BACKGROUND: The acromion projects laterally in a curving orientation. When a fracture of the acromion occurs, despite being rare, matching the best-fit fixation plate is challenging due to few options and limited availability of fixation plate types. Alternative fixation methods can carry risk of nonunion complications. PURPOSE: The objective of this study was to investigate the morphological curvature pattern of the acromion to assess the level of the fixation plates fitness and provide the suitable imaging modalities for evaluating the acromion curvature. BASIC PROCEDURES: The correlation between the acromion curvature and five fixation plates were calculated and their fitness level was evaluated statistically. The curvature of acromion and the five available fixation plates were photographed and assessed digitally by software (FIJI ImageJ and Microsoft Excel). The method entails plotting seven points along the curving surface and margins of the acromion, while the Excel Solver function calculates the regression, ultimately giving curvature values. First, the acromion parameters were studied on 180 paired healthy dry scapulae. Then, the acromion curvature values were compared to the fixation plates curvatures. Likewise, the acromion curvature was assessed as applicable on 153 (100 AP- views, 50 Y- views, and 3 superior-views) retrospective plain X-rays and 40 3D-CT scapula reconstructions of healthy acromia. MAIN FINDINGS: The mean length of the acromion was 48.70 ± 5.29 mm, mean thickness was 8.51 ± 1.67 mm, and mean width was 25.97 ± 5.97 mm. The calculated values of the mean curvatures were 0.050 ± 0.015 mm-1 for the mean acromion surface, 0.042 ± 0.027 mm-1 for the internal margin, and 0.055 ± 0.010 mm-1 for the external margin. The curved geometry of the acromion was plotted on a graph giving a spectrum of curvature patterns with distribution values revealing fixation plates fitness represented by area under the curve with frequencies of 4.32 % for the acromion-specific fixation plate, 14.28 % for the large clavicle fixation plate, 0.26 % for the small clavicle fixation plate, 53.38 % for the flexible universal fixation plate, and none for the rigid universal fixation plate. PRINCIPAL CONCLUSIONS: Approximately 27.76 % of the acromion surface curvatures distribution does not overlap with any of our measured fixation plates. Evaluating the acromion surface curvature was possible on plain X-rays in the Y-view only.
- MeSH
- akromion * diagnostické zobrazování zranění anatomie a histologie chirurgie MeSH
- fraktury kostí * chirurgie diagnostické zobrazování MeSH
- kostní destičky * MeSH
- lidé MeSH
- lopatka * diagnostické zobrazování anatomie a histologie MeSH
- radiografie MeSH
- vnitřní fixace fraktury * metody přístrojové vybavení MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: In this study, we aimed to evaluate acromiohumeral distance (AHD) and supraspinatus tendon (ST) thickness measurements and their relationship with pain and function in ST pathologies. MATERIAL AND METHODS: The study included 111 patients and 25 healthy controls (HC). Patients were divided into 3 groups according to their diagnosis: non-tear tendinopathy (NTT), partial thickness tear (PTT), and full thickness tear (FTT). The AHD and ST thickness of the participants were measured with ultrasound. The pain and functional status of the patients were evaluated with the Numeric Rating Scale (NRS), The QuickDASH shortened version of the DASH Outcome Measure - Disabilities of the Arm Shoulder and Hand (QDASH), and Simple Shoulder Test (SST). RESULTS: The AHD value was significantly higher in the NTT group (p=0.000). The AHD value was significantly lower in the FTT group (p=0.000). ST thickness value was significantly lower in the PTT group compared to the NTT group (p=0.000). There was a positive correlation between ST thickness and BMI (r=0.553,p<0.01). There was a negative correlation between ST thickness and SST and a positive correlation between ST thickness (r=-0.223,p<0.05) and QDASH (r=0.276,p<0.05). CONCLUSIONS: We found that AHD and SST thicknesses significantly differed in the NTT, PTT, FTT, and HC groups. This difference may be important for diagnosis. In addition, the effect of obesity on ST thickness and the relationship between ST thickness and functional scores may be considered. Weight control may be effective at this point. KEY WORDS: acromiohumeral distance, supraspinatus tendon thickness, ultrasound.
