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PubMedDate not supplied

Scapulothoracic fusion for painful winging of the scapula in nondystrophic patients.

A modified technique of scapulothoracic fusion was used in 6 patients who did not have muscular dystrophy and who were later evaluated clinically. The cause of the painful winging of the scapula was traumatic disruption of the trapezius and the accessory nerve in 3 patients, injury to the brachial plexus in 2, and Sprengel's deformity in 1. To obtain fusion, double wires were passed around each of 4 ribs. A Rush pin was then contoured to fit the curvature of the scapula, and the wires were passed through the scapula and tied over the Rush pin with bone graft. The mean age of the patients was 30 years (range, 22-39 years), with a mean follow-up of 49 months. The mean increase in elevation was 18 degrees with significant pain relief. The medium-term results showed that this operation was successful in achieving stability of the scapula while improving pain and function in patients without facioscapulohumeral dystrophy.

Adult↗
PubMedDate not supplied

Arthroscopic treatment of painful snapping of the scapula by using a new superior portal.

PURPOSE: To evaluate the results of arthroscopic resection of the superomedial corner of the scapula, using a new superior portal, in patients with a snapping scapula problem. TYPE OF STUDY: Case series. METHODS: Ten patients with painful snapping of the scapula were treated arthroscopically using standard portals as well as a recently developed superior arthroscopic portal. There were 4 women and 6 men with a mean age of 26.9 years (range, 16 to 40 years). All patients were right-handed with a right side operation in 8 cases. There was a history of significant shoulder trauma in 6 patients. All patients had normal preoperative computed tomography scans and radiographs. The average duration of symptoms before surgery was 53.2 months (range, 12 to 154 months). At follow-up, the results were scored using the UCLA system. RESULTS: All patients were followed-up at an average of 11.5 months (range, 3 to 23 months). There were no intraoperative or postoperative complications and, in particular, no neurologic lesions resulting from the introduction of arthroscopic instruments. The scapulothoracic crepitus resolved in 2 patients and decreased in 8 patients. There was reduction of pain in all cases, with a mean postoperative visual analog pain score of 2.6. Nine patients were able to return to their preoperative work and 6 could return to their previous sports activity. According to the UCLA scores, the results were 4 excellent, 5 good, and 1 fair. All patients reported that the procedure was worthwhile. CONCLUSIONS: Arthroscopic surgery is beneficial for patients with painful snapping of the scapula. The new superior portal is safe and has made the operation easier to perform.

Adolescent↗
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

Anomalies of the scapula.

This is a report of a case of double acromion and double coracoid and a commentary on the comparative anatomy and embryology of the shoulder. Congenital elevation of the scapula, ossification of the transverse scapular ligament, clasp-like superior border of the scapula, coracoclavicular joint, coracoclavicular bridge, coracosternale bone, os acromiale, elongated acromion, convex glenoid, hypoplasia of the inferior border of the glenoid, dentated glenoid, infrascapular bone, and notched inferior angle of the scapula are other anomalies of the scapula reported in the literature.

Acromion↗
PubMed2006

Treatment of scapula fractures: systematic review of 520 fractures in 22 case series.

BACKGROUND: Fractures of the scapula account for 3% to 5% of all fractures of the shoulder girdle and make up less than 1% of all broken bones. Scapula fractures typically occur after high-energy trauma, and approximately 90% of the patients have associated injuries. OBJECTIVE: (1) To determine the incidences of nonoperative and operative treatment of different scapula fracture types, (2) to systematically stratify the reported results of nonoperatively and operatively treated scapula fractures on the basis of different fracture types and to summarize functional results, and (3) to quantify infection and secondary surgical procedure rates after operative treatment.

Adult↗
PubMed2006

Scapulopexy of winged scapula secondary to facioscapulohumeral muscular dystrophy.

UNLABELLED: Facioscapulohumeral muscular dystrophy is an hereditary disease that causes weakness of the scapulothoracic muscles and leads to winged scapula. Patients with facioscapulohumeral muscular dystrophy are unable to sustain shoulder abduction or flexion and are limited in daily activities. We retrospectively reviewed nine patients (18 procedures) who had scapulothoracic fixation without arthrodesis (scapulopexy). The technique consists of repositioning the scapula over the rib cage and fixation to four ribs with metal wires. We assessed improvement in range of motion of the shoulder, maintenance of the correction with time, and cosmetic and functional results. The average age of the patients at surgery was 25.2 years (range, 15-35 years), and there were no major complications. The average followup was 9.9 years (range, 3-16 years). All patients had complete resolution of the winged scapula and improved range of motion. Arm abduction increased from an average of 68.3 degrees (range, 45 degrees-90 degrees) preoperatively to 96.1 degrees (range, 60 degrees-120 degrees) postoperatively. Arm flexion increased from an average of 57.2 degrees (range, 45 degrees-90 degrees) preoperatively to 116.1 degrees (range, 80 degrees-180 degrees) postoperatively. The position of the scapula obtained by surgery was maintained with time, and the patients had satisfactory cosmetic results. LEVEL OF EVIDENCE: Therapeutic study, Level IV. See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Measurement of scapula upward rotation: a reliable clinical procedure.

