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PubMed2000

Active and passive scapulohumeral movement in healthy persons: a comparison.

OBJECTIVES: Clinical studies investigating shoulder complaints have found that active exercises and passive manipulation are not equally effective treatments, perhaps because active and passive movements align the individual shoulder girdle components differently. This study sought to investigate whether a significant difference exists in scapulohumeral rhythm of the healthy shoulder when the humerus is elevated actively or passively. STUDY DESIGN: Both shoulders of 10 healthy volunteers (9 men; mean age 50 yrs) were studied using an electromagnetic coordinate system to locate the position of the scapula relative to the humerus and trunk. Scapula position in three dimensions was recorded at 10 degrees intervals during active and passive humeral elevation in the coronal plane between 10 degrees and 50 degrees. Each shoulder was measured three times. RESULTS: Analysis of variance showed that in all three planes of scapula movement (lateral rotation, backward tip, and retraction) the components of variance attributable to the differences in active and passive movement were less than 5%. CONCLUSIONS: During humeral elevation between 10 degrees and 50 degrees no significant difference exists between active and passive shoulder complex motion in healthy individuals. These findings may help to explain why passive manipulation is an effective treatment for shoulder complaints.

Adolescent↗
PubMed2003

Three-dimensional shoulder kinematics during a pressure relief technique and wheelchair transfer.

OBJECTIVE: To assess 3-dimensional scapulothoracic and glenohumeral kinematics in able-bodied subjects during a weight-relief raise and while transferring to and from a wheelchair. DESIGN: Repeated-measures analysis of variance. SETTING: Research laboratory. PARTICIPANTS: Twenty-five able-bodied subjects without spinal cord injury or shoulder symptoms (20 men, 5 women; age range, 20-37y). INTERVENTIONS: Completion of weight-relief raise and transfer tasks. MAIN OUTCOME MEASURES: An electromagnetic motion capture system tracked 3-dimensional position and orientation of the thorax, scapula, and humerus. Absolute angular values assessed included scapular downward and upward rotation, internal and external rotation, and posterior and anterior tipping all relative to the thorax, as well as humeral internal and external rotation relative to the scapula. Data were compared across 3 phases of the weight-relief raise and for transfer direction (leading arm, trailing arm). RESULTS: Key findings included significantly increased anterior tipping and internal rotation of the scapula and decreased scapular upward rotation and external rotation of the humerus during the weight-relief raise. The leading arm showed significantly greater scapular anterior tipping and internal rotation and less scapular upward rotation and humeral external rotation than the trailing arm during the final phase of the transfer. CONCLUSIONS: Both the weight-relief raise and transfer result in scapular and humeral positions and directions of motion that may negatively impact the available subacromial space. This may present increased risk for injury or progression of shoulder pain in persons who must routinely perform these tasks.

Adult↗
PubMed2003

Shoulder kinematics in subjects with frozen shoulder.

OBJECTIVES: To describe 3-dimensional humeral motion in subjects with frozen shoulder and to determine whether a consistent capsular pattern of restriction was present. DESIGN: Descriptive study including repeated measurements of shoulder kinematics. SETTING: Motion-analysis laboratory. PARTICIPANTS: Ten (9 women, 1 man) volunteers with a diagnosis of idiopathic adhesive capsulitis and 10 (9 women, 1 man) subjects with asymptomatic shoulders as comparison subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Electromagnetic tracking sensors monitored the 3-dimensional position of the trunk, scapula, and humerus throughout active shoulder motions. Peak humeral positions relative to the trunk and scapula were determined for shoulder flexion, abduction, scapular plane abduction, external rotation (ER), and internal rotation (IR). Descriptive statistics (means, standard deviations, percentage of normal) were calculated and capsular patterns described. RESULTS: For humeral position relative to the trunk, subjects' mean peak motion was as follows: abduction, 98.4 degrees; ER at the side, 4.5 degrees; ER with the arm abducted, 33.5 degrees; flexion, 116.9 degrees; IR at the side, 54.3 degrees; IR with the arm abducted, 17.8 degrees; and scapular plane abduction, 113.4 degrees. For humeral position relative to the scapula, subjects' mean peak motion was as follows: abduction, 46.4 degrees; ER at the side, 34.7 degrees; ER with the arm abducted, 45.3 degrees; flexion, 70.5 degrees; IR at the side, 10.3 degrees; IR with the arm abducted, -6.4 degrees; and scapular plane abduction, 61.7 degrees. CONCLUSIONS: Symptomatic subjects demonstrated substantial kinematic deficits during humeral range of motion. No single capsular pattern emerged.