- MeSH
- akromion diagnostické zobrazování MeSH
- bolest ramene etiologie diagnostické zobrazování patofyziologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti metody MeSH
- poranění rotátorové manžety * diagnostické zobrazování patofyziologie MeSH
- rotátorová manžeta * diagnostické zobrazování patofyziologie MeSH
- studie případů a kontrol MeSH
- tendinopatie diagnostické zobrazování patofyziologie MeSH
- ultrasonografie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. MATERIAL AND METHODS: Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients' MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. RESULTS: A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18-79). There was a statistically signifi cant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically signifi cant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). CONCLUSIONS: Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.
- MeSH
- akromion MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka MeSH
- osteoartróza * diagnostické zobrazování chirurgie MeSH
- rameno * MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Almost 70 scapular fractures in children and adolescents, up to the age of 17 years, have been described in detail in the literature since 1839. The diagnosis of these injuries was based on autopsy, radiographs, CT and MRI examinations. The most frequent findings were fractures/epiphyseolyses of the coracoid, followed by fractures of the infraspinous part of the body and avulsion of the inferior angle of the scapular body. Less common were fractures of the acromion. Intra-articular fractures of the glenoid, or separation of an intact glenoid along the line of the anatomical or surgical necks, were reported only sporadically. Scapulothoracic dissociation was also recorded in several cases. The majority of fractures were treated non-operatively; operative treatment was used in glenoid fractures, certain fractures of the coracoid and fractures of the scapular body with intrathoracic penetration. Except for scapulothoracic dissociation, outcomes of treatment of these injuries were very good.
- MeSH
- akromion MeSH
- dítě MeSH
- fraktury kostí * diagnostické zobrazování chirurgie MeSH
- fraktury proximálního humeru * diagnostické zobrazování MeSH
- intraartikulární fraktury * MeSH
- lidé MeSH
- lopatka chirurgie MeSH
- mladiství MeSH
- poranění hrudníku * MeSH
- radiografie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF THE STUDY To compare the functional and radiological results of the total arthroscopic treatment (TAT) performed due to the rotator cuff (RC) tear problem with the results of the arthroscopically assisted mini-open surgery (AAMOS). MATERIAL AND METHODS This study conducted over a two-year period included all had TAT or AAMOS. Patients were included in the study if they had undergone arthroscopic or mini-open rotator cuff repair, with a minimum of 2 years' follow-up. Patients were divided into two groups in terms of the surgical technique performed. Patients who had TAT was included into the group 1 and, AAMOS group 2. Exclusion criteria included other significant intra-articular pathology such as SLAP lesions or glenohumeral arthrosis, previous rotator cuff surgery, massive rotator cuff tears (>5 cm), and neurologic disorders such as brachial plexopathy or suprascapular neuropathy. Every patient underwent magnetic resonance imaging evaluation before surgery and at last follow-up after surgery. Acromion typed of patients were recorded. Patients were questioned for ASES and Constant score. RESULTS Fifty-eight shoulders were included in the study. Twenty-eight patients were female and 30 were male. The mean age was 55.63 ± 8.06 years. Both groups had 29 patients per each. Mean follow-up period was 26.26 ± 11.46 months. There was no statistically significant difference between the mean age and gender distribution of the groups (p > 0.05). No statistically significant difference in the follow-up period between two groups (p > 0.05). No statistically significant difference was found between the postoperative ASES measurements between the two groups (p > 0.05). There was no statistically significant difference in postoperative Constant measurements between the two groups (p > 0.05). There was no statistically significant difference between the Acromion types between the two groups (p > 0.05). No statistically significant difference was found between the both groups in terms of accompanying shoulder pathology and AC joint degeneration (p > 0.05). In the postoperative MRIs of the patients, 7 patients in the Group 2 and 6 patients in the Group 1 were found to have recurrent tears. No statistically significant difference was found (p > 0.05). DISCUSSION When compared their patients who underwent RC repair by AAMOS intervention with those treated with TAT intervention and stated that the results were satisfactory for both groups and close to each other during their 2-year follow-up regardless of the tear diameter. Rotator cuff repairing with TAT is becoming a popular method of shoulder surgery. Initial reports of outcomes with this technique have indicated similar results when compared with open techniques, with less perioperative morbidity. Patients with RC tears treated by TAR, the shoulder range of motion was achieved in a shorter time and the rate of development of fibrous ankylosis was found to be lower. We performed the same configuration for the repair technique that may avoid to differ the results. Additionlay, all patients in study had the same rehabilitation protocol not to differ the results. Our study demonstrated similar results, with no differences noted in clinical outcomes between the TAT and the AAMOS for all scoring scales evaluated. Our experience with TAT notes a steep learning curve for proper technique. Certainly, surgeons may attempt a TAT, knowing that the patient's long-term outcome will not differ if the AAMOS is needed. CONCLUSIONS It must be kept in mind that both surgical methods may provide satisfactory results; the decision regarding which method should be used must be based on the skills, experience and technical oppurtunities of the orthopedic surgeon. However, any of the surgical technique is chosen, smilar excellent clinical results can be achieved. Key words: rotator cuff, mini-open surgery, total arthroscopic repair, cuff tear, Constant score, ASES score.
