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PubMed1990

Scapulothoracic arthrodesis for patients who have fascioscapulohumeral muscular dystrophy.

In nine patients who had fascioscapulohumeral muscular dystrophy, thoracoscapular arthrodesis was done for the treatment of symptomatic winging of the scapula. The objective was to improve the use of the upper extremity in the performance of activities of daily living. Seven patients had a bilateral procedure. The active range of motion of the shoulder improved in all patients, with flexion increasing an average of 33 degrees and abduction, 25 degrees. Complications included pneumothorax, pleural effusion, atelectasis, fracture of the scapula, and pseudarthrosis. The length of follow-up averaged sixty-nine months, and the results did not deteriorate with time.

Adolescent↗
PubMed1987

Dislocation and/or congenital malformation of the shoulder joint. Observations on a Mediaeval skeleton from Denmark.

The purpose of this paper is to present a Mediaeval skeleton of an approximately 16 year old boy, which was excavated at a Danish cemetery containing ca. 150 graves. The skeleton reveals several pathologic changes, probably due to congenital malformation. The most intriguing find is seen at both scapulae, and the changes are bilateral symmetric. Both the glenoid cavities are placed posterior but at the normal height of the bone. The joints are almost perpendicular to their normal direction. The size of the glenoid cavities is normal and the shape is rather flat in accordance to the development stage of the skeleton, where the epiphysis of the rim has not yet appeared to form the gently concave fossa as normally seen in adults. Both the surface and the borderlines of the glenoid cavities are, however, more irregular than normally at that age. The position of the joints may be caused by dislocation and/or congenital malformation which is discussed. Due to the shape of the cavities, to the symmetric bilaterality, and to the minor congenital malformations, it is primarily believed to be caused by congenital malformation. Probably the young man was not much affected by the malformation of the shoulder joints, which is indicated by the normal form and size of the humeri and the well-developed muscle attachments of the bones. The claviculae seem shorter and more twisted than normal, which may be caused by a twisting of the scapulae. So the glenoid cavities may have pointed almost in the normal direction in spite of the malformation. Other minor malformations are spina bifida of the atlas and the 5. lumbar vertebra, multiple minor changes of the joints of both feet and malformations of one metatarsal bone in both feet. Agenesi of the praemolars is also seen. Although our study of the literature, we have not succeeded in correlation our finds with any known congenital syndrome, and as far as we know no similar case has been described in clinical observation or in skeletal finds.

Denmark↗
PubMed1988

[The function of the coracoacromial ligament].

The function of the coracoacromial ligament was investigated in 8 dissecting-room scapulae. Strain gauges were attached around the coracoid process and the acromion, and tension (50 or 100 N) applied through the remaining muscle stumps. The results showed that, after division of the ligament, significantly more distortion could be measured in the acromion than in the coracoid process, which suggests that the 'stay' effect of the coracoacromial ligament is stronger for the former. Since the degree of distortion is largely dependent on the direction of pull, the ligament is interpreted as a dynamic brace between the two processes of the scapula.

Acromion↗
PubMed1978

[The omovertebral bone--new possibility of preoperative examination by computed axial tomography (author's transl)].

After a brief review of literature a case of congenital high scapula with omovertebral bone is presented by conventional X-ray films (plain X-ray and a. p. tomography). The additional computed axial tomography is of great diagnostic value, giving the surgeon a good deal of preoperative information on the anatomy of the bony connection between cervical vertebrae and scapula. The possible pitfalls of this new diagnostic technique are discussed as well as its limitation.

Cervical Vertebrae↗
PubMed1984

[Role of computerized tomography in the evaluation of the stability of the glenohumeral articulation].

CT scans of the shoulder were performed on 30 normal subjects. The bony architecture of the glenohumeral joint and of the shoulder as described by definite angles and index was determined. Attention was primarily drawn upon the parameters often implicated in the mechanism of glenohumeral stability, namely: the glenoid antero-posterior tilt and the anteversion angle of the scapula. While the former is a static determinant, the latter is a dynamic determinant of joint stability. An inversely proportional relationship was found to exist between these two components of glenohumeral stability. It may be speculated that an high glenoid tilt, which is unstable, may be counterbalanced by a functional reduction in anteversion of the scapula, thus improving the joint stability.

Adolescent↗
PubMed1984

[Significance of the limbus glenoidalis for the stability of the shoulder joint].