Biomechanical Phenomena↗
PubMed2001

A three-dimensional regression model of the shoulder rhythm.

OBJECTIVE: The development of a thorax-fixed regression model for the shoulder which statistically predicts the orientation of the clavicle and the scapula from the humerus orientation. BACKGROUND: The application of three-dimensional position recording systems to the shoulder mechanism is limited to laboratory conditions. Studies in the field of ergonomics and sports require a method that can be applied in situ. It was found that the relation between the scapular and the humeral motions is consistent. In order to facilitate the biomechanical research on the shoulder a descriptive statistical model of the shoulder rhythm was developed. METHODS: The orientation of the shoulder bones of 10 subjects was determined in a large range of 23 humerus positions. The elbow was flexed in a splint and the arm was fully supported. The subjects exerted a 20 N external abduction and adduction force at the elbow in a plane perpendicular to the humerus. Other forces and moments were mechanically minimized. During the task the postures of the shoulder were recorded. The linear regression equations for the clavicular and scapular orientations were determined by means of a repeated measurements multi-variate analysis of variance for the co-variates: humerus orientation, initial orientation of the clavicle and the scapula, external force direction, gender and morphological characteristics of the subjects. RESULTS: The orientation of the clavicle and the scapula was predicted by five linear regression equations, including the co-variates: humerus orientation, external force direction and initial position. Morphology and gender did not significantly contribute to the clavicular and scapular orientation predictions. CONCLUSIONS: A statistical model is developed for the prediction of clavicular and scapular orientations, based on the humerus position, the initial posture and the direction of the external force. The model fitted well on an independent set of recorded position data for a different group of subjects. RELEVANCE: Morphological data of the shoulder girdle and gender did not significantly contribute to the model structure.

Biomechanical Phenomena↗
PubMed2000

A method of measuring three-dimensional scapular attitudes using the optotrak probing system.

OBJECTIVE: To develop a method to obtain accurate three-dimensional scapular attitudes and to assess their concurrent validity and reliability. STUDY DESIGN: In this methodological study, the three-dimensional scapular attitudes were calculated in degrees, using a rotation matrix (cyclic Cardanic sequence), from spatial coordinates obtained with the probing of three non colinear landmarks first on an anatomical model and second on a healthy subject. BACKGROUND: Although abnormal movement of the scapula is related to shoulder impingement syndrome, it is not clearly understood whether or not scapular motion impairment is a predisposing factor. Characterization of three-dimensional scapular attitudes in planes and at joint angles for which sub-acromial impingement is more likely to occur is not known. METHODS: The Optotrak probing system was used. An anatomical model of the scapula was built and allowed us to impose scapular attitudes of known direction and magnitude. A local coordinate reference system was defined with three non colinear anatomical landmarks to assess accuracy and concurrent validity of the probing method with fixed markers. Axial rotation angles were calculated from a rotation matrix using a cyclic Cardanic sequence of rotations. The same three non colinear body landmarks were digitized on one healthy subject and the three dimensional scapular attitudes obtained were compared between sessions in order to assess the reliability. RESULTS AND CONCLUSIONS: The measure of three dimensional scapular attitudes calculated from data using the Optotrak probing system was accurate with means of the differences between imposed and calculated rotation angles ranging from 1.5 degrees to 4.2 degrees. Greatest variations were observed around the third axis of the Cardanic sequence associated with posterior-anterior transverse rotations. The mean difference between the Optotrak probing system method and fixed markers was 1.73 degrees showing a good concurrent validity. Differences between the two methods were generally very low for one and two direction displacements and the largest discrepancies were observed for imposed displacements combining movement about the three axes. The between sessions variation of three dimensional scapular attitudes was less than 10% for most of the arm positions adopted by a healthy subject suggesting a good reliability. The Optotrak probing system used with a standardized protocol lead to accurate, valid and reliable measures of scapular attitudes. RELEVANCE: Although abnormal range of motion of the scapula is often related to shoulder pathologies, reliable outcome measures to quantify three-dimensional scapular motion on subjects are not available. It is important to establish a standardized protocol to characterize three-dimensional scapular motion on subjects using a method for which the accuracy and validity are known. The method used in the present study has provided such a protocol and will now allow to verify to what extent, scapular motion impairment is linked to the development of specific shoulder pathologies.

