Reconstruction of the anatomic defect following extra-articular shoulder resection is a challenging problem, particularly in cases when function of the deltoid muscle and rotator cuff are compromised. Standard reconstruction techniques often result in either instability or rigidity. Constrained implants have been used to overcome these problems; however, they have been associated with a high rate of aseptic loosening. Recently, a novel double-constrained implant has been introduced, yielding promising functional results. Nonetheless, this implant exhibited a cosmetic defect related to protrusion of the humeral component that becomes apparent with time as result of surrounding muscle atrophy. An updated improved design of the implant has been developed to counteract this.We report the case of a 15-year-old patient who underwent an extra-articular (Malawer type V) shoulder resection due to osteosarcoma and received an innovated custom-made double-constrained implant. Moreover, we describe a new modification of the Malawer utilitarian approach to the shoulder girdle that enhances tumor visibility and allows safer dissection. The patient recovered well with satisfactory outcomes at 18 months follow-up, highlighting the potential benefits of this implant design and surgical approach.
- MeSH
- artroplastika ramenního kloubu * metody MeSH
- lidé MeSH
- mladiství MeSH
- nádory kostí * chirurgie patologie MeSH
- náhrada ramenního kloubu * MeSH
- osteosarkom * chirurgie patologie MeSH
- ověření koncepční studie MeSH
- prognóza MeSH
- protézy - design * MeSH
- ramenní kloub * chirurgie patologie MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie * metody MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: This study provides an insight on the extent of muscular variability at the suprascapular notch and elaborates on its anatomical interference in suprascapular nerve arthroscopic decompression procedures. METHODS: The suprascapular notch was dissected and its muscular topography was observed in 115 cadaveric specimens. High resolution imaging of the suprascapular notch was captured by a handheld digital microscope (Q-scope). The supraspinatus and subscapularis muscles were traced as they course at the suprascapular notch vicinity. The omohyoid muscle attachment onto the suprascapular ligament was measured. A scoping review and meta-analysis were done to investigate the observed rare muscular variants. RESULTS: In 3.48%, the suprascapular notch anterior surface was fully covered by the subscapularis muscle. The omohyoid muscle inserted onto the suprascapular ligament in 31.25% and extended up to 3/4th of the suprascapular ligament length in 2.61%. Two rare variant muscles were encountered: subclavius posticus muscle and a newly reported "coracoscapularis muscle". CONCLUSIONS: Four categories of muscles with topographical relationship to the suprascapular notch and its arthroscopic feasibility have been classified: (1) constant muscles not intervening with the suprascapular notch space - supraspinatus muscle; (2) constant muscles with variable positions that can intervene with the suprascapular notch space - subscapularis muscle; (3) constant muscles with variable positions that can intervene with the surgical approach - omohyoid muscle; (4) variable muscles intervening with the suprascapular notch space and surgical approach - subclavius posticus and coracoscapularis muscles. This study elucidates the necessity to assess/secure the omohyoid muscle attachment onto the suprascapular ligament in suprascapular nerve decompression ligamentectomy. LEVEL OF EVIDENCE: V Basic Science Research.
- MeSH
- anatomická variace * MeSH
- artroskopie * metody MeSH
- chirurgická dekomprese metody MeSH
- kosterní svaly * inervace anatomie a histologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka inervace anatomie a histologie MeSH
- mrtvola * MeSH
- ramenní kloub inervace chirurgie anatomie a histologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: This study investigated the relationship between the position of the tip of the coracoid process (CP) relative to the glenoid with subscapularis (Ssc) tears. We hypothesized that the coracoid tip is more inferior, lateral and posterior in patients with Ssc tear. MATERIAL AND METHODS: This research enrolled 34 isolated Ssc tears and 44 controls. We introduced the axial central glenoid-coracoid angle (acGCA) and sagittal central glenoid-coracoid angle (scGCA) to evaluate the position of the tip of the CP relative to the glenoid center on MRI images. In both groups, acGCA, scGCA on MRI and critical shoulder angle (CSA), glenoid inclination (GI) on true anterior-posterior shoulder radiography were evaluated. RESULTS: When both groups were compared in terms of acGCA, the acGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of acGCA for Ssc tears was 28.3°. acGCA values higher than 28.3° showed 93.3% sensitivity and 93.1% specificity for Ssc tears (likelihood ratio:13.53, AUC: 0.979, 95% CI of AUC: 0.950- 0.999). In terms of acGCA, the power analysis between Ssc tears group and control group was 99.9% between Ssc tears and the control group (effect size d=2.63). When both groups were compared in terms of scGCA, the scGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of scGCA for Ssc tears was 41.4°. Scores of scGCA greater than 41.8° showed 80% sensitivity and 89.7% specificity for Ssc tears (likelihood ratio: 7.73, AUC: 0.899 95% CI of AUC: 0.837-0.958). In terms of scGCA, the power analysis between Ssc tear and control group was 99.8% (effect size d=1.23). When both groups were compared in terms of CSA and GI; CSA and GI values in the Ssc tear group were significantly higher (p<0.001 and p<0.012, respectively). CONCLUSIONS: AcGCA values higher than 28.3° indicate that the coracoid tip is located more laterally and posteriorly; scGCA values higher than 41.8° indicate that the coracoid tip is located more inferiorly and these two new indexes are showing that more laterally, posteriorly and inferiorly coracoid tip is related to subscapularis tears. KEY WORDS: coracoid process, subscapularis tear, coracoid morphology, scapula morphology.