BACKGROUND: It is important to deal with the scapula when developing rehabilitation strategies for the shoulder complex. This requires clinical measurement tools that are readily available and easy to apply and which provide a reliable evaluation of scapula motion. AIM: To determine the reliability of the Plurimeter-V gravity inclinometer for the measurement of scapular upward rotation positions during humeral elevation in coronal abduction in a group of patients with shoulder pathology. METHOD: Twenty six patients were assessed in two repeat tests within a single testing session. Patients exhibiting a wide spectrum of shoulder pathology were selected. The angle of scapular upward rotation was measured during total shoulder abduction. The measurement protocol was performed twice during a single testing session by a single tester. Results of the two tests were compared and the reliability assessed by intraclass correlation coefficients (ICCs). RESULTS: There was no significant difference in the scapula measurements taken during the two tests at each testing position. Overall, there was very good intrarater reliability (ICC = 0.88). The ICC ranged from 0.81 (at 135 degrees) to 0.94 (at both resting and end of total shoulder abduction range). CONCLUSION: The Plurimeter-V gravity inclinometer can be used effectively and reliably for measuring upward rotation of the scapula in all ranges of shoulder abduction in the coronal plane.

Adult↗
PubMedDate not supplied

Isokinetic evaluation of shoulder rotational strength between the plane of scapula and the frontal plane.

The purpose of this study was to determine whether shoulder rotational strength was greater in the plane of the scapula or the frontal plane. Isokinetic shoulder rotational strength was evaluated in 20 subjects. Using the Merac (Universal Gym Equipment, Inc., Cedar Rapids, IA), test data was gathered in the right shoulders, in 45 degrees abduction, at a speed of 60 deg/sec, in the plane of the scapula and the frontal plane. Each subject returned within 1 week for retests to establish reliability. The average correlational coefficient across tests was 0.87. The Merac computer system was used to analyze data. Mean and standard deviations for peak torque to body weight were calculated. A paired t-test was used to examine the difference in the means for internal and external rotation between the two positions. The results indicated no significant difference between the two positions for shoulder internal rotational strength values. However, shoulder external rotational strength values in the plane of the scapula were statistically significantly higher than in the frontal plane (P less than 0.001). These preliminary results suggest isokinetic strength training and testing may be preferable in the plane of the scapula rather than the frontal plane.

Adolescent↗
PubMed2000

Dual origin and segmental organisation of the avian scapula.

Bones of the postcranial skeleton of higher vertebrates originate from either somitic mesoderm or somatopleural layer of the lateral plate mesoderm. Controversy surrounds the origin of the scapula, a major component of the shoulder girdle, with both somitic and lateral plate origins being proposed. Abnormal scapular development has been described in the naturally occurring undulated series of mouse mutants, which has implicated Pax1 in the formation of this bone. Here we addressed the development of the scapula, firstly, by analysing the relationship between Pax1 expression and chondrogenesis and, secondly, by determining the developmental origin of the scapula using chick quail chimeric analysis. We show the following. (1) The scapula develops in a rostral-to-caudal direction and overt chondrification is preceded by an accumulation of Pax1-expressing cells. (2) The scapular head and neck are of lateral plate mesodermal origin. (3) In contrast, the scapular blade is composed of somitic cells. (4) Unlike the Pax1-positive cells of the vertebral column, which are of sclerotomal origin, the Pax1-positive cells of the scapular blade originate from the dermomyotome. (5) Finally, we show that cells of the scapular blade are organised into spatially restricted domains along its rostrocaudal axis in the same order as the somites from which they originated. Our results imply that the scapular blade is an ossifying muscular insertion rather than an original skeletal element, and that the scapular head and neck are homologous to the 'true coracoid' of higher vertebrates.

Animals↗
PubMed1995

Winging of the scapula: the underlying biomechanics and an orthotic solution.