Biomechanical Phenomena↗
PubMed1998

Scapular dislocation.

Isolated dislocation of the scapula is a rare entity encountered in the emergency department. Two mechanisms have been proposed, a distraction injury to the arm or direct trauma to the posterior scapula. With blunt trauma, a search for adjacent injuries should be performed. Radiographs, especially anterior oblique views, will demonstrate lateral displacement of the scapula. Acute presentations should be managed by closed reduction, whereas for those presenting later or if the diagnosis is not initially suspected, open surgical reduction may be required. A case is reported of 32-year-old man with a scapular dislocation, and the literature is reviewed.

Adult↗
PubMed1999

Morphological character of the shoulder and leg skeleton in Przewalski's horse (Equus przewalskii).

The skeletal feature was observed in Przewalski's horse (Equus przewalskii) and the domestic horse (E. caballus). As results of the observations, remarkable differences were found in the scapula. The caudal border of the scapula in Przewalski's horse is curved in the caudal direction more than that of the domestic horse. Moreover, in the domestic horse, the sharp caudal border is formed by the shift of the outer muscular line (Linea muscularis) to the border. In Przewalski's horse, however, the caudal border is rounded because the outer muscular line does not shift to the border but lies beside it. We suggest that the morphological difference observed between the scapulae of these horses may lead to changes in the shoulder movement with the various attachments of the long head of the triceps muscle (Caput longum musculi tricipitis). The skeletal measurement and the measurement ratio show that the leg skeleton of Przewalski's horse is shorter and thicker than that of the domestic horse. These results show that the center of gravity of Przewalski's horse is low in position and that it has a short stride.

Animals↗
PubMed2001

Correction of scapular winging by supraclavicular neurolysis of the long thoracic nerve.

Injury to the long thoracic nerve results in winging of the scapula. When there is no known direct site of injury to this nerve, the traditional treatment consists of bracing the shoulder and, if recovery of function does not occur, then carrying out a muscle transfer to reconstitute the forces required to bring the scapula into appropriate position with respect to the thorax. The present report describes four patients in whom a site of compression of the long thoracic nerve within the scalene muscles proved to be the site of compression. A supraclavicular neurolysis of the long thoracic nerve resulted in correction of the winged scapula in all four of these patients.

Adult↗
PubMedDate not supplied

An alternative portal for scapulothoracic arthroscopy.

Access to the superior angle of the scapula during scapulothoracic arthroscopy with current standard portals can be difficult. A safe, effective alternative portal for scapulothoracic arthroscopy, located superior to the scapula, is described, which enables easier resection of the superomedial angle for treatment of the snapping scapula.

Arthroscopy↗
PubMed1989

Scapulectomy with latissimus dorsi musculocutaneous flap in the treatment of sarcoma of the upper back.

We present a patient in whom scapulectomy was performed to treat a huge malignant fibrous hystiocytoma of the back. Computed tomographic examination showed the tumor to have invaded the musculature of the upper back and about the scapula. To achieve adequate surgical excision, a major portion of the skin and soft tissue of the upper back was excised in conjunction with subtotal scapulectomy. The defect, with exposed vertebral spines and transected scapula, was covered with an ipsilateral latissimus dorsi musculocutaneous flap. Now, four years postoperatively, the patient has no evidence of recurrent disease and has good use of his arm. Total or partial excision of the scapula is rarely performed and poses unique problems. As our case demonstrates, scapulectomy (combined with musculocutaneous flap) is well tolerated, and surgeons should not be discouraged from using it when appropriate.

Aged↗
PubMed1998

Reconstruction of the shoulder joint using an acetabular allograft. A report of two cases.

