTERVENTION: The ipsilateral fibula, iliac crest, radius, and lateral border of the scapula were harvested and multiply sectioned at predetermined sites. OUTCOME MEASURE: Implantability was determined for each section based on measurements of height, width, and cross-sectional area utilizing computer planimetry. RESULTS: The iliac crest was the most consistently implantable donor site, followed by the scapula, fibula, and radius (83%, 78%, 67%, and 21% of sections from each donor site satisfying the criteria for implantability). Consistent regional differences in implantability were encountered at each donor site except the scapula. CONCLUSIONS: Following ablation of oromandibular malignant neoplasms, restoration of stable retentive dentition is a prerequisite to a successful functional oral rehabilitation. This is best achieved with enosseous implants, capable of supporting a stable dental prosthesis, placed directly into vascularized bone flaps at the time of mandibular reconstruction. The implications of the results obtained in this study for gender, donor site selection, and orientation of the vascularized bone flap are discussed.

Aged↗
PubMed1989

Bone metastases in hypernephroma. Frequency of scapular involvement.

A consecutive series of 95 patients with hypernephroma was studied retrospectively after it was clinically suspected that there was a propensity for this tumor to metastasize to the scapula. Fifteen patients (15.8%) have developed scapular metastases which account for 36.6% of all bone metastases in this series, the majority of which required radiotherapy for pain relief. The scapula was a solitary site of bone metastasis in the majority of patients, and, even when associated with other bone lesions, was frequently an isolated site of pain. A comparative series of 40 consecutive patients with breast cancer metastatic to bone was retrospectively studied. Twenty-five percent of these showed scapular metastases but these were all in association with multiple (greater than 3) other bone metastases; none was symptomatic or required treatment. There was a suggestion that hypernephromas spread more often to the ipsilateral scapula, but the trend did not reach statistical significance. Scapular metastasis in hypernephroma is a common and clinically significant problem, sometimes giving a clue to the primary site. The cause for this predilection is not known.

Adult↗
PubMed1988

Fossil platyrrhine forelimb bones from the early miocene of Argentina.

Primate scapula and ulna fragments of uncertain taxonomic affinity (MACN-SC 101) have been recovered from the Pinturas deposits at Arroyo Feo, Santa Cruz, Argentina in association with Santacrucian (Early Miocene) land mammals. Least-squares regression of body weight on surface area and on height of the glenoid fossa of the scapula indicates an estimated mean weight of 3.6 kg for this individual. On the basis of qualitative and several metric features, the fossil scapula and ulna most closely resemble living platyrrhine monkeys. In estimated body weight and relative height of the coronoid process, the fossil is similar to arboreal quadrupeds, such as Cebus apella and Chiropotes. However, spinoglenoid, axilloglenoid, and axillospinal angles, length of lever arm, and length and breadth of the sigmoid notch imply behavioral similarity with larger species that also use their forelimbs extensively in climbing, such as Alouatta and Lagothrix. MACN-SC 101 may represent the incipient divergence of a generalized platyrrhine arboreal quadruped toward a more suspensory form.

Animals↗
PubMed1978

Functional analysis of the shoulder girdle of cats during locomotion.

The movements of the shoulder girdle of eight adult cats during overground stepping were studied, using standard slow motion cinematographic techniques. The patterns of activity of shoulder muscles were examined, using simultaneous intramuscular electromyography. Walking, trotting and galloping steps were analyzed from digitized single motion picture frame images. Angular movements of the shoulder girdle consist of biphasic flexion and extension of the shoulder joint and a monophasic flexion-extension alternation of the scapula on the thorax during each step cycle. In addition, the center of the scapula moves craniad during the swing phase and caudad during the stance phase with respect to a fixed reference point on the animal. Similar vertical movements of the center of the scapula also occur in each step cycle. Results of EMG studies of the 17 muscles capable of acting on the shoulder girdle indicate that three overall patterns of activity are found: (1) a pattern typical of extensor muscles, active during all the extension epochs; (2) a pattern typical of flexor muscles, active during the flexion epoch; and (3) a biphasic pattern of activity, active twice in each step. There data are used, along with a re-examination of previous models of the mechanics of the shoulder girdle of carnivores to examine the function and mechanics of shoulder motion. It is concluded that the rotary and translatory movements of the shoulder girdle during stepping combine to enhance step length.

Animals↗
PubMed1983

Electromyography of the opercularis muscle of Rana catesbeiana: an amphibian tonic muscle.