Winging of the scapula occurring in muscular disorders (muscular dystrophy and spinal muscular atrophy) or nerve injury has been investigated, resulting in a thorough understanding and presentation of the underlying biomechanics causing this occurrence. This includes a biomechanical explanation of the characteristic prominence of the medial border of the scapula upon attempted elevation, together with the biomechanical reasons for the rotation of the scapula in a direction contrary to the normal scapulohumeral rhythm. Based on these findings, a non-invasive alternative to the surgical technique for scapular stabilization has been devised, using an inflatable orthosis, placed between the scapula and an external restraint (such as a spinal jacket). The device has been tested on one subject using a 3SPACE Isotrak electromagnetic source and sensor system, and gave encouraging results. Elevation increased by up to 35 degrees (37 per cent), and functional improvement in the use of the hand around the head and face has been achieved. The technique needs no aftercare or physiotherapy and is therefore both economical and functionally effective.

Biomechanical Phenomena↗
PubMed2005

Quantitative morphology of the scapula: normal variation of the superomedial scapular angle, and superior and inferior pole thickness.

This study examined the normal variation of the superomedial scapular angle and the thickness of the superior and inferior scapular borders. Scapulae of 53 cadaver shoulders were dissected free from all soft tissue. A line was drawn from the most superior to the most inferior point on each scapula, and the scapulae were cut along this line to obtain cross sections. The supero-medial scapular angle (alpha) was measured with a goniometer from the cross section as a ABC: through the inferior tip (A), base of the spine (B), and superior tip (C). Superior and inferior pole thickness was measured with a digital caliper from the thickest portions on the cross section of the poles. Average superomedial angle was 139 degrees +/- 6 degrees (range: 125 degrees - 156 degrees). Average thickness for the superior and inferior poles was 3.9 +/- 0.9 mm (range: 2.1 - 8.3 mm) and 7.5 +/- 1.5 mm (range: 4 - 11 mm), respectively. The thickness of both superior and inferior poles was significantly different between male and female specimens (P < .05), with male scapulae having the higher values.

Aged↗
PubMed1999

[Selective peripheral denervation for spasmodic torticollis involving the levator scapulae muscle].

Patients with laterocollis or rotatory type torticollis tend to show abnormal contraction of the levator scapulae muscle and the scalene muscles. These muscles are innervated from the anterior branches of the cervical spinal nerves. Because of this, the traditional Bertrand operation dealing with posterior branches does not adequately affect the symptoms of laterocollis. The authors report selective denervation of the levator scapulae muscle in three patients and discuss its rationale. All the three patients underwent denervation of both the C1-C6 posterior spinal rami and the branches from the C3 and C4 anterior rami to the levator scapulae muscle. We added myotomy of the scalene muscle in one patient, and denervation of the omohyoid muscle which is innervated from the ansa cervicalis and the descending branch of the hypoglossal nerve. The pre/post-operative Tsui scores were 12/4, 15/1, and 14/3 respectively. There were no complications. We conclude that selective peripheral denervation of the levator scapulae muscle is safe and effective in the treatment of laterocollic type torticollis.

Adult↗
PubMed1999

The angular branch of the thoracodorsal artery and its blood supply to the inferior angle of the scapula: an anatomical study.

An anatomical study of the thoracodorsal arterial system was performed; it focused on the angular branch. The aim of the study was to document the anatomical variations of this pedicle and to delineate the area of supply to the inferior angle of the scapula with a view to free bone transfer. A total of 81 cadaver dissections were performed; they revealed the constant presence of the thoracodorsal artery and four vascular patterns of origin of the angular branch. Selective India ink perfusion studies performed on 11 sides in six fresh cadavers demonstrated a reliable supply to the inferior angle of the scapula to the extent of 6 cm of the vertebral margin and 3 cm of the lateral margin of the scapula. Histologic analysis of sections of this region of the scapula confirmed the presence of ink within the periosteal, cortical, and medullary vascular channels, implying the viability of this area of bone if transferred based on the angular branch.

Cadaver↗
PubMed2000

Quantitative anatomy of the scapula.

Thirty adult bony scapulae were used to report detailed bony dimensions of the scapula. The measurements of bony dimensions of the scapula included the glenoid, coracoid, spine, and body. The results of the measurements showed that the thickest bony stock (posteroanterior diameter), with a mean value of 13 mm to 23 mm in the glenoid process, was found in the middle third of the area within 1 cm medial to the glenoid rim. In the scapular spine region, the greatest superoinferior diameter of the bone was noted in the lateral portion of the spine, followed by the medial portion. It was also found that smallest superoinferior diameter (2 mm to 7 mm) of the spine was located at the middle portion between the base and ridge along the whole spine. On the lateral border of the scapula, the posteroanterior diameter of bone was relatively greater for the upper portion (8 mm) than for the lower portion, including the inferior angle (6 mm). This information may be helpful in open reduction and internal fixation of significantly displaced scapular fractures.