- MeSH
- akromion MeSH
- artroskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění rotátorové manžety * diagnostické zobrazování chirurgie MeSH
- ramenní kloub * MeSH
- rotátorová manžeta diagnostické zobrazování chirurgie MeSH
- rozsah kloubních pohybů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Until now, classifications of coracoid fractures have been based on plain radiographs, without use of 3D CT reconstructions. Therefore, the aim of the present study has been to describe the pathoanatomy of these fractures and their associated injuries to the shoulder girdle, on the basis of 3D CT reconstructions. METHODS: The cohort comprised 39 patients, who each sustained a coracoid fracture investigated with 3D CT reconstructions. The patients were assessed in terms of age, gender, pathoanatomy of the coracoid fracture, fractures of other parts of the scapula, and associated injuries to the shoulder girdle. RESULTS: We identified 24 fractures of the base, one fracture of the beak body, eight fractures of the apex, and six comminuted fractures of the coracoid process. A total of 22 associated injuries were found (7 fractures of the acromion, 5 fractures of the anterior glenoid rim, 3 fractures of the superior glenoid, 1 fracture of the inferior glenoid, 4 fractures of the surgical neck, 2 fractures of the scapular body) and 18 other associated injuries to the shoulder girdle (8 AC dislocations, 5 proximal humeral fractures, and 5 clavicular fractures). CONCLUSION: On the basis of 3D CT reconstructions, four basic coracoid fracture patterns were identified. The authors´ findings and literature review have shown that a considerable number of coracoid fractures are combined with injuries to other parts of scapula and shoulder girdle. These associated injuries must be taken into account and targeted when taking the patient's history, and during clinical and primarily radiological examinations.
Superior Shoulder Suspensory Complex (SSSC) is a bone and soft-tissue ring securing the connection of the upper extremity to the axial skeleton via the clavicle and sternoclavicular joint. An isolated injury to one component of SSSC is usually stable. An injury to 2 of its components is a potential source of shoulder girdle instability and requires surgical stabilisation. An injury affecting 3 and more components is extremely rare and surgical stabilisation should be indicated. Our study presents the case of a 50-year-old man who fell off the bicycle and sustained a direct blow to his left shoulder resulting in an ipsilateral fracture of the coracoid and acromion process combined with the fracture of the distal end of the clavicle. Following a standard clinical examination and a subsequent X-ray and a CT scan with three-dimensional shoulder reconstruction, an open reduction and stabilisation of all the injured SSSC components was performed. Later, early and gradual rehabilitation of the shoulder girdle was commenced. At 48 weeks after the surgery, almost full range of motion of the shoulder joint was achieved and the muscle strength of the operated upper extremity was comparable to that of the healthy one. Key words:Superior Shoulder Suspensory Complex, fracture, acromion, coracoid process, clavicle.
- MeSH
- akromion diagnostické zobrazování zranění MeSH
- fraktury kostí diagnostické zobrazování rehabilitace chirurgie MeSH
- klíční kost diagnostické zobrazování zranění MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka diagnostické zobrazování zranění MeSH
- poranění ramene diagnostické zobrazování rehabilitace chirurgie MeSH
- processus coracoideus diagnostické zobrazování zranění MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
UNLABELLED: Displaced fractures of the acromion are rare injuries. A 45-year-old lady presented with an isolated acromion fracture (type III, Kuhn classification) resulting from a direct blow to the top of her right shoulder in a fall while skiing. After standard clinical and radiological examination of the shoulder, an open reduction and internal plate fixation using a postero-superior approach to the scapula was performed. Early rehabilitation of the arm and shoulder was initiated. At 50 days after surgery the patient achieved a full range of motion in her right shoulder and muscle strength equal to that of the contralateral extremity. By 12 weeks radiographic union of the fracture was recorded. The final functional outcome after open reduction and internal plate fixation of the fracture was comparable with results reported in the literature and, in comparison with conservative treatment, the risk of non-union was significantly reduced. KEY WORDS: acromion fracture, scapula, osteosynthesis.
