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PubMed2003

Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles.

STUDY DESIGN: This study used a prospective, single-group repeated-measures design to analyze differences between the electromyographic (EMG) amplitudes produced by exercises for the trapezius and serratus anterior muscles. OBJECTIVE: To identify high-intensity exercises that elicit the greatest level of EMG activity in the trapezius and serratus anterior muscles. BACKGROUND: The trapezius and serratus anterior muscles are considered to be the only upward rotators of the scapula and are important for normal shoulder function. Electromyographic studies have been performed for these muscles during active and low-intensity exercises, but they have not been analyzed during high intensity exercises. METHODS AND MEASURES: Surface electrodes recorded EMG activity of the upper, middle, and lower trapezius and serratus anterior muscles during 10 exercises in 30 healthy subjects. RESULTS: The unilateral shoulder shrug exercise was found to produce the greatest EMG activity in the upper trapezius. For the middle trapezius, the greatest EMG amplitudes were generated with 2 exercises: shoulder horizontal extension with external rotation and the overhead arm raise in line with the lower trapezius muscle in the prone position. The arm raise overhead exercise in the prone position produced the maximum EMG activity in the lower trapezius. The serratus anterior was activated maximally with exercises requiring a great amount of upward rotation of the scapula. The exercises were shoulder abduction in the plane of the scapula above 120 degrees and a diagonal exercise with a combination of shoulder flexion, horizontal flexion, and external rotation. CONCLUSION: This study identified exercises that maximally activate the trapezius and serratus anterior muscles. This information may be helpful for clinicians in developing exercise programs for these muscles.

Adult↗
PubMed1996

A case report of Cheyletiella infestation on a Whippet dog in Korea.

A clinical case of Cheyletiella infestation on a dog born and raised in Korea is reported. A three-year old female Whippet was hospitalized due to a multiple fracture and displacement of the left scapula caused by a recent car accident. The mite infestation was not noticed at the time of hospitalization. The dog underwent multiple operations involving internal fixation of the fractured scapula with wire and a plate, followed by extensive chemotherapy with antibiotics and prednisolone. After two months of hospitalization, a pruritic dermatitis near the left scapula developed. Multiple white dandruff-like flakes were seen on the hair coat, especially over the dorsal spine and neck, and the dog expressed increased pruritus by frequently licking and scratching the affected areas. Local dense accumulations of skin debris that became crusty were also observed. Microscopic examination of a skin scraping revealed a heavy infestation of cheyletiella yasguri, as identified by the presence of hoks of the palpi and the heart-shaped sensory organ on genu I. Immunosuppression elicited by the extensive administration of prednisolone was suspected for the initiation of the generalized mite infestation.

Animals↗
PubMed2000

[Advantages and limitations of whole-body bone marrow MRI using Turbo-STIR sequences in comparison to planar bone scans] .

UNLABELLED: At modern MRI tomographs the whole body can be screened for bone marrow metastases within 45 min. AIM of this study was to evaluate the diagnostic advantages and disadvantages of a whole-body bone marrow MRI protocol using Turbo Short Tau Inversion Recovery [STIR] sequences in comparison to planar bone scintigraphy (SZ). PATIENTS AND METHODS: In order to screen for bone metastases within two weeks SZ and whole-body MRI with Turbo-STIR-sequences were performed in 20 patients with known breast cancer. For further evaluation five regions were defined: skull, spine including the pelvis, femora, humeri and ribs including scapulae and sternum. RESULTS: In 9/20 patients neither with SZ nor with MRI bone metastases were detected (staging M0). Among the remaining 11 patients SZ detected 109 and MRI 150 lesions which were typical for bone metastases. All of these 11 patients were staged M1 correspondingly with both methods. Within the thorax (ribs, sternum, scapulae) MRI discovered only 6/17 and within the skull 0/6 lesions which were suspicious for metastases in SZ. Inversely MRI identified much more metastatic lesions than SZ within the femora (20/16), the humeri (14/12) and the spine including the pelvis (110/58). CONCLUSIONS: Susceptibility-, truncation-, chemical-shift-, third arm- and particularly pulsation artifacts along with the impossibility to chose slice orientation equally advantageous for all regions of the body cause impaired image quality of MRI whole body scanning. Therefore, concerning the detection rate of bone metastases within the thorax (ribs, sternum and scapulae) and the skull, conventional Turbo-STIR-MRI whole-body scans are even less accurate than conventional planar bone scintigraphy in those regions.