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- poranění rotátorové manžety * diagnostické zobrazování MeSH
- processus coracoideus * zranění diagnostické zobrazování MeSH
- ramenní kloub diagnostické zobrazování MeSH
- senzitivita a specificita MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Approximately, one-third of patients with tumors of proximal humerus will require an extra-articular resection to achieve oncologic margins. This procedure yields poor functional outcomes with a considerable rate of revisions. Unconstrained implants are prone to instability hindering also function of the elbow and hand, whereas constrained shoulder reconstructions suffer from early aseptic loosening of the glenoid component due to bone overload. The purpose of this study was to develop a constrained implant suitable for extra-articular resection with loss of function in deltoid and rotator cuff, which would provide both stability and passive motion, whilst also decreasing the risk of aseptic loosening of the glenoid component. METHODS: In cooperation with Czech Technical University in Prague, we devised an implant consisting of two constrained joints in series connected by a dumbbell piece. The biomechanical analysis showed a reduction of load transfer to the glenoid component with a torque of 8.6 Nm capable of generating an 865-N pulling force on bone screw to just 0.07 Nm, hence shielding the glenoid component from undesired forces and decreasing the risk of aseptic loosening. Three patients with extra-articular resection with a total loss of function of both rotator cuff and deltoid muscle received this type of reconstruction. The average follow-up was 16 months. RESULTS: The surgical technique is straightforward. The surgery took 175 min on average with average blood loss of 516 ml. There were no surgical- or implant-related complications. All three patients were pain-free and had a stable shoulder joint after the reconstruction. All had fully functional elbow, wrist, and hand joints. The average Musculoskeletal Tumor Society (MSTS) score was 21/30 (70%). All patients were pleased with the results. CONCLUSION: The presented innovative implant design has demonstrated to be a promising alternative for reconstruction in these challenging cases.
- MeSH
- humerus MeSH
- lidé MeSH
- lopatka MeSH
- pooperační komplikace etiologie MeSH
- ramenní kloub * chirurgie MeSH
- rameno MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- fraktury humeru diagnóza terapie MeSH
- klíční kost zranění MeSH
- lidé MeSH
- lopatka zranění MeSH
- luxace ramenního kloubu diagnóza terapie MeSH
- ortopedické výkony metody MeSH
- poranění ramene * diagnostické zobrazování patologie terapie MeSH
- poranění rotátorové manžety diagnóza patologie terapie MeSH
- ramenní kloub anatomie a histologie patologie MeSH
- syndrom zhmožděného ramene diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: Differentiating the anatomical variations of the anterosuperior portion of the glenoid labrum from pathologies is important to avoid unnecessary iatrogenic complications resulting from inaccurate diagnosis. Additionally, the presence of several variations was reported to be conductive to lesions involving the glenoid labrum. Thus, the aim of this study was to state the prevalence rates of the sublabral recess, sublabral foramen, and the Buford complex, and to verify their association with labral lesions. METHODS: Systematic search of electronic databases was conducted to gain potentially eligible literature. Suitable studies were selected in a two-round screening, and relevant data were subsequently extracted. Calculation of the pooled prevalence estimates, including sub-analyses on cohort size, study type, and geographical variance, was conducted. Pooled analysis of risk ratios (RR) was used to assess the conductive nature of the discussed variants to superior labrum anterior to posterior (SLAP) lesions. RESULTS: The screening resulted in selection of 20 studies investigating the morphological features of the glenoid labrum, consisting of 7601 upper limbs. On the bases of random-effects meta-analysis the sublabral recess, sublabral foramen and Buford complex occur with a pooled prevalence of 57.2% (95% CI 30.0-84.4%), 13.5% (95% CI 8.2-18.9%), and 3.0% (95% CI 1.5-4.5), respectively. Moreover, individuals with Buford complex have RR 2.4 (95% CI 1.3-4.7) of developing SLAP lesions, especially type II (95.5%; 95% CI 86.1-100%), whereas such risk for sublabral recess and sublabral foramen was not statistically significant. CONCLUSION: Morphological variants of the glenoid labrum posing diagnostic confusion are frequently observed. Gradually, the Buford complex may be a predisposing factor for sustaining a SLAP lesion.