The opercularis muscle of Rana catesbeiana originates on the suprascapular cartilage of the shoulder girdle and inserts on the otic opercular element. It is part of the levator scapulae musculature and lies dorsomedial to the levator scapulae superior and inferior muscles. Bipolar electrode recordings from all three muscles show electrical activity linked to cyclical firing of the posterior intermandibularis muscle, an important ventilatory muscle. The opercularis muscle shows low amplitude, erratic signals when animals are submerged. Upon emergence of the snout region, the opercularis muscle shows rhythmic low amplitude activity at twice the rate of buccal pumping. Lung ventilation is synchronized with this rhythm and at ventilation the opercularis muscle shows higher amplitude activity. Upon submergence, opercularis activity again shows low level activity with no rhythmic pattern. Opercularis muscle activity has a major low frequency component (about 30 Hz) that probably corresponds to activity of tonic muscle fibers. Higher frequency signals (about 200-250 Hz) comparable to those of the levator scapulae muscles are also present and probably represent activity of phasic muscle fibers. Activity of the opercularis muscle is correlated with conditions in which aerial respiration is possible, and this pattern of activity supports an opercularis role in aerial hearing and/or detection of substrate vibrations. As far as we know, this is the first report of electromyographic analysis of a vertebrate tonic muscle.

Animals↗
PubMed2006

3D kinematic analysis of the acromioclavicular joint during arm abduction using vertically open MRI.

Many researchers have evaluated the motions of the shoulder girdle, especially scapular and humeral motion. However, few reports exist that describe motions of the acromioclavicular joint. The purpose of the present study was to analyze the 3D kinematics of the acromioclavicular joint during arm abduction using 3D MR images obtained by a vertically open MRI. Fourteen shoulders of seven volunteers were examined in seven static positions from 0 degrees to the maximum abduction in a seated position. 3D surface models of the clavicle and scapula were created, and the movements of the acromioclavicular joint from 0 degrees to each position were calculated using the volume-based registration technique. From these calculations, the translations were evaluated and the rotational motions were analyzed using the concept of the screw axis. In the anteroposterior direction, the clavicle translated most posteriorly (-1.9 +/- 1.3 mm) at 90 degrees of abduction and most anteriorly (1.6 +/- 2.7 mm) at maximum abduction. In the superoinferior direction, the clavicle translated slightly superiorly (0.9 +/- 1.9 mm). When analyzing relative motion of the scapula with respect to the clavicle, the scapula generally rotated about a specific screw axis passing through the insertions of both the acromioclavicular and the coracoclavicular ligaments on the coracoid process. The average rotation was 34.9 +/- 8.4 degrees.

Acromioclavicular Joint↗
PubMed1985

Scapular foramina.

Although foramina in the scapula are a rare occurrence, they produce radiolucent defects that simulate those related to skeletal metastasis or multiple myeloma. In order to define the typical location and appearance of these foramina, we initiated a radiographic and pathologic examination of macerated modern and ancient scapulae. Of 93 macerated scapulae that were examined, foramina were observed in 27 specimens (29%). These occurred at four sites: at the superior border of the bone at its junction with the coracoid process, caused by ossification of the superior transverse ligament (21 specimens); in the body of the bone inferior to the scapular spine, resulting from a disturbance in ossification during fetal development (five specimens); in the superior fossa, as a clasp-like defect (one specimen); and, at the superomedial border above the scapular spine (one specimen). The radiographic features of these foramina were compared to those produced by normal vascular channels, anatomic thinning of the bone, and skeletal metastasis or multiple myeloma. Knowledge of the typical appearance and site of scapular foramina assures accurate diagnosis.

Humans↗
PubMed1995

Displaced scapular fractures: indication and long-term results of open reduction and internal fixation.

Displaced scapular fractures are often found in polytraumatized patients. In emergency treatment they assume a minor role. Advances in dealing with severely injured patients in most instances allow us to perform an operation on the fractured scapula within the first 2 weeks after injury. A differentiated approach is necessary as exclusively conservative treatment does not always bring about good results. From 1981-1991 we performed open reduction and internal fixation (ORIF) in 25 patients with displaced fractures of the scapula. The long-term results could be assessed in 20 patients after an average of 6.1 years. The different types of fractures were classified according to Habermeyer/Ideberg, and the Constant score was used in the evaluation of results. Some 64% of patients were involved in road accidents, and 64% suffered concomitant injuries. Articular fractures (n = 6) were the most common ones, followed by fractures of the coracoid process (n = 5) and the neck of the scapula (n = 2). There was no early postoperative complication, and follow-up showed a breakage of K-wires in one patient (fracture of the acromion). Thirteen patients obtained a very good, two patients a good, four a fair and one a poor result (according to the Constant score). Fractures of the scapular neck had the best results in terms of pain, daily activity, range of motion, and strength) as compared with fractures of the glenoid and apophyseal fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Digital fluoroscopic assessment of the scapulohumeral rhythm.