Wide resection of tumors involving the glenoid region of the scapula compromises a center of motion in the shoulder joint and can cause significant loss of function. Two patients with aggressive tumor of the scapula were treated with wide resection and reconstruction using an osteoarticular acetabular allograft. The ball and socket geometry of the newly reconstructed joint and secure reattachment of soft tissues in the allograft provided a stable shoulder joint. The functional results of the two patients were 87% and 93%, respectively according to the Musculoskeletal Tumor Society system. In a select group of patients with locally aggressive lesions of the scapula, a surgical reconstruction with an osteoarticular allograft would yield satisfactory functional and cosmetic results.

Acetabulum↗
PubMedDate not supplied

Elastofibroma dorsi: CT demonstration.

Elastofibroma dorsi is a pseudotumorous connective tissue mass that characteristically arises between the chest wall and the inferior angle of the scapula. Its long axis is typically craniocaudal. Two patients are illustrated, each presenting with a fixed subscapular mass. Computed tomography showed each mass as elongated, incompletely marginated, and of soft tissue density deep to the inferior angle of a scapula. The latissimus dorsi and an underlying layer of fat were posterolaterally elevated inferior to the tip of the scapula. After incisional biopsy excluded sarcoma, each mass was locally excised.

Aged↗
PubMed1996

Isolated serratus anterior paralysis: a simple surgical procedure to reestablish scapulo-humeral dynamics.

We present an original surgical technique for the treatment of an isolated paralysis of the serratus anterior muscle. We used this technique on six patients in whom nonoperative treatment failed. We fixed the inferior angle of the scapula at approximately 35 degrees of lateral position with synthetic ribbon: not to the rib behind the inferior scapular angle but to the next lower rib, usually the eighth. Therefore the scapula was not fixed directly to the pectoral cage, but over a loop of 2-2.5 cm in length. This is the crux of the procedure, because this "loose" fixation enables lateral movement of the scapula and complete painless arm elevation without scapular winging. The follow-up period was 1-7 years (mean, 4 years and 9 months). The clinical results were "excellent" for five patients and "very good" in one patient. We recommend this procedure for its excellent restoration of shoulder function.

Adult↗
PubMed1986

The osteocutaneous scapular flap for mandibular and maxillary reconstruction.

Microfil injections in 8 cadavers and clinical experience with 26 patients have demonstrated a reliable blood supply to the lateral border of the scapula based on branches of the circumflex scapular artery. This tissue has been used successfully for reconstruction of a variety of defects resulting from maxillectomy and mandibular defects from cancer and benign tumor excisions. Advantages of this tissue over previous reconstructive methods include the ability to design multiple cutaneous panels on a separate vascular pedicle from the bone flap allowing improvement in three-dimensional spatial relationships for complex mandibular and maxillary reconstructions. The lateral border of the scapula provides up to 14 cm of thick, straight corticocancellous bone that can be osteotomized where desired. The thin blade of the scapula provides optimum tissues for palate and orbital floor reconstruction. There have been no flap failures and minimal donor-site complications.

Adolescent↗
PubMed1998

Vascularized bone grafts to the upper extremities.

From 1979 to 1995 in our clinic, vascularized bone grafting was performed in 29 patients with large bone defects, established nonunion, congenital pseudoarthrosis, or avascular necrosis in the upper extremity. Four patients had traumatic bone defects, six had posttraumatic nonunions, two had congenital pseudoarthroses, five had amputations, nine had defects following tumor resection, and three had other lesions. Reconstructed sites were the humerus in 7 patients, the radius in 12, the ulna in 2, both radius and ulna in 1, and the metacarpal and phalangeal bones in 7. Donor bones were fibula in 19 cases, radius in 6, scapula in 2, and medial condyle of the femur in 2. Postoperative circulatory disturbances and venous thrombosis resulted in revision surgery in two patients. Thrombectomy and reanastomosis to other veins were performed, and these flaps took successfully. No patients required additional bone grafts. The mean period required to obtain radiographic bone union was 4 months (fibula, 4.5 months; scapula, 3.5 months; radius, 2.6 months; medial condyle of the femur, 4 months). Vascularized fibula graft is indicated in patients with large bone defects in the humerus, radius, and/or ulna. The scapula is easy to transfer to the proximal humerus on its pedicle. This donor is indicated in young women because operative scars can be hidden. The radius is usually harvested with skin, and its use is indicated in patients with bone loss in the hand including thumb amputations. Thin corticoperiosteal graft from the femur is indicated in patients with established nonunion of the humerus and radius without significant bony defects.

