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PubMed1996

Measurements of scapular position and rotation: a reliability study.

Smooth motion of the scapula and humerus with respect to the thorax is essential for shoulder function and abnormalities may indicate clinical entities. Recent studies have made an attempt to devise simple, practical means of quantifying scapular position. The aim of this study was to examine the intra-tester and inter-tester reliability of two methods and to determine if significant differences existed between the dominant versus non-dominant extremity. Seventeen healthy volunteers (4 M; 13 F) were examined by two testers. The tape measurements consisted of the classic methods of Kibler and DiVeta in three sitting postures, expanded by the measurement of the linear distance from the medial border to the thoracic mid-line, and the scapular size measure. The SAS software package was used for data analysis. The Intraclass Correlation Coefficient (ICC) intra-tester reliability ranged between 0.96-0.8 for both methods without significant differences, whereas the ICC for inter-tester reliability ranged between 0.42-0.9 with higher values (moderate and good) for the Kibler technique. In the additional tests high values were also obtained for ICC intra-tester, except for the measurements of the linear distance of the medial border of the scapula to the thoracic mid-line and the distance of the inferior process of the acromion to the third vertebra, both in 90 degrees abduction and internal rotation. The ICC for inter-tester was only acceptable for the DiVeta measurement on 45 degrees abduction. Significant differences were noted between both testers on the following measures: Kibler in 45 degrees abduction, DiVeta in 45 degrees abduction and 90 degrees abduction and the scapular size measure. The comparison of dominant versus non-dominant extremity revealed larger but not significantly different means for the dominant extremity in the classic methods. Significant differences occurred for Tester 1 in the measurement of the distance of the medial border to the thoracic mid-line and Tester 2 in DiVita in 45 degrees abduction. The SEM values never exceeded 1 cm. We believe that the Kibler technique holds promise for further studies, has the advantage of measuring in three positions and with some familiarisation can be reliable. Further research is necessary in patients with pathological conditions.

Adult↗
PubMed1979

Sprengel's deformity. Radiology of the pathologic deformation.

A unique specimen of unilateral Sprengel's deformity, and contralateral normal pectoral girdle, were studied morphologically and roentgenographically. The cervical spine exhibited multiple abnormalities involving both the vertebral centra as well as the posterior elements (Klippel-Feil abnormality). A small spina bifida involving C5 and C6 was present. Abnormalities of the spinous processes included an articulation with a well-formed omovertebral bone that also articulated with the vertebral (infraspinatus) margin of the scapula. Secondary (presumed epiphyseal) ossification was present in the omovertebral bone at the distal end. The scapula was deformed, especially in the supraspinatus portion. The clavicle was shorter and had a different contour.

Abnormalities, Multiple↗
PubMed1990

The Tikhoff-Linberg procedure for bone tumors of the proximal humerus: the classical "extensive" technique versus a modified "transglenoid" resection.

The authors report on two groups of patients (each with 12) with primary bone tumors of the humerus who underwent either a classical Tikhoff-Linberg (T-L) procedure or a modified technique by which the body of the scapula was saved. The latter procedure was an "en bloc" resection of the glenohumeral joint after an extra-capsular osteotomy of the neck of the scapula, followed by reconstruction with a modular prosthesis. Indications, perioperative differences, and complications of both procedures are discussed. Besides producing better aesthetic and functional results, the modified technique offered the advantages of shorter anesthesia time, less blood loss, and a better anchorage of the prosthesis. The results of this study show that the proposed modification of the T-L procedure is indicated in patients with bone tumors of the proximal humerus in which invasion of the joint capsule is present without macroscopic involvement of the glenoid.

Adolescent↗
PubMed1992

Bilateral scapular fractures secondary to electrical shock.

Fractures of the scapula are rare injuries. Usually the scapula requires a high-energy impact to sustain a fracture. Various fractures have been noted as a result of convulsive seizures. We report bilateral scapular fractures caused by electric shock and discuss their pathomechanical origin.

Electric Injuries↗
PubMed2006

Orientation feedback during simulated simple translation tests has little clinical significance on the magnitude and precision of glenohumeral joint translations.