Bone Marrow↗
PubMed2002

[Mechanical complications of total shoulder inverted prosthesis].

Our series of inverted prosthesis included 5 patients with a mean age of 73 +/- 6 years. In 4 cases, the implant was performed as a surgical revision. The follow up was 81 +/- 15 months. Three shoulders were pain free whereas two caused a dull pain after a free interval due to mechanical complications. The mean active elevation was 72 degrees while external rotation was - 2 degrees. The adjusted Constant score passed from 32 to 60. In case of complications, the score dropped to 32. Mechanical complications were important with in one case, an unscrening of the glenosphere and in two cases, a loosening of the glenoid prosthesis. This last and major complication occurred 6 years after surgery and was promoted by the occurrence of a progressive bone erosion in the scapula. This gap represented an attempt to accomodate the medial part of the humeral prosthesis under the scapula when the arm is at rest or in adduction. The concept of an inverted prosthesis is attractive and this implant remains one of the options in cuff-tear arthropathy. Our results were not as good as those reported by others but most of ours patients had been already operated before. The occurrence of an osseous gap on pilar of scapula may lead to failure of this prosthesis. This gap remains a threath as it can progress and as such warrants a design alteration of the prosthesis.

Activities of Daily Living↗
PubMed2003

Disseminated Mycobacterium avium complex (DMAC) in an immunocompetent adult.

A female patient with multiple osteomyelitis and pulmonary Mycobacterium avium disease visited an orthopaedic clinic with back pain. Systemic bone scan showed multiple sites of increased radioactivity in the vertebral bodies, right scapula, femurs and ribs. M. avium was isolated from sputum and a sample aspirated from the right scapula. The route of infection was unknown as there was no history of trauma or surgery. HIV testing was negative. As there was no underlying immunological disease she was diagnosed as disseminated M. avium complex (DMAC) disease in an immunocompetent adult. Cytokine production on several stimuli from peripheral blood mononuclear cells was similar to that in pulmonary M. avium patients. Sequence analysis of IFN-gamma receptor revealed no nucleotide substitution. We detected serotypes 1, 2 and 4 from mycobacteria cultured from the right scapula, and conclude that this case could be the result of undetected immune deficiency and/or unrecognised virulence of the infecting isolate.

Female↗
PubMed1992

[Bilateral absence of the quadrangular space of the axilla].

In the 1988 student course on gross anatomy dissection of cadavers at Iwate Medical University School of Medicine, two cases of the absence of the quadrangular space of the axilla were found bilaterally in a 92-year-old female who had died of heart failure. The cases were investigated anatomically. The tendons of insertion of the latissimus dorsi and the teres major muscles and the tendon of origin of the long head of the triceps brachii muscle were united, forming a conjoint tendon that attached to the infraglenoid tubercle of the scapula and the lower part of the anatomical neck of the humerus adhering to the articular capsule of the shoulder joint. The subscapularis muscle was normal except that a muscular bundle arose from the conjoint tendon and inserted to the lesser tubercle of the humerus and the crest continuing down from the tubercle. A part of the conjoint tendon was covered by the insertion of the subscapularis muscle, and there was no space between the conjoint tendon and the insertion of the subscapularis muscle. The teres major muscle was poorly developed, but the area of origin was rather wide and arose from both the dorsal and costal surfaces of the scapula. The anatomical features of the latissimus dorsi and the long head of the triceps brachii muscles were normal except for the insertion of the former and the origin of the latter. The triangular space of the axilla was found to be surrounded by the conjoint tendon, teres major muscle, and the lateral border of the scapula covered by the subscapularis and the teres minor muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Simple obesity in children. A study on the role of nutritional factors].