Previous studies have shown that abnormal rotation of the scapula is associated with shoulder pathology. Among the methods which have been proposed, planar x-ray measurements are probably the only methods, which enable clinicians to assess accurately and objectively the scapulohumeral function in vivo. The aim of this study was to develop a method for the assessment of scapulohumeral kinematics using digital fluoroscopy. Anteroposterior images of the right glenohumeral joint were taken, in thirty-four healthy males, with the arm at rest, 30 degrees, 60 degrees, 90 degrees, 120 degrees, 150 degrees and maximum abduction, in the scapular plane. High inter- and intra-examiner reliability was observed regarding the arm and scapular angle measurements (ICC = 0.92-0.99). The positioning of the arm at the proposed angles was also highly accurate (< 2.3 degrees misplacement) and reproducible (CV% < 5.3%). The mean radiation dose was 0.075 mSv (+/- 0.027 mSv). At the resting position the scapula was in slight downward rotation (-2.4 degrees +/- 4.3 degrees) and the arm in slight abduction (1.5 degrees +/- 6.6 degrees). The mean maximum scapular rotation and the mean maximum arm abduction was 61.4 degrees (+/- 5.2 degrees) and 162.4 degrees (+/- 6.6 degrees) respectively. A curvilinear relationship was found between the arm angle (AA) and the scapular angle (SA) (p < 0.0001). The AA:SA ratio for the entire range of abduction was 2.5:1. The greatest contribution of the scapula (1.7:1) achieved at 30 degrees-60 degrees of arm. The high accuracy and reliability of our method and the low radiation recordings suggests that digital fluoroscopy may be considered for further investigation of the scapulohumeral kinematics in both healthy and pathological shoulders.

Adolescent↗
PubMed2001

Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome.

This study presents an objective evaluation of both scapular upward and axial rotational tilts in shoulder impingement syndrome, using a scapular spine line defined on antero-posterior (AP) radiographs of the shoulder as the referential line. Twenty-seven patients with unilateral shoulder motion pain, who were diagnosed as having chronic shoulder impingement syndrome, were enrolled in the study. Scapular upward and axial rotational tilts were compared between the affected and contralateral shoulders. AP radiographs were obtained at shoulder abduction angles of 0 degrees, 45 degrees, and 90 degrees, and the X-ray films were digitized by computer. The upward and axial rotational tilts of the scapula were then evaluated on the digital images. In shoulder impingement syndrome, both upward and axial external rotations of the scapula were impaired at the painful arc angle of abduction. This tended to be more apparent for the axial rotation of the scapula than for the upward rotation. These reductions in scapular rotations reduce available clearance for the rotator cuff and humeral greater tuberosity as the shoulder is abducted.

Adult↗
PubMed2006

Unusual cause of painful shoulder in an elderly woman with rheumatoid arthritis.

The painful shoulder is a very common condition encountered in the rheumatology clinic with rotator cuff disorders, glenohumeral disorders, acromioclavicular joint disease and referred neck pain being the most common causes. Other rare causes have to be considered in the presence of "red flag" indicators. We describe a case of a patient with mild rheumatoid arthritis and a past medical history of stage 2C epithelial ovarian carcinoma who presented to the rheumatology clinic with a painful shoulder and who was initially diagnosed with rotator cuff tendinopathy. When seen 3 months later she was found to have a 15 x 10-cm firm, non-tender soft tissue mass over the right scapula and X-rays showed a large lytic mass destroying much of the upper border of the scapula, suggestive of metastasis. Bone metastases in patients with ovarian carcinoma are very rare; they occur in about 2% of cases and are invariably predictors of poor prognosis. To our knowledge, this is the first case of ovarian cancer metastasised to the scapula. We suggest that rheumatologists should be aware of the differential diagnosis of painful shoulder and look for "red flag" indicators in patients with known rheumatic conditions.

Aged, 80 and over↗
PubMed1985

Hydraulic resistance in bones of the canine shoulder.

The hydraulic properties of trabecular bone were explored in both sides of normal canine shoulders by following the hydrostatic pressure response to transchondral injections of saline. In a series of isovolumetric injections at sites 9 mm beneath either joint surface, the pressure consistently rose higher and lasted longer in the humerus than it did in the scapula. Hydraulic resistance, the linear function of pressure per unit flow, averaged 8.8 times higher within the humerus than in the scapula in a second series of experiments. Hydraulic resistance fell by average factors of 9.6 in the humerus and 4.3 in the scapula when the surrounding bone was cut away to leave the injection site centered within a 1 cm 'cube' of trabecular bone. Direct determinations of hydraulic resistance provide a useful tool for the study of normal and abnormal physiology in trabecular bone.