Besides the osseous structures and the muscular elements, the capsular and ligamentous apparatus, including the limbus genoidalis, is of utmost importance for the stability of the shoulder-joint. In the literature the limbus glenoidalis (L.G.) is generally described as a fibrocartilagineous structure comparable to the menisci of the knee-joint. Basically, the cause of a primary foreful shoulder-dislocation may be either a direct or an indirect trauma. The lesions during luxation concern the joint's capsula, the L.G. and the head of the humerus. However, in the literature one finds many different explanations as to which of those lesions is responsible for the subsequent development of recurring shoulder dislocation. The variability of concepts is reflected by the large number of operative procedures that are advised as treatment of a recurring dislocation. Assuming that the L.G. substantially contributes to the stability of the shoulder joint, we have investigated structure, blood-perfusion and anatomical connections of the L.G. The mechanism of the primary shoulder dislocation was simulated in mechanical strain-experiments, carried out on human corpse specimens. The occurring lesions were analysed. The following investigations were undertaken in alltogether 182 fresh specimens of human shoulder joints: measurement and calculation of the joint-surfaces of scapula and humeral head, dye-injection of the arteria axillaris, in order to demonstrate the vascular supply of the limbus glenoidalis, histological examination of the structure of the limbus glenoidalis, mechanical strain-experiments, that simulate the dislocation mechanism of the shoulder-joint. The calculations of joint-surfaces showed a relative decrease of the scapular joint-surface with growing age. The relation of the scapular joint-surface (always plus limbus glenoidalis) to the joint-surface of the humeral head is 1: 2.25 +/- 0.38 in men and 1: 2.20 +/- 0.11 in women (age-group: 20 to 49 years). In the age-group of 70 to 89 years the respective numbers are 1: 2.90 +/- 0.35 and 1: 2.99 +/- 1.04. The differences in the relations of surfaces between the different age-groups are statistically significant for both sexes (p less than 0.01; Student-t-test). The dye-injection showed that the main artery supplying the limbus glenoidalis is a branch of the arteria circumflexa scapulae. This branch is connected by several anastomoses with the arteriae circumflexa humeri anterior and posterior. These macroscopical observations were confirmed by histological and microangiographic examinations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Results of modified Bristow procedure.

A modified Bristow procedure was performed on 23 patients over a two-year period. The modification consisted of splitting the subscapularis muscle in line with its fibers and attaching the coracoid process to the neck of the scapula with a malleolar screw. The results were evaluated by questionnaire, physical examination, and radiographs. The average age of the patients was 24 years. There were 20 men and three women. The patients presented 16 left shoulders and seven right shoulders; nine were dominant. The number of previous dislocations was 12. The average follow-up period was 25 months and the average hospital stay was two days. There were no blood transfusions. Each patient returned to his or her preoperative activity level; no patient had pain in the shoulder at rest. With overhead activity, five patients had some pain and 18 had none. Of the nine patients whose surgery was on the dominant side, only two had difficulty in throwing. There were no postoperative recurrent dislocations. There was an average loss of external rotation of 13 degrees and an average loss of internal rotation of 12 degrees. Bony fusion of the coracoid to the neck of the scapula occurred in only one out of 13 shoulders. Complications were minor and resolved completely. The advantages of the procedure are good surgical exposure, minimal tissue trauma, insignificant blood loss, and fewer days in the hospital per patient. The procedure was relatively safe and generally effective.

Adolescent↗
PubMedDate not supplied

Scapular reactivity to contact irritants: application-time and area variations.

Twenty-two diurnally active, fair-skinned, male volunteers were repeatedly patch tested with 10, 15 and 20% lapyrium chloride (LC) and 0.3 and 0.5% sodium lauryl sulfate (SLS) for 5 consecutive days. A series of 5 patches containing SLS and LC were placed vertically once daily for 6 h on different sites of the scapula: paravertebral, lateral and medial. The sites of application were randomized over subjects for patch testing once a day per area at either 08%, 16% or 00%. Each patch was left in place 6 h; scoring of each site, using a 13-point scale, was done 2, 10 and 18 h after removal. The cutaneous reactivity varied in a statistically significant manner according to the time and area of patch application. For each day except the first, LC scores exhibited highest and lowest responses at 16% and 00%, respectively. For SLS, a statistically significant application-time difference in reactivity was detected only for the readings of day 2 when scores were highest at 00% and lowest at 16%. Intraregional variations in scapular reactivity were also exhibited. Strongest reactions to LC occurred in the center of each scapula; weakest reactions were elicited on either the lateral or paravertebral sites. For SLS, statistically significant intraregional differences in reactivity were detected only for the second day of patching, with strongest responses near the spinal column and weakest near the axilla.