UNLABELLED: Excessive amount of adipose tissue in children and adolescents and simple obesity in particular constitute a growing health problem throughout the world. Adverse health effects of obesity of children justify the need to look for efficient treatments, among them the dietary treatment. THE AIM OF THE STUDY was to examine the effectiveness of dietary treatment in children with simple obesity on the basis of thorough analysis of their state of nutrition, method of nutrition and eating habits and the impact of other environmental factors. Four research hypotheses were formulated: 1. simple obesity of children is influenced by selected environmental factors such as parents' level of education, familial inclination to obesity and health habits, 2. chosen and accepted by the child and/or its mother/parents programme of dietary treatment in the form of low-energy diet with elements of low glycemic index results in the loss of body mass in children, 3. implemented dietary treatment translates into the modification of basic anthropometric features--body mass, body height, thickness of skin and adipose folds on arm, below shoulder blade (scapula), on abdomen as well as arm circumference and anthropometric parameters of examined children--body mass index BMI, waste-hip ratio, body fat content, 4. implemented dietary treatment has an impact on modification of certain biochemical indicators--lipid profile of children with increased indicators of lipid metabolism. MATERIAL AND METHODS: The research concerned 236 children living in the Mazowsze region with diagnosed simple obesity (relative body mass index rel BMI =20%), directed to Gastroenterological and Endocrinological Unit of the Institute of Mother and Child, after the children and/or their mothers/parents had accepted participating in a ten-week long research programme. The state of nutrition was evaluated on the basis of the examination of 8 basic features and 5 anthropometric parameters and basic biochemical indicators of metabolism of carbohydrates and fats, before and after the beginning of dietary treatment. The assessments of the method of nutrition, including eating habits, proportions of food products in the food ration and nutritional value of daily food rations was conducted on the basis of 10-14-day records of the child's diet before the implementation of dietary treatment and on the basis of randomly selected 3-day records of the child's diet from the diet book after the dietary treatment was introduced. The environmental data were collected on the basis of a questionnaire, constructed for this study. RESULTS: The main risk factors for simple obesity in examined children (n=236) aged 3-15 yrs were familial and environmental conditions. A significant correlation was found between the children's obesity expressed by a normalized body mass index BMI z-score, unrelated to age and sex, and mother's level of education and father's obesity (Chi(2) test, p<0.05). A positive correlation was demonstrated between the normalized relative body mass index (BMI z-score) and children's anthropometrical parameters--thickness of skin and adipose folds on the arm, below the shoulder blade (scapula), on the abdomen and their sum, arm circumference, waste-hip ratio and body fat content and the children's parents body mass index (father's BMI, mother's BMI). In boys with simple obesity the tendency to central obesity was observed since early childhood. In the examined group of children no distortions of metabolism of carbohydrates were observed (correct fasting levels of glucose), while in children with obesity the irregularities of metabolism of fats were noted. The implemented dietary treatment (low energy diet with elements of low glycemic index) had a significant impact on improvement of lipid metabolism in all children in whom the irregularities of metabolism of fats were noted. Modification of the diet of children aged 3-6 by implementing dietary recommendations, including the increased frequency of meals and the choice of products with low glycemic index, did not have a significant impact on the decrease of the body mass index in 95% of examined children. A considerable number of children aged 3-6 (n=12) continued to eat only three meals a day and their model of nutrition, including the selection of products, was not significantly modified. The introduced low energy diet with elements of low glycemic index in children of school age (7-15 years) with simple obesity positively influenced the decrease of analyzed features and parameters (p<0.0001). During dietary treatment statistically significant decrease of the children's body mass was observed as well as a decrease of the thickness of skin and adipose folds on the arm, below the shoulder blade (scapula), on the abdomen and a decrease of arm circumference and body fat content. The change of the energy content of a daily food ration, the amount of consumed carbohydrates and products from the group of sugar and sweets, cereal foodstuffs and fat and products from the group of other fats was positively correlated with body mass loss expressed as the difference between z-score BMI before and after the dietary treatment. The modification of the eating habits--increased frequency of meals and reduction or elimination of eating between the meals during the nutrition intervention were not significantly linked to the change of normalized body mass index in the examined children. Only the frequency of eating sweets was related to the change of z-score BMI (p<0.05). The implemented dietary treatment in obese children aged 7-15 yrs significantly influenced the body mass loss. In children (n=38/236) with lipid metabolism abnormalities, the low energy diet with elements of low glycemic index had a favorable impact on the lipid profile. The increased levels of total cholesterol, LDL cholesterol and triglycerides returned to normal. CONCLUSIONS: 1. Simple obesity in children aged 3-15 yrs is connected with familial and environmental factors, including incorrect eating habits. 2. Dietary treatment consisting in the lowering of energetic value of the diet through the reduction of fat consumption and quantity and quality changes with respect to carbohydrates consumption decreased the children's obesity, and was more effective in the older age group (7-15 yrs). Dietary treatment normalizes the lipid profile in children. 3. Significant body mass loss has been observed in children in whose diet the amount of proteins and their share in the total energy value only slightly differs from the level before the dietary treatment. The amount of proteins in the children's diet was within the range of physiological recommendations.

Adolescent↗
PubMed1980

[Shoulder movements during abduction and adduction of quadriplegic patients (author's transl)].