Adolescent↗
PubMed1999

The anatomy of the angular branch of the thoracodorsal artery.

This study reports an anatomical investigation of the angular branch of the thoracodorsal artery, which can be used in reconstructive surgery to serve as a pedicle for gaining osseous material from the scapula. The study was performed on 135 samples and topography and morphometry of the vessel were investigated. It was found that this artery has five main types of origin. It courses in the fascial gliding layer between the serratus muscle, and the teres major and subscapular muscle to the inferior angle of the scapula. There it provides the bone with blood through periostal branches as part of the arterial rete on the costal and dorsal side of the scapula. The mean length of the angular branch and the thoracodorsal artery together was 148 mm, and when also adding the subscapular artery the overall length became 167 mm. It was found that the length of a pedicle consisting of the angular branch and the thoracodorsal artery is determined by the difference in origin of the vessels with minor influences of the body size. The internal diameters of unfilled fixated vessels measured 3.06 mm for the subscapular, 1.77 mm for the circumflex scapular, 1.30 mm for the thoracodorsal and 0. 64 mm for the angular branch. The exact knowledge of the microanatomy in this area is necessary to be able to use the osseous free flap more selectively and have less traumatization in the donor area.

Aged↗
PubMed1998

Articular facets of the coracoclavicular joint in Koreans.

This study was performed to investigate the occurrence of the coracoclavicular joint in Koreans. Materials used in this study were paired clavicles and scapulae obtained from 102 adult Korean cadavers (61 males, 41 females) ranging from 18 to 97 years in age. The occurrence of the joint was identified by a definite articular facet on the conoid tubercle of the clavicle and also by one on the superomedial surface of the coracoid process of the scapula. To compare the morphometric differences between specimens with and without coracoclavicular joint, the clavicle length, scapular border length, glenoid length, coracoid height, coracoacromial (CA) arch height, coracoid slope, and acromion slope were measured on all bones examined. The coracoclavicular joint was found in 10 (9.8%) of 102 individuals examined. Among them, nine (8.8%) showed bilateral coracoclavicular joints, and a unilateral right joint was noted in one case (1.0%). No significant difference in the incidence of the joint was noted between the right and left side. The incidence of the joint in males, a frequency of 9.8%, was the same as that in females. The joint was not found in individuals under 40 years old. However, the joint was present in 9.5% of those aged 40-59 years, and in 11.4% of those aged 60 years or over. There was no significant difference between various measurements taken from specimens with and without a coracoclavicular joint. These findings suggest that the occurrence of the coracoclavicular joint is related to aging, but not to the size of the scapulae or the slopes and heights of some CA arch elements.

Adolescent↗
PubMed2001

Scapular insertion of the rabbit latissimus dorsi muscle: gross anatomy and fibre-type composition.

This paper defines the characteristics and significance of the scapular insertion of the latissimus dorsi muscle (LDM) of the rabbit. In a study of the New Zealand White species (n = 10) the scapular insertion was found to be a consistent anatomical feature of the LDM that made up 12.3% (+/-2.3) of the total muscle weight. The fibres arise from the medial aspect of the body of the LDM and run in a caudocranial direction to be inserted into a broad, thin tendon beneath the scapula ridge. This is morphologically different from the scapular component of the human LDM which is a well-recognized but inconsistent feature and consists of no more than a small leash of fibres running around the lower pole of the scapula. The scapular insertion was deeper red in colour than the body of the muscle and fibre-typing demonstrated a mean slow-fibre composition of 49% (+/-2.6) compared to 16% (+/-1.7) for the body of the muscle (p < 0.01). Mapping of the fibre types throughout the remainder of the LDM confirmed that the body of the muscle was of fast phenotype but with significantly more slow fibres in the superomedial segment of the muscle than elsewhere. This region of the muscle contributes mainly to the scapular insertion and it is proposed that this part of the muscle takes on a predominantly postural role in stabilising the scapula during movement of the forelimb.

Adenosine Triphosphatases↗