Animals↗
PubMed1993

The dorsoscapular nerve in traumatic brachial plexus lesions.

The origin and course of the nerval innervation of the levator scapulae and rhomboid muscles was studied in four human cadavers. Special attention was given to surgical anatomy. The levator scapulae muscle receives two small segmental nerves from C3 and C4, respectively. The rhomboid muscle receives two segmental nerves, one from C4 and the other from C5. Moreover, in a series of 137 patients with a traumatic brachial plexus lesion, the linkage between levator scapulae and rhomboid muscle function impairment and site of the brachial plexus lesion was studied. Paresis of one or both of these muscles was noted in 13 cases. It was concluded that the rhomboid muscle may function on a single C4 nerve supply without any loss of strength. Arguments are put forward to support the relevance of rhomboid muscle testing in the assessment of brachial plexus lesions.

Adult↗
PubMed1995

Scapulothoracic anatomy for the arthroscopist.

Because endoscopic management has recently been introduced as treatment for painful subscapular snapping, we designed a cadaveric study to identify the boundaries of the scapulothoracic spaces and the relationship of important neurovascular structures to safe portal sites for arthroscopic surgery. We studied eight fresh, unembalmed cadaveric shoulders by anatomic dissection alone and eight fresh, unembalmed cadaveric shoulders by dissection after arthroscopy. We noted the following findings: (1) the scapulothoracic articulation has two triangular spaces, the serratus anterior space and the subscapularis space, that are divided obliquely by the serratus anterior muscle; (2) the boundaries of the larger serratus anterior space include the chest wall anteriorly, the serratus anterior muscle posteriorly, and the rhomboids medially; (3) the boundaries of the subscapularis space are the serratus anterior muscle anteriorly, the subscapularis muscle posteriorly, and the axilla laterally; and (4) a well-defined bursa occupies the serratus anterior space. Based on these findings, we recommend that portals for arthroscopic surgery should be inferior to the spine of the scapula and three to four finger-breadths from the vertebral border of the scapula (1) to avoid the neurovascular structures at the superomedial angle of the scapula, (2) to avoid the dorsosacpular nerve and artery, and (3) to prevent perpendicular orientation of the arthroscope to the lateral chest wall.

Arthroscopy↗
PubMed2004

Elastofibroma: a rare soft tissue tumour with a pathognomonic anatomical location and clinical symptom.

BACKGROUND: Elastofibromas are rare benign soft tissue tumours that are almost always located at the inferior pole of the scapula, deep to the serratus anterior muscle. Their anatomical location and a distinctive clinical symptom distinguish them from malignant soft tissue tumours. PATIENTS AND METHODS: A prospective histo-pathological database of all soft tissue tumours referred for treatment to the Royal Marsden Hospital between 1995 and 2003 was searched. Seven patients treated in this institution with a histological diagnosis of elastofibroma were identified. RESULTS: The usual presenting symptoms were that of a mass at the angle of the scapula (7/7), and clunking of the scapula on shoulder abduction (5/7). Pain was an infrequent symptom (1/7). Imaging by CT or MR usually indicated an indeterminate soft tissue neoplasm deep to the peri-scapular muscles, but the histological diagnosis was confirmed pre-operatively by core biopsy in all patients. Subsequent surgical excision was only performed if symptoms were severe. CONCLUSIONS: The clinical presentation of these benign neoplasms is typical and the suspected clinical diagnosis can be confirmed easily by core biopsy. Surgery can be safely reserved for symptomatic patients.

Aged↗
PubMedDate not supplied

Long-term results of scapulothoracic arthrodesis of facioscapulohumeral muscular dystrophy.

Many patients with facioscapulohumeral muscular dystrophy eventually have instability of the scapula resulting from weakness of the scapula stabilizers. A subset of patients, however, has sufficient strength in the supraspinatus and deltoid muscles to flex and abduct the arm, if the scapula has been stabilized. The purpose of this study is to report the clinical results of six patients (9 shoulders) that underwent scapulothoracic arthrodesis for the treatment of limited shoulder motion and scapular winging caused by facioscapulohumeral muscular dystrophy. The average preoperative active flexion was 71 degrees , which improved to 109 degrees at the last follow-up. The UCLA Shoulder Score also rose from 18.4 points to 27.9 points at the last follow-up. All patients did well in activities of daily living after the procedure. Scapulothoracic arthrodesis is considered a successful treatment method for facioscapulohumeral muscular dystrophy, as it improves appearance, function, and tolerance to exercise.

Adolescent↗