The relationship between glenohumeral and scapular movements during abduction and adduction of the limb in the scapular plane were studied in twenty normal subjects and nine quadriplegic patients by analysis of roentgenograms and enveloped electromyograms with electrogoniometer. In normal subjects the ratio of glenohumeral to scapulothoracic movement was 4.2 : 1 for the range 0-30 degrees and 1.7 : 1 for the range 30-150 degrees for abduction, and 1.9 : 1 for the range 150-30 degrees and 1.7 : 1 for the range 30-0 degrees for adduction. In comparing quadriplegic patients with normal subjects, outstanding medial shift of the scapula was observed in early phase of abduction, elevation, and upward rotation of the scapula which were limited through whole abduction. Distances of the shift of the scapula in quadriplegic patients were the same as those in normal subjects in the final phase of adduction. In enveloped electromyograms of normal subjects, each activity of the six sampled muscles, increased or decreased gradually during abduction and adduction in similar relationships. The upper fiber of the trapezius demonstrated the highest activity through abduction and adduction. During abduction and adduction the supraspinatus showed undulated wave patterns and had the plateau at 80-140 degrees. The activity of the supraspinatus was higher than that of the deltoideus statistically for the range 0-40 degrees for abduction. In each quadriplegic patient the patterns of muscle activities during abduction and adduction were characteristically peculiar and did not indicate any constant relationship findings in normal subjects, irrespective of the functional level.

Action Potentials↗
PubMed1994

[Biomechanics of the shoulder and its surgical consequences: personal experience operating on 250 shoulders].

Functional anatomy induces functional surgery. According to the anatomy of the locomotor apparatus, biomechanics opens the way to a more logical surgery. Two main concepts rule the study of the shoulder: the articular complex; the muscular chain. The articular complex: the scapulo- humeral joint is the main of the motion. The 50% remaining are due to the movements of the scapula around the thorax. The muscular chain: sixteen muscles are concerned in shoulder motion. They are classified in two principal groups: long muscles, fixing the scapula upon the thorax short muscles are disposed in two plans: superficial (deltoïd) deep, called the rotator cuff (subs scapularis; supraspinatus; infra-spinatus; teres minor). They only produce motion of the humerus on the scapula. The lateral elevation of the arm relies on the harmonious contraction of all these muscles. The mechanical environment of the cuff, particularly of the supra spinatus is not a favorable one: poorly vascularised, overworking, it goes through a narrow osteo fibrous tunnel. This produces irritation or rupture of the muscle. The surgery is indicated only in case of medical treatment failure. It has two alternative purposes, either to suppress the anterior conflict between the acromial vault and the cuff, or to repair a rupture of the supra spinatus. The acromioplasty is a benign operation that gives excellent results: 65% recover a normal shoulder. We notice 10 to 15% failures (105 cases. Follow up one to ten years). The surgery of reinsertion of the supra spinatus is a little more difficult and the results are less convincing: 36% good and excellent results; 43% fair; 21% failures (82 cases. Follow up one to fifteen years).

Biomechanical Phenomena↗
PubMed1998

Association of active myofascial trigger points and cervical disc lesions.

We investigated the occurrence of active myofascial trigger points in specific muscle groups in relation to the existence of cervical disc bulging at various levels. One hundred and five patients (48 men, 57 women; mean age, 45.8 +/- 12.1 yr) who had active trigger points in the neck or upper back after trauma were divided into two groups on the basis of magnetic resonance imaging (MRI) evidence of bulging disc(s). The discN group consisted of 46 patients who had normal MRI findings in the cervical spine. The other 59 patients, with mild cervical disc bulging, were assigned to the disc' group. The correlations between specific muscles with active trigger points (clinical finding) and cervical disc lesions at specific levels (MRI finding) were analyzed. There were significant associations between the level of disc lesion and the muscles with trigger points, namely C3-4 lesions with levator scapulae and latissimus dorsi trigger points; C4-5 lesions with splenius capitis, levator scapulae, and rhomboid minor trigger points; C5-6 lesions with splenius capitis, deltoid, levator scapulae, rhomboid minor, and latissimus dorsi trigger points; and C6-7 lesions with latissimus dorsi and rhomboid minor trigger points. For each disc level, the average pain intensity (assessed using a numerical analog scale) of trigger points in certain correlated muscles (as indicated above) in the disc group was significantly higher than that in the discN group (p < 0.05 for all disc levels). We conclude that active trigger points are more likely to occur in certain muscles in the presence of cervical disc lesions at specific levels.

Adult↗
PubMed1986

Surgical anatomy of the scapular spine in the trapezius-osteomuscular flap.