- MeSH
- akromion zranění patofyziologie chirurgie MeSH
- fixace fraktury metody MeSH
- fraktury kostí etiologie patofyziologie chirurgie MeSH
- kostní destičky MeSH
- lidé středního věku MeSH
- lidé MeSH
- lyžování zranění MeSH
- rozsah kloubních pohybů fyziologie MeSH
- vnitřní fixace fraktury přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY To evaluate the effect of acromial morphology, as assessed on radiographs, on rotator cuff tears. MATERIAL A total of 200 patients surgically treated for shoulder disorders were enrolled. All were older than 40 years and had good quality shoulder radiographs. Two groups were composed: First, a clinical model group of 136 patients to be investigated for three parameters of rotator cuff injury that was divided into two subgroups. One included 68 patients, with an average age of 53.5 years, in whom surgery revealed no injury to the rotator cuff; the other subgroup of 68 patients, with an average age of 58 years, had a ruptured supraspinatus tendon. Subsequently, a control group of 64 patients (32 with rotator cuff injury and 32 without it) was used to verify the results of the model group. METHODS Three parameters describing the acromion, i.e., acromion index (Al), lateral acromion angle and acromial slope, were measured on standard radiographs. Tangential antero-posterior and scapular "Y" (supraspinatus outlet) views were taken, the images were digitalised and evaluated using a TomoCon 3.0 Viewer programme, and the results of the two groups were statistically analysed and compared. RESULTS The difference between the patients with rotator cuff injury and those without it was best shown, in both groups, by significant differences in the acromion index. This was true for both the men and women. The Al values for the patients with rotator cuff injury were 0.66 and 0.65 in the model and control groups, respectively. The same Al value of 0.76 was found for uninjured rotator cuffs in both groups. The two other parameters investigated did not appear to be of any significant validity for assessment of rotator cuff tears. DISCUSSION The aetiology of injury to the rotator cuff has not been fully understood yet but, undoubtedly, the causes will be many. The shape of the acromion is regarded as one of the important factors. We agree with Nyffeler et al. that a lateral extension of the acromion is most often associated with rotator cuff tears and that the acromion index proposed by these authors is a good parameter to assess this morphological change. CONCLUSIONS A lateral extension of the acromion plays an important role in the aetiology of degenerative tears of the supraspinatus tendon. The acromion index appears to be the best instrument for assessing this morphological change.
- MeSH
- akromion anatomie a histologie radiografie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění rotátorové manžety MeSH
- ramenní kloub radiografie MeSH
- rotátorová manžeta radiografie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
The aim of this work is to describe the biomechanics of the shoulder complex. The shoulder is the most complicated joint of the body. In biomechanical point of view the scapula is the most important part of modeling the shoulder girdle and it is the best indicator of setting joints. This work describes shape and mobility of the shoulder complex (especially the scapula) in healthy individuals and patients. In case of the shoulder pathology the scapula changes the position and reduces the mobility. The human shoulder can be seen as a perfect compromise between mobility and stability. The article discusses the stability and instability of the shoulder girdle too.
- Klíčová slova
- scapulothorakální rytmus, odstávající lopatka, scapulothorakální kinematika, model kloubu,
- MeSH
- akromion anatomie a histologie patofyziologie patologie MeSH
- anatomické modely MeSH
- biomechanika MeSH
- financování organizované MeSH
- hlavice humeru fyziologie patofyziologie patologie MeSH
- humerus fyziologie patofyziologie patologie MeSH
- kosterní svaly fyziologie patofyziologie patologie MeSH
- lidé MeSH
- lopatka anatomie a histologie patofyziologie patologie MeSH
- nemoci kloubů patofyziologie patologie MeSH
- nestabilita kloubu patofyziologie patologie MeSH
- předloktí fyziologie patofyziologie patologie MeSH
- ramenní kloub anatomie a histologie fyziologie patologie MeSH
- rotátorová manžeta fyziologie patofyziologie patologie MeSH
- rozsah kloubních pohybů fyziologie MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