Adult↗
PubMed1978

Plating of canine scapular fractures.

The purpose in this study was to determine whether there was a significance difference between conservative management and plating of scapular body fractures. Bilateral scapular body fractures were created in 10 dogs. The left scapula in each dog was treated by open reduction and plating of the scapular spine. The right scapula was not treated. Plating enhanced healing and early return of function, but there was no significant difference in the long-term results.

Animals↗
PubMed1995

[Role of the subacromial space on development of the impingement syndrome. I].

In the first part of the study reported in this paper the anatomy of 150 scapulae was studied to find out whether variation in the subacromial space might cause impingement syndrome. Sixteen different parameters, including various angles, size and shape of the acromion and the coracoid process, and length of the coracoacromial ligament and the acromion, were measured. Soft tissue was completely removed from the bone, so that no statement on the rotator cuff was possible. The data were processed using the Tukey LSD test. A statistically significant correlation between the size of the shoulder blade and the length of the acromion and the coracoacromial ligament was found. The shape of the coracoid process showed more individual variations, and no correlation with the size of the bony scapula was found. The shape of the subacromial space was obtained by using four different bony landmarks (acromial angle, tip of the anterior rim of the acromion, tip of the coracoid process and supraglenoid tubercle). Three different types were found: a "rhomboid" in 103 cases, an approximate "kite" shape in 35 cases, and a triangle in 12 cases. The rhomboid form means a larger plane surface, so that the rotator cuff can glide more smoothly than with the other types. The different shapes of the subacromial space did not influence the slope of the acromion in the scapular plane.

Acromion↗
PubMedDate not supplied

Measurements of interface pressure between body sites and the surfaces of four specialised air mattresses.

Four specialised air mattresses had interface pressure measured under six body sites prone to pressure sores in 10 subjects, supine and sitting. The mattresses were the Clinirest (SSI) and FirstStep (KCI) continuous airflow mattress overlays, and Airwave (Pegasus) and Nimbus (Huntleigh) alternating pressure air mattresses. On the mattress overlays, average supine interface pressures were 2.33 kPa (scapula), 4.15 kPa (elbow), 1.94 kPa (sacrum) and 2.79 kPa (buttock), although they were higher at the occiput (7.97 kPa) and heel (11.7 kPa). The alternating pressure air mattresses had an average minimum interface pressure close to zero for three sites, rising to 4.28 kPa under the heel. Average maximum interface pressures were 8.61 kPa (occiput), 5.21 kPa (scapula), 4.90 (elbow), 4.85 kPa (sacrum), 4.61 kPa (buttock) and 13.2 kPa (heel). No accepted scientific method exists for comparing the two types of mattress. Our data suggest a clinical benefit at the occiput and heel (supine) in using an alternating pressure air mattress and a benefit in using a continuous airflow mattress overlay at other sites.

Air Pressure↗
PubMed1996

Scapulothoracic dissociation: a case report.

Scapulothoracic dissociation has been described as a "closed traumatic forequarter amputation" and is characterized by massive soft tissue swelling of the shoulder, lateral displacement of the scapula, neurovascular injuries (brachial plexus, subclavian artery), an osseous-ligamentous injuries. In addition to the lateral displacement of the scapula, an acromioclavicular separation, a displaced fracture of the clavicle or sternoclavicular separation can be identified on plain X-rays. This injury pattern has been infrequently reported. We present a patient who had a previously unreported combination of roentgenographic findings, and in whom the diagnosis was revealed by computed tomographic evaluation.

Accidents, Traffic↗
PubMed1977

Embryologic pathogenesis of renal agenesis associated with cervical vertebral anomalies (Klippel-Feil phenotype).