Measurements of the spine of the scapula in relationship to the trapezius-osteomuscular flap were made in a series of cadavers. These measurements enable estimation of the amount of available bone present and give the reconstructive surgeon a series of guidelines for using the trapezius-osteomuscular flap in correcting mandibular defects. A related phase of this investigation was the development of a roentgenographic technique using the 30 degree cephalic view of the shoulder for preoperative assessment of the spine of the scapula.

Aged↗
PubMed2003

Scapular fixation in muscular dystrophy.

BACKGROUND: Winging of the scapula is caused by weakness of the thoracoscapular muscles, which allows the scapula to lift off the chest wall during shoulder movements. In facioscapulohumeral muscular dystrophy (and occasionally in other muscular dystrophies) there is selective weakness of the thoracoscapular muscles which may spare other shoulder muscles such as the deltoid muscle. This imbalance results in significant winging and loss of shoulder function. Historically, a number of different surgical and non-surgical interventions have been used to achieve scapular stability. This review examines the evidence available for the use of all scapular fixation techniques in muscular dystrophy, especially facioscapulohumeral muscular dystrophy. OBJECTIVES: To examine the evidence for the relative efficacy of scapular fixation techniques in muscular dystrophy (especially fascioscapulohumeral muscular dystrophy) in improving upper limb function. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group trials register (search updated March 2003) for randomised trials and other reports, and made enquiries from authors of trials and other experts in the field. SELECTION CRITERIA: All reports of scapular fixation for muscular dystrophy, including quasi-randomised or randomised controlled trials, comparing any form of scapular fixation (surgical and non-surgical) in people (of all ages and of all severity) with scapular winging due to muscular dystrophy. Our primary outcome measure was objective improvement in shoulder abduction. Our secondary outcome measures were: patient-perceived improvement in performance of activities of daily living, cosmetic results, subjective improvement in pain and proportion of patients with significant postoperative complications. DATA COLLECTION AND ANALYSIS: We collated and summarised studies on the treatment of scapular winging in muscular dystrophy. MAIN RESULTS: No randomised trials were identified. We therefore present a review of the non-randomised literature available. REVIEWER'S CONCLUSIONS: Operative interventions appear to produce significant benefits, though these have to be balanced against postoperative immobilisation, need for physiotherapy and potential complications. We conclude that a randomised trial would be difficult, but a register of cases and the use of a standardised assessment protocol would allow more accurate comparison of the disparate techniques.

Humans↗
PubMed1989

Congenital shortness of the costocoracoid ligament.

We report a large kindred in which individuals presented with fixation of the scapula to the first rib by a congenitally short costocoracoid ligament. Cosmetic deformity with rounding of the shoulder and loss of the anterior clavicular contour was the main concern of the affected individuals. Movements requiring rotation or retraction of the scapula were limited, although this did not interfere with normal activities. Surgical treatment consists of excision of the costocoracoid ligament and resulted in some correction of the cosmetic deformity. The pedigree supports an autosomal dominant mode of inheritance with variable expression. The abnormality results in a pectoral girdle which is reminiscent of that seen in the monotremes.

Adult↗
PubMed2006

On the trail of pulmonary tuberculosis based on rib lesions: results from the Human Identified Skeletal Collection from the Museu Bocage (Lisbon, Portugal).

In the last 20 years, studies on human identified skeletal collections have revealed a significant relationship between new bone formation on the visceral surface of ribs and pulmonary tuberculosis (TB). To improve methods of differential diagnosis of respiratory diseases in archaeological skeletons, an investigation was conducted on 197 individuals from the Human Identified Skeletal Collection of the Museu Bocage (Lisbon, Portugal). This sample included 109 males and 88 females who lived during the 19th-20th centuries, with ages at death ranging from 13-88 years. The skeletons were grouped according to cause of death: 1) pulmonary TB (N = 84); 2) pulmonary non-TB diseases (N = 49); and 3) a control group (N = 64) composed of individuals randomly selected among the extrapulmonary non-TB causes of death. The ribs, sterna, scapulae, and clavicles were macroscopically observed. New bone formation on the visceral surface of ribs was recorded in 90.5% (76/84) of individuals who died from pulmonary TB, in 36.7% (18/49) with a pulmonary non-TB disease as cause of death, and in 25.0% (16/64) of the control group. These differences were statistically significant (P < 0.001). Furthermore, in individuals with pulmonary TB, the bony lesions presented mainly as lamellar bone on the vertebral end of the upper and middle thoracic rib cage. Proliferative alterations also occurred on one sternum and in nine clavicles and eight scapulae. This work strongly supports the results of similar studies performed on other documented collections, suggesting that new bone formation on ribs, although not pathognomonic, is a useful criterion for the differential diagnosis of pulmonary TB.