Adult↗
PubMed1987

Rotation of the scapula and shoulder subluxation in hemiplegia.

Inferior subluxation of the shoulder in hemiplegia was measured using a tridimensional (3-D) x-ray technique. This technique gave the true vertical distance separating the apex of the humeral head and the inferior margin of the glenoid cavity. Both shoulders of each subject were evaluated and the difference used as a measure of subluxation. This measure was then compared to the orientation of the scapula relative to the vertical, to the abduction, and to the relative abduction of the arm. Relative abduction is defined as the angle between the humerus and the glenoid fossa. It has been suggested that these factors are associated with inferior subluxation in hemiplegia. Results of this study of 50 volunteer stroke patients indicated that the affected and nonaffected shoulders were different (subluxed) in terms of the vertical position of the humerus vis-à-vis the scapula. The orientation of the glenoid cavities was also different, the subluxed one facing less downward. The angle of abduction of the arm of the affected side was significantly greater than on the nonaffected side, but the relative abduction of the arm was on the same order of magnitude for both sides. There was no significant relationship between the orientation of the scapula and the severity of the subluxation. The abduction of the humerus was weakly (r = .24) related to the subluxation, which partly explained the weak association found between the relative abduction of the arm and the subluxation. It was concluded that the position of the scapula and the relative abduction of the arm cannot be considered important factors in the occurrence of inferior subluxation in hemiplegia.

Female↗
PubMed1995

Osteochondroma of the scapula.

Osteochondromas are common primary bone tumors which are usually located in the distal femur. In a large retrospective study from the Mayo clinic, osteochondromas comprised 36% of benign bone tumors and nearly 10% of all bone tumors. While the scapula is rarely involved, this is the most common tumor of the scapula. Clinical signs of this lesion include shoulder pain and limited range of motion. Patients may present with winging of the scapula. Computed tomography is often necessary to fully define the location and character of the lesion. We present the case of a 14-year-old girl with pain and limited range of motion of the left shoulder. The diagnosis was that of osteochondroma of the scapula.

Adolescent↗
PubMed1993

Levator scapulae syndrome: an anatomic-clinical study.

Twenty-two patients, all young females, presenting with a common clinical picture of pain over the upper medial angle of the scapula were studied. The dominant shoulder was the most commonly involved (82%). Pain radiated to the neck and shoulder, but rarely to the arm. Movements that stretched the levator scapulae on the affected side aggravated symptoms. Radiographs and bone scans of the shoulders and cervical spine were negative. Increased heat emission from the upper medial angle of the affected shoulder was found on thermography in more than 60% of the patients. Anatomic dissections of 30 cadaveric shoulders showed great variability in the insertion of the levator. A bursa was found between the scapula, the serratus, and the levator in more than 50% of the shoulders. This study suggests that this syndrome, leading to bursitis and pain, may be caused by anatomic variations of the insertion of the levator scapulae and origin of the serratus anterior. This may explain the constant trigger point and crepitation as well as the increased heat emission found on thermography. Local steroid injections relieved symptoms partially in 75% of those patients who underwent treatment.

Adult↗
PubMed1997

Anatomic considerations for a modified posterior approach to the scapula.

A modified posterior approach to the scapula was tested on 20 cadavers. The approach also was used in 2 cases with fractures involving the scapular neck and glenoid fossa. The incision is C shaped, with the convexity directed toward the lateral angle of the scapula. The posterior muscle fibers of the deltoid are reflected laterally after detaching them from their origin. The infraspinatus is mobilized without division to expose the posterior surface of the scapular neck and glenoid. Access to the rest of the posterior and the superior surfaces of the glenoid can be achieved by osteotomizing the acromion. The suprascapular neurovascular bundle is identified and protected at an average of 1.4 +/- 0.1 cm from the glenoid rim, where it is adherent to the spinoglenoid angle of the scapula. The circumflex scapular artery is protected at the lateral border of the scapula at an average of 2.8 +/- 0.5 cm from the inferior glenoid margin. The axillary nerve is protected inferior to the teres minor. However, care should be taken not to excessively retract the teres minor because the nerve lies in close proximity to the shoulder joint capsule.

Acromion↗