Existing embryologic data suggest that the blastema of the cervical vertebrae, scapulae, and the genitourinary system have an intimate spatial relationship at the end of the 4th or beginning of the 5th week of fetal life. An alteration in this region can affect the cervical vertebrae and scapulae directly, and the genitourologic changes are mediated indirectly through the inductive capacity of the pronephric duct. The genitourinary malformation documented in patients with a specified Klippel-Feil phenotype support such an embryologic pathogenesis. Urologic pathology, in both sexes, is consistent with partial or absent induction of ureteral bud formation, and genital pathology in the female reflects partial or complete failure of müllerian duct development. These data also suggest a more frequent bilateral occurrence of these anomalies; a phenomenon that, in its most severe form, would result in bilateral renal agenesis, as illustrated by the stillborn presented in this paper.

Adult↗
PubMed1997

Voluntary scapulothoracic subluxation: a case report.

Dislocation of the scapula is a rare event, usually associated with massive trauma and injury. We report a case of a patient for whom dislocation was the sole presentation. The possibility of voluntary dislocation for secondary gain was suspected, but because of perceived progressive brachial plexus involvement, urgent closed reduction was undertaken and led to resolution of the neurologic symptoms. The patient returned 1 year later with similar complaints and findings, but declined another closed reduction attempt when offered only an interscalene regional block as pain relief. The diagnosis of voluntary dislocation should be considered in a patient presenting with superior and lateral migration of the scapula, without a history of trauma.

Adult↗
PubMed1997

[Fundamentals, possibilities and limitations of sonography of osteofibrous tunnels in the shoulder area. 1].

The first part of this report includes basic morphological as well as morphometric data concerning osteo-fibrous pathways within the shoulder region as determined by investigating a large number of anatomical specimens (286 macerated scapulae, 122 cadaver shoulders). Some parts of these passages, either inaccessible by means of ultrasonography or already sufficiently dealt with in the relevant literature, are not taken into consideration. This applies especially to the so called subacromial space. As to the shape of the scapular notch, five different patterns were found. The spinoglenoid notch appeared in four distinguishable types. According to the results of the measurements, type II ("shallow") and type IV ("V-shaped") scapular notches can be regarded as being predisposed to cause suprascapular nerve lesions. Contrary to what has previously been reported, nerve entrapment due to a partially ossified superior transverse scapular ligament seems to be unlikely. Cadaver dissections confirmed these observations. A comparison was made between the different types of scapular notches and the outlines of the scapular foramina (shapes one to nine) showing that a large indentation does not necessarily result in a larger nerve passage. By reason of the restricted space, foramina classified as "buttonhole-shaped" (shape 5) must be regarded as a possible threat to the suprascapular nerve. In contrast, hypertrophy of the ligament as mentioned above causing nerve problems is, to say the least, doubtful. A spinoglenoid ligament bridging the neck of the scapula was found in over half of the cases studied. A clear relationship was detected between the coracoacromial distance and the shape of the coracoacromial ligament: the greater the distance the more arched was the band. Measurements of this distance in shoulder blades were also found to be highly dependent on the sex (significantly smaller in females). Side differences relative to the aforementioned parameters did not occur. This also applies to the dimensions of the following structures: the long head of the biceps brachii muscle, the intertubercular groove and the transverse humeral ligament. The author considers the latter as having been underrated so far. Due to its constancy as well as its consistency, the ligament has to be regarded as a valuable contribution to the protection of the biceps tendon. A basic knowledge of the local anatomy is essential to sonographic analysis.

Cadaver↗
PubMed1997

Intraoperative mapping of sensate flaps. Electrophysiologic techniques and neurosomal boundaries.