The repeatability of shoulder instability clinical examinations has been reported to be poor, producing a large range of translations. The objective of this study was to determine the effect of providing the clinician with joint orientation feedback on the magnitude and precision of glenohumeral joint kinematics. A 6-degree of freedom magnetic tracking system was used to determine the kinematics of the humerus with respect to the scapula (n=8 cadaveric shoulders). The joints were preconditioned with simple loading tests five times. At 60 degrees of glenohumeral abduction and 0 degrees of flexion/extension, a clinician then applied an anterior and posterior load to the humerus until a manual maximum simulating a simple translation test (STT) was achieved at 0, 30, and 60 degrees of external rotation with and without angular orientation feedback of the humerus with respect to the scapula. The precision for the external rotation was within 4.3 degrees for the feedback group and 17.5 degrees for the no feedback group over all external rotations. For achieving the target external rotation of 30 degrees , there was a significant difference in precision between the feedback and no feedback groups (p<0.05). The magnitudes of the anterior translations were 18.2+/-5.3, 15.5+/-5.1, and 9.9+/-5.5 mm for the feedback group and 19.3+/-6.6, 17.5+/-4.9, and 11.5+/-5.3 mm for the no feedback group, at 0, 30, and 60 degrees of external rotation, respectively. There was a significant difference in the precision of anterior translation at 30 and 60 degrees of external rotation for 4 of 8 specimens (p<0.05). Significant differences in the precision of the posterior translation was only detected at 0 degrees of external rotation for 3 of 8 specimens (p<0.05). Based on the data obtained, providing orientation feedback to a clinician performing a simulated STT results in increased precision for not only the target external rotations but also the resulting glenohumeral translations. While providing feedback may be a necessary step to achieving precise results for experimental studies, the magnitudes of translations in the anterior and posterior directions were relatively similar for the feedback and no feedback states indicating little benefit for clinical examinations.

Biomechanical Phenomena↗
PubMed2003

Duplication of the clavicle with triplication of the coracoid process.

A very rare case of duplication of the clavicle and triplication of the coracoid process of the scapula is presented. Duplication of the clavicle has been described in only six reports based on a search of the world literature. There is no mention of duplication or triplication of the coracoid process of the scapula in the world literature and this would appear to be the first report of this kind. A combination of bifurcation and triplication of the clavicle and coracoid process, respectively, in the present case illustrates that even anomalous bones search for their counterpart to form a joint. The process of duplication or triplication is explained with a new hypothesis.

Adult↗
PubMed2000

The subclavius posticus muscle: a factor in arterial, venous or brachial plexus compression?

During dissection practice in 1993 and 1995 to 1999, we found an aberrant muscle which connected the first costal cartilage and the superior margin of the scapula in 12 sides (4.8%) of 11 cadavers (8.9%) among 248 sides of 124 cadavers. The muscle originated from the cranial surface of the sternal end of the first rib, ran laterodorsally, and inserted into the superior margin of the scapula. According to the origin and insertion, the aberrant muscle was considered to be the subclavius posticus (Rosenmüller, 1800). We also examined the supraclavicular region of a living subject by MR imaging to estimate the course of such an aberrant muscle. It is thought that the aberrant muscle runs on the anterior surface of the subclavian vein and crosses over the brachial plexus. Such a muscle could be considered as a possible factor causing the Paget-von Schrötter syndrome which is recognized as spontaneous or effort-related thrombosis of the axillo-subclavian vein. It is recommended to take into account the possible existence of such an aberrant muscle during the examination of patients with thoracic outlet syndrome, especially in those with symptoms of venous compression.

Brachial Plexus↗
PubMed1999

Bone mineral density of the shoulder joint in frozen shoulder.

The purpose of this study was to evaluate the osteopenia in several parts of the shoulder joint in a series of individuals suffering from frozen shoulder and to elucidate the pathogenesis. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA). In 30 cases of frozen shoulder, 16 men and 14 women, BMD of the head of the humerus, greater tubercle of the humerus, surgical neck of the humerus, and neck of the scapula was evaluated. The average age of the male patients was 58.4 years and of the women, 59.5 years. At the neck of the scapula, there were no significant differences in any of the cases. However, there was a marked decrease in BMD at the proximal end of the humerus on the affected side of women. In contrast, men showed no significant difference between the affected and unaffected shoulders, suggesting that the degree of osteopenia remains low compared with women. Although frozen shoulder is a disease which may occur in both men and women, the loss of bone was conspicuous only in women. This may be due to the involvement of female hormones in alterations of bone in frozen shoulder, as in cases of osteoporosis, in addition to the originally low bone density in women. The degree of osteopenia of the proximal humerus with frozen shoulder was not correlated with the duration of the disease, range of motion of the shoulder joint, or patient's age.