Adolescent↗
PubMed1991

Structural studies of the mineral phase of calcifying cartilage.

The calcified cartilage of the epiphyseal growth plate of young calves has been studied by x-ray diffraction. Fourier transform infrared spectroscopy, magic angle 31P nuclear magnetic resonance spectroscopy, and chemical composition. The powdered tissue was separated by density centrifugation as a function of mineral content and thus qualitatively of the age of the calcium-phosphorus mineral phase. The individual density centrifugation fractions were examined separately. X-ray diffraction of the samples, especially of the lowest density fractions, revealed very poorly crystalline apatite. Fourier transform infrared spectroscopy and 31P nuclear magnetic resonance spectroscopy revealed the presence of significant amounts of nonapatitic phosphate ions. The concentration of such nonapatitic phosphates increases during the early stages of mineralization but then decreases as the mineral content steadily rises until full mineralization is achieved. The total concentration of carbonate ions was found to be much lower in calcified cartilage than in bone from the same organ (scapula). The carbonate ions are located in both A sites (OH-) and B sites (PO4(3-)), with a distribution similar to that found in bone mineral. However, discrepancies between infrared resolution factors of phosphate and carbonate bands are consistent with a heterogeneous distribution of carbonate ions in poorly organized domains of the solid phase of calcium phosphate. These initial studies permit one to characterize the calcium phosphate mineral phase as a very poorly crystalline, immature calcium phosphate apatite, rich in labile nonapatitic phosphate ions, with a low concentration of carbonate ions compared with bone mineral of the same animal, indeed from the bone of the same organ (scapula).

Animals↗
PubMed2003

Sonographic detection of elastofibroma dorsi.

We describe the case of a 78-year-old man with a large elastofibroma deep to his scapula that was inconspicuous on MRI examination with his arm at his side in neutral position. The mass was not detected sonographically until the patient abducted his arm, allowing the elastofibroma to emerge from under the scapula. The diagnosis of elastofibroma was suggested by the typical sonographic appearance of a hypoechoic mass with interspersed linear echogenicity, resembling muscle. The mass was excised, and the diagnosis was confirmed on histopathologic examination.

Aged↗
PubMed2005

Growth of the pectoral girdle of the Leopard frog, Rana pipiens (Anura: Ranidae).

This article describes the growth of the anuran pectoral girdle of Rana pipiens and compares skeletal development of the shoulder to that of long bones. The pectoral girdle chondrifies as two halves, each adjacent to a developing humerus. In each, the scapula and coracoid form as single foci of condensed chondrocytes that fuse, creating a cartilaginous glenoid bridge articulating with the humerus. Based on histological sections, both the dermal clavicle and cleithrum begin to ossify at approximately the same time as the periosteum forms around the endochondral bones. The dermal and endochondral bones of the girdle form immobile joints with neighboring girdle elements; however, the cellular organization and growth pattern of the scapula and coracoid closely resemble those of a long bone. Similar to a long bone epiphysis, distal margins of both endochondral elements have zones of hyaline, stratified, and hypertrophic cartilages. As a result, fused elements of the girdle can grow without altering the glenoid articulation with the humerus. Comparisons of anuran long bone and pectoral girdle growth suggest that different bones can have similar histology and development regardless of adult morphology.

Animals↗
PubMed2006

The thoracodorsal artery perforator flap with a vascularized scapular segment for reconstruction of a composite lower extremity defect.

High-energy trauma resulting in a composite defect of the lower extremity confronts the microvascular surgeon with more difficulties than do free flap reconstruction elsewhere in the body, since the choice of distant recipient vessels is particularly difficult. Combining principles of perforator flap surgery with those of composite tissue transfer, we designed a thoracodorsal artery perforator flap with a vascularized bone segment from the scapula for reconstruction of a composite lower extremity defect in a patient following a paragliding accident. This is the first report on the application of a composite thoracodorsal artery perforator flap with vascularized scapula in lower extremity reconstruction. Among its multiple advantages, such as preservation of latissimus dorsi function, it is a good tool for one-stage reconstruction of traumatic composite lower extremity defects because its low donor site morbidity and long vascular pedicle enables anastomosis placement outside the zone of injury.

Humans↗