BACKGROUND: The desirability of restoring sensation to the upper aerodigestive tract has led to an expanded use of sensate flaps for reconstruction of mucosal defects. Sensation can be restored via preformed neural pathways through the anastomosis of recipient and donor nerves, provided that the sensate flap falls within the boundaries of the neurosome for the identified sensory nerve. OBJECTIVES: To perform detailed electrophysiologic mappings of neurosomes of potential sensate flap donor sites, to describe their variability, and to investigate the usefulness of intraoperative mapping in terms of flap design and harvesting. DESIGN: A case series of 27 patients who were undergoing free flap reconstruction of various postablative head and neck defects were examined. Two silver-silver chloride recording electrodes were placed in direct contact with the dissected sensory nerve, and the overlying skin was either mechanically or electrically stimulated. Auditory feedback, as well as visualization of the responses on an oscilloscope, determined whether the stimulated area fell within the neurosome. This technique was applied to the lateral antebrachial cutaneous nerve of the radial forearm flap (n = 15), the lateral sural cutaneous nerve of the fibula flap (n = 5), the subcostal nerve of the iliac crest flap (n = 6), and the dorsal cutaneous rami of spinal nerve T-1 or T-2 of the scapula flap (n = 1). RESULTS: The neurosome of the lateral antebrachial cutaneous nerve was relatively consistent with the variability only at the distal boundary (ie, the dorsum of the hand). The neurosome of the lateral sural cutaneous nerve was more variable, falling into 2 distinct innervation patterns: one showing innervation that was limited to the upper lateral and posterior portions of the calf and the other demonstrating significant extension into the lower half of the calf. The neurosome of the subcostal nerve showed little variability and consistently overlapped the proposed skin paddle. The neurosome of the T-1 or T-2 spinal nerve was mapped in 1 patient and is described. CONCLUSIONS: The consistency of neurosomal boundaries is dependent on the donor site. Intraoperative mapping of flap donor sites may not only assure the harvesting of a true sensate flap, but may also allow for intraoperative decision making with regard to possible modifications of flap design and harvesting techniques. Two new sensate flaps from the iliac crest and scapula are accurately described.

Adult↗
PubMed1997

Distribution of motoneurons supplying feline neck muscles taking origin from the shoulder girdle.

A combination of fluorescent retrograde tracers and horseradish peroxidase (HRP) was used to compare the spinal distributions of motoneurons supplying shoulder muscles with attachments to the skull and cervical spinal cord that suggest a significant role in head movement. Two muscles, the rhomboideus and the levator scapulae, were innervated by multiple segmental nerve bundles that entered the muscles at different rostrocaudal locations. Motoneurons that were labelled retrogradely from rhomboideus nerve bundles formed a single, long column in the ventral horn from C4 to C6, lateral to previously studied motor nuclei supplying deep neck muscles. When different tracers were used to differentiate motoneurons supplying specific nerve bundles, discrete subnuclei could be identified that were organized in a rostrocaudal sequence corresponding to the rostrocaudal order of the nerve bundles. Levator scapulae motoneurons formed a second elongate column immediately lateral to the rhomboidues motor nucleus. Three other muscles, that trapezius, sternomastoideus, and cleidomastoideus, were supplied by cranial nerve XI. Labelled motoneurons from these muscles formed a single column from the spinomedullary junction to middle C6. Within this column, the three motor nuclei supplying the sternomastoideus, cleidomastoideus, and trapezius were laminated mediolaterally. Sternomastoideus and cleidomastoideus motoneurons were confined to upper cervical segments, whereas trapezius motoneurons were found from C1 to C6. In C1 and C6, the motoneuron column was located centrally in the gray matter, but, between C2 and C5, the column lay on the lateral wall of the ventral horn in a position dorsolateral to motor nuclei supplying the rhomboideus and the deeper neck muscles. The findings in this study suggest that descending and propriospinal systems responsible for coordinating head movement may have to descend as far caudally as C6 if they are to project onto muscles controlling the mobility of the lower neck.

Accessory Nerve↗
PubMed1997

Chondroblastoma of bone: use of fine-needle aspiration biopsy and potential diagnostic pitfalls.

Chondroblastoma of bone is a well-characterized entity. When the radiographic features are classic and the lesion is present in typical locations (i.e., epiphysis of a long bone), the diagnosis is often easily established by fine-needle aspiration biopsy and/or surgical curettage. Tumors in unusual locations, in older patients, or when complicated by aneurysmal bone cysts may pose more diagnostic difficulty. We report four examples (three primary and one-recurrent) of chondroblastoma of bone diagnosed by fine-needle aspiration biopsy. All patients were men, ranging from 18 to 28 yr of age. Sites of involvement included the acromion process of the scapula, left humerus, right ischium, and left distal femur. Three of the tumors were diagnosed as chondroblastoma on fine-needle aspiration cytology; the fourth case, involving the scapula, consisted mostly of a large aneurysmal bone cyst and remained unrecognized until surgical curettage was performed. Typical-appearing chondroblasts were present in three of the cases; osteoclast-type giant cells were observed in all four cases. Matrix material consistent with chondroid was also identified in all cases. We believe that in the absence of inflammatory cells, the presence of classic-appearing chondroblasts, even without chondroid matrix, is sufficient for a diagnosis of chondroblastoma of bone.

Adolescent↗