Absorptiometry, Photon↗
PubMed1986

Reconstruction of the mandible using the scapular spine pedicled upon trapezius muscle; description of the posterior approach to the transverse cervical vessels.

We describe the reconstruction of the mandible using the spine of the scapula pedicled upon trapezius in a woman who had undergone previous mandibular irradiation and surgery. We show how the vascular supply to the trapezius scapular spine compound flap can be approached posteriorly and the spine of the scapula used to provide good length and contour for replacement of a wide mandibular defect.

Ameloblastoma↗
PubMed1988

Comparison of bone formed intramuscularly after transplantation of scapular and calvarial osteoblasts.

Previous work suggested that osteoblasts determine the size of the bone marrow area within the bone and that calvarial osteoblasts differ from those induced intramuscularly by cartilage formed by transplanted epiphyseal chondrocytes. This study reports morphological observations of bone formed by transplanted scapular and calvarial osteoblasts isolated from bones of young rats. In intact scapulas of 28-day-old rats the percentage area occupied by bone tissue in relation to bone marrow was 6 times larger than in parietal bones of comparable age. Isolated syngeneic scapular osteoblasts usually produced an ossicle with similar general structure and ratio bone tissue/bone marrow area as in intact scapulas. In transplants of calvarial osteoblasts numerous islands of bone tissue with a small amount of bone marrow appeared. Bone formed in allogenic transplants was rejected. These results suggest that osteoblasts from endochondral scapular bone may have different properties than those from intramembranous calvarial bones. Alternatively, the large amount of medullary space in bone produced by transplanted scapular osteoblasts could result from their contamination with bone marrow stromal cells.

Animals↗
PubMed2005

Scapular kinematics during humeral elevation in adults and children.

BACKGROUND: Appropriate motion of the scapula is important for dynamic positioning of the glenoid during humeral elevation. A number of studies have described the typical scapular kinematics during humeral elevation in adults. However, children and adults may have differences in scapulothoracic musculature and scapular osteology. To our knowledge, no study has been performed examining scapular kinematics in children with either typical or atypical development. Consequently in children the influence of age and development on scapular motion is currently unknown. The aim of this study was to describe and compare the kinematic patterns of the scapula during humeral elevation in children with typical development and healthy adults. METHODS: Fifteen adults, 7 females, 25-37 years of age, and 14 children, 8 females, 4-9 years of age, participated in this study. Kinematic data were collected using a magnetic tracking device. Subjects were asked to elevate their arm in the scapular plane (40 degrees anterior to the frontal plane) in a sequence of three trials. FINDINGS: Significant differences were seen between the two age groups in the dependent variables. During scapular plane rotation from 25 degrees to 125 degrees , children showed greater upward rotation (43.9 degrees SD 6.39 degrees ) than adults (29.1 degrees SD 10.1 degrees ). The mean glenohumeral to scapulothoracic ratio in the scapular plane was 2.4:1 for adults, 1.3:1 for children. INTERPRETATION: This study demonstrates that there are significant differences in scapular kinematic patterns between children and adults. Children have a greater contribution from the scapulothoracic joint, specifically upward rotation toward humeral elevation. From a clinical perspective, these results can be used to help determine the incorporation of stabilization and mobilization of the scapulothoracic joint during exercises for a child with impairment at the shoulder for improving shoulder function.

Adult↗
PubMed2006

3-D scapular kinematics during arm elevation: effect of motion velocity.