- MeSH
- artroskopie MeSH
- horní končetina MeSH
- lidé MeSH
- poranění ramene * epidemiologie MeSH
- prevalence MeSH
- ramenní kloub * patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
OBJECTIVE: To investigate the relationship between osseous variations of the glenoid fossa and thinning of the overlaying articular cartilage. MATERIALS AND METHODS: In total, 360 dry scapulae, comprising adult, children and fetal specimens, were observed for potential presence of osseous variants inside the glenoid fossa. Subsequently, the appearance of the observed variants was evaluated using CT and MRI (each 300 scans), and in-time arthroscopic findings (20 procedures). New terminology of the observed variants was proposed by an expert panel formed by orthopaedic surgeons, anatomists and radiologists. RESULTS: Tubercle of Assaky was observed in 140 (46.7%) adult scapulae, and an innominate osseous depression was identified in 27 (9.0%) adult scapulae. Upon radiological imaging, the tubercle of Assaky was found in 128 (42.7%) CTs and 118 (39.3%) MRIs, while the depression was identified in 12 (4.0%) CTs and 14 (4.7%) MRIs. Articular cartilage above the osseous variations appeared relatively thinner and in several young individuals was found completely absent. Moreover, the tubercle of Assaky featured an increasing prevalence with aging, while the osseous depression develops in the second decade. Macroscopic articular cartilage thinning was identified in 11 (55.0%) arthroscopies. Consequently, four new terms were invented to describe the presented findings. CONCLUSION: Physiological articular cartilage thinning occurs due to the presence of the intraglenoid tubercle or the glenoid fovea. In teenagers, the cartilage above the glenoid fovea may be naturally absent. Screening for these variations increases the diagnostic accuracy of glenoid defects. In addition, implementing the proposed terminological updates would optimize communication accuracy.
- MeSH
- dítě MeSH
- dospělí MeSH
- kloubní chrupavka * diagnostické zobrazování MeSH
- kloubní jamka lopatky * diagnostické zobrazování MeSH
- lidé MeSH
- lopatka MeSH
- magnetická rezonanční tomografie MeSH
- mladiství MeSH
- počítačová rentgenová tomografie MeSH
- ramenní kloub * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
Horná končatina je dôležitým a komplikovaným orgánom, ktorý umožňuje širokú škálu pohybov potrebných pre prácu, tvorbu a realizáciu zámerov. Problémy v oblasti ramenného kĺbu majú výrazný dopad na kvalitu života človeka. Rameno, ako koreňový kĺb hornej končatiny, je najpohyblivejší a zároveň anatomicky a funkčne najzložitejší kĺb tela. Pre jeho špecifickú stavbu, veľký rozsah pohybu a neustálu aktivitu je ľahko zraniteľný a môže dôjsť k impingement syndrómu. Vyskytuje sa v čoraz mladšej populácii v produktívnom veku a býva príčinou dlhodobej práceneschopnosti. Cielenou fyzioterapiou je ale možné v danej oblasti funkčné zmeny a patologické svalové zreťazenie ovplyvniť, čím sa kvalitatívne zlepší hybný stereotyp. Vyšetrovali sme 20 pacientov s diagnózou impingement syndrómu bez predošlého operačného riešenia. Cielenou fyzioterapiou sme dokázali z väčšej miery úspešne odstrániť bolesť u 85 % pacientov, znormalizovať zvýšený tonus horných fixátorov a tíming u 60 % pacientov a správne zafixovať lopatku u 70 % pacientov.
The upper extremity is an important and complicated organ that enables a wide range of movements necessary for work, creation and realization of intentions. Problems in the area of the shoulder joint have a significant impact on a person’s quality of life. The shoulder, as the root joint of the upper limb, is the most mobile and, at the same time, the most anatomically and functionally complex joint of the body. Due to its specific structure, a large range of movement and constant activity, it is easily vulnerable and impingement syndrome can occur. It occurs in an increasingly younger population of productive age and is the cause of long-term incapacity for work. However, with targeted physiotherapy, it is possible to influence functional changes and pathological muscle concatenation in the given area, which qualitatively improves the movement stereotype. We investigated 20 patients with a diagnosis of impingement syndrome without a previous surgical solution. With targeted physiotherapy, we were able to largely successfully eliminate pain in 85% of patients, normalize the increased tone of the upper fixators and timing in 60% of patients, and correctly fix the scapula in 70% of patients.
- MeSH
- bolest ramene etiologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ramenní kloub anatomie a histologie patofyziologie MeSH
- syndrom zhmožděného ramene * etiologie patofyziologie rehabilitace MeSH
- techniky fyzikální terapie MeSH
- výzkum MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- MeSH
- artroskopie metody MeSH
- bolest ramene diagnóza etiologie MeSH
- burzitida chirurgie diagnóza farmakoterapie MeSH
- diferenciální diagnóza MeSH
- luxace ramenního kloubu chirurgie diagnóza etiologie MeSH
- pooperační péče metody rehabilitace MeSH
- poranění ramene chirurgie etiologie MeSH
- poranění rotátorové manžety chirurgie diagnóza MeSH
- ramenní kloub * chirurgie patofyziologie MeSH
- syndrom zhmožděného ramene chirurgie diagnóza farmakoterapie MeSH
- techniky fyzikální terapie * MeSH
- věkové faktory MeSH
- Publikační typ
- přehledy MeSH