BACKGROUND: No three-dimensional (3-D) data exist on the influence of motion velocity on scapular kinematics. The effect of arm elevation velocity has been studied only in a two-dimensional setting. METHODS: Thirty healthy subjects performed dominant (right) arm elevation in two planes, sagittal and frontal, and at slow and fast self-selected arm speed. Scapular orientation and humeral elevation were measured at 30 Hz recording frequency with use of a 6-degree-of-freedom electromagnetic system (Polhemus Fastraka). Motion was computed according to the International Society of Biomechanics standards. Scapular orientation was also determined with the arm held in different static positions. FINDINGS: We obtained a full 3-D kinematic description of scapula achieving a reliable, complex 3-D motion during humeral elevation and lowering. The maximal sagittal arm elevation showed a characteristic "M"-shape pattern of protraction/retraction curve. Scapular rotations did not differ significantly between slow and fast movements. Moreover, protraction/retraction and tilt angular values did not differ significantly between static and dynamic tasks. However, scapular lateral rotation values differed between static and dynamic measurements during sagittal and frontal arm elevation. Lateral scapular rotation appears to be less in static than in dynamic measurement, particularly in the sagittal plane. INTERPRETATION: Interpolation of statically recorded positions of the bones cannot reflect the kinematics of the scapula.

Adult↗
PubMed2005

Method for determining the spatial position of the shoulder with ultrasound-based motion analyzer.

Several methods have been developed recently for the analysis of the spatial motion of the scapula and the arm, whereby the spatial position of shoulder bones is determined in static conditions by interrupting motion. The authors have developed a 3D motion analysis method recording scapular motion in progress with appropriate accuracy in the course of arm movements of various degrees. The objective of this study is to explore the applicability of the method developed, as well as to compare it with and verify it by other methods developed earlier. The position and displacements of shoulder bones were determined on 30 shoulders of 15 healthy people. The newly developed measurement method is based on the mechanical basic principle stating that the position and motion of a rigid body -- in this case, the bones (segments) forming the shoulder joint -- can be calculated at any moment from the spatial coordinates of three points of a segment and any changes thereof in the course of motion. Ultrasound-based triplets providing the three points (fundamental points) by a segment as required for measurement were fixed on the sternum (modeling the trunk), the clavicle, the acromion (modeling the scapula), the upper arm, and the lower arm. The position of the sixteen anatomical points involved in the study were determined by an ultrasound-based pointer in the local coordinate system specified by the fundamental points before starting measurements. The ZEBRIS ultrasound-based motion analysis system was used for measuring the spatial coordinates of triplets in the course of continuous motion. The spatial coordinates of the designated anatomical points can be calculated by the method of triangulation. The method was calibrated by a ZEBRIS mapping (3DCAD) software commercially available, and the measurement error rate of the method was determined by statistical calculations. On the basis of calibration and error calculations it could be established that the accuracy and the reproducibility of the method were appropriate, in accordance with the limit values to be found in the literature.

Acromion↗
PubMed2005

Effects of shoulder muscle fatigue caused by repetitive overhead activities on scapulothoracic and glenohumeral kinematics.

The purpose of this study was to determine the effects of shoulder muscle fatigue on three dimensional scapulothoracic and glenohumeral kinematics. Twenty healthy subjects participated in this study. Three-dimensional scapulothoracic and glenohumeral kinematics were determined from electromagnetic sensors attached to the scapula, humerus, and thorax. Surface electromyographic (EMG) data were collected from the upper and lower trapezius, serratus anterior, anterior and posterior deltoid, and infraspinatus muscles. Median power frequency (MPF) values were derived from the raw EMG data and were used to indicate the degree of local muscle fatigue. Kinematic and EMG measures were collected prior to and immediately following the performance of a shoulder elevation fatigue protocol. Following the performance of the fatigue protocol subjects demonstrated more upward and external rotation of the scapula, more clavicular retraction, and less humeral external rotation during arm elevation. All muscles with the exception of the lower trapezius showed EMG signs of fatigue, the most notable being the infraspinatus and deltoid muscles. In general, greater scapulothoracic motion and less glenohumeral motion was observed following muscle fatigue. Further studies are needed to determine what effects these changes have on the soft tissues and mechanics of the shoulder complex.

Adolescent↗
PubMedDate not supplied

The subscapular and subcoracoid bursae: descriptive and functional anatomy.

The subscapularis and subcoracoid bursae, as well as the subscapularis muscle, were studied in 42 fresh cadaveric shoulders. Fibrous bands were found in the medial part of the muscle; they were intercalated with the distal tendon-like bands. The superior distal fibrous band was always found to be thicker than the others. Strong fibrous attachments of the subscapularis muscle were found along the lateral border of the scapula as well as along the medial third of the bony crests in the subscapular fossa. Between the crests, the muscle bundles were directly attached to the bone. In the lateral part of the scapula, the subscapularis muscle had only weak connective links with the bone. The subscapularis bursa was found in all cases as a pouch strongly attached to the scapular neck and the adjacent part of the joint capsule. The top of the bursa was linked to the coracoid process by a fibrous attachment called the suspensory ligament. The subcoracoid bursa had only weak connective links with the coracoid process. In 28% of cases, the subscapularis and subcoracoid bursae merged into a unique wide bursa. The subscapular bursa had two types of links with the muscle: (1). weak connective links with the superficial muscle bundles and (2). at least 2 fibrous arcs joining the lateral tendon-like bands, the bursa, and bony crests of the subscapularis fossa. These arcs allow the bursa to follow the course of the muscle exactly. During movements of the glenohumeral joint, the subscapularis muscle sustains huge changes of orientation, particularly the upper part of the muscle that coils around the coracoid process. The strong superior fibrous band enables the muscle to maintain contact with the coracoid process. It is the function of the subscapularis and subcoracoid bursae to manage the friction of the superficial fibers against the scapular neck, the humeral head, and the coracoid process.

Aged↗
PubMedDate not supplied

Subacromial impingement syndrome: the role of posture and muscle imbalance.

Changes in upper body posture, colloquially termed forward head posture (FHP), are considered to be an etiologic factor in the pathogenesis of subacromial impingement syndrome (SIS). The literature suggests that postural deviations associated with FHP follow distinct patterns involving an increase in the thoracic kyphosis angle and a downwardly rotated, anteriorly tilted, and protracted scapula, which in turn leads to increased compression in the subacromial space. These postural changes are thought to occur concurrently with an imbalance of the musculature, and conservative rehabilitation commonly involves addressing both posture and muscle imbalance. There is a paucity of evidence supporting the hypothesis that posture and muscle imbalance are involved in the etiology of SIS. The purpose of this study was to investigate whether FHP was associated with an increased thoracic kyphosis, an altered position of the scapula; and a reduction in glenohumeral elevation range. Selected sagittal and frontal plane postural measurements were made in 60 asymptomatic subjects and 60 subjects with SIS. The findings suggested that upper body posture does not follow the set patterns described in the literature, and further research is required to determine whether upper body and scapular posture and muscle imbalance are involved in the pathogenesis of SIS.

Adult↗
PubMedDate not supplied

Tumors of the shoulder girdle: a review of 194 cases.

The upper extremity is the third most common site of primary bone and soft-tissue tumors. The purpose of this study was to determine the types and prevalence of bone and soft-tissue tumors that occur in the shoulder girdle and to identify physical findings that may be indicative of malignancy. This is a retrospective review of 194 consecutive neoplasms of the shoulder girdle seen by the senior author from 1996 through 2000. Benign tumors (n = 139) were more common than malignant tumors (n = 55). The presence of pain and the presence of mass were not risk factors for malignancy (P = .41 and P = .16, respectively). Malignant tumors occurred in an older population (P < .0007). Tenderness and tumor location in the scapula were also found to be risk factors for malignancy (P = .0002 and P = .0001, respectively). In summary, we have identified 3 variables that were found to be associated with malignancy in the shoulder girdle: older age, tenderness on palpation, and a lesion in the scapula.

Adolescent↗
PubMedDate not supplied

The effect of scapular protraction on isometric shoulder rotation strength in normal subjects.

To measure the effect of scapular protraction on isometric shoulder rotation strength, 20 normal subjects completed 2 maximal isometric internal and external rotation contractions in 2 scapular positions (scapula neutral [SN] and scapula protracted [SP]) from 3 arm positions (90 degrees internal rotation [IR], 45 degrees internal rotation [MR], and 90 degrees external rotation [ER]). Scapular protraction reduced shoulder rotation strength in 5 of 6 test positions (P < .0004), with significant interactions between scapular position and arm position (P < .001) and between scapular position and contraction type (P < .0001). Protraction significantly reduced IR strength by 13% to 24% relative to SN. The effect of SP on ER strength was more position-dependent, increasing strength by 6% in the IR position and decreasing it by 7% in the MR position and 20% in the ER position. In conclusion, acute changes in scapular position affect shoulder isometric IR and ER strength. The potential adverse effects of scapular protraction on shoulder rotation strength should be considered during the evaluation and treatment of shoulder pain.

Adolescent↗