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
Bolesti ramenního kloubu jsou v populaci relativně časté a v ortopedických ambulancích tvoří nemalou část klientely. Následující práce shrnuje diagnostický algoritmus s důrazem na klinické vyšetření pacienta, které jsem schopni provést bez jakéhokoliv zázemí a speciálního vybavení. Tuto část doplňuje nástin používaných diagnostických zobrazovacích metod. Poslední částí je stručný souhrn jednotlivých patologií, se kterými se běžně můžeme v ambulantním provozu setkat a návrh na terapeutické postupy v daných případech.
Shoulder joint pain is relatively common in the population and accounts for a significant part of the clientele in orthopedic outpatient clinics. The following paper summarizes the diagnostic algorithm with emphasis on the clinical examination of the patient, which I am able to perform without any background or special equipment. This section is supplemented by an outline of the diagnostic imaging methods used. The last part is a brief summary of the individual pathologies commonly encountered in the outpatient setting and a suggestion for therapeutic procedures in these cases.
- MeSH
- bolest ramene * diagnóza patologie terapie MeSH
- diagnostické techniky a postupy MeSH
- lidé MeSH
- osteoartróza diagnóza patologie terapie MeSH
- ramenní kloub anatomie a histologie diagnostické zobrazování patofyziologie MeSH
- syndrom zhmožděného ramene diagnóza patologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- akromioklavikulární kloub patologie MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- lopatka patologie MeSH
- muskuloskeletální nemoci * diagnostické zobrazování klasifikace patologie terapie MeSH
- nemoci kloubů diagnostické zobrazování klasifikace patologie terapie MeSH
- poranění rotátorové manžety diagnostické zobrazování etiologie terapie MeSH
- ramenní kloub diagnostické zobrazování patologie MeSH
- sternoklavikulární kloub patologie MeSH
- tendinopatie diagnostické zobrazování terapie MeSH
- tortikolis chirurgie etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY This study aimed to evaluate the clinical outcomes and the rate of recurrence in patients who had undergone arthroscopic Bankart repair with remplissage for anterior instability of the glenohumeral joint. MATERIAL AND METHODS The study included 96 arthroscopic Bankart procedures with remplissage performed between 2013 and 2019 at our department in 93 patients (81 men and 12 women; with the mean age of 33 years). We gathered and analysed preoperative data, including a 3D-CT scan of the affected shoulder. Apart from stability, the functional results were assessed postoperatively using the WOSI, SSV, Rowe score, and by measuring the strength of shoulder girdle muscles. The non-parametric MannWhitney U-test was used to identify the predisposing factors for recurrence of glenohumeral instability. RESULTS The arthroscopic Bankart repair with remplissage was indicated in 74 shoulders for primary TUBS and in 22 shoulders as a revision procedure. The recurrent instability was observed in 13 of 96 operated shoulders (13.5%). Subjective instability (positive apprehension test in the extreme positions of the shoulder joint, in abduction and external rotation in particular) was reported by 10 patients (10/13; 77%), three patients experienced a redislocation of the glenohumeral joint in the postoperative follow-up (3/13 patients; 23%). The risk of recurrence of the glenohumeral instability was not correlated with either the number of previous stabilisation procedures, or any other preoperative or intraoperative parameters. Conversely, a new postoperative injury was a factor of key importance. The patients with recurrent instability (subjective instability or glenohumeral dislocation) achieved a significantly lower Rowe score, SSV, postoperative VAS, and worse overall satisfaction with the procedure compared to the group with no recurrent instability. The remplissage induced minor limitations of external rotation at 0° abduction and internal rotation at 90° abduction. After rehabilitation, the muscle strength of the operated shoulder in both groups was comparable to that of the untreated shoulder in all planes of the shoulder range of motion. DISCUSSION Our study confirms the clinical relevance of the addition of remplissage to the arthroscopic Bankart procedure for reducing the rate of recurrent glenohumeral instability in TUBS with a clinically significant Hill-Sachs lesion. Satisfaction with the surgical outcome is high; the functional outcomes are very good, including muscle strength. Surprisingly, though, the risk of recurrent instability does not correlate with the number of implants used in the stabilisation procedure. CONCLUSIONS Addition of remplissage to the arthroscopic Bankart stabilisation in patients with a clinically significant Hill-Sachs lesion shows a low risk of recurrence of glenohumeral instability after surgery compared to the conventional arthroscopic Bankart repair alone. The remplissage does cause minor restrictions in the glenohumeral joint external rotation, but it was not reflected in the satisfaction of patients or a lower clinical score of the shoulder joint. The preoperative assessment of the HillSachs lesion using the "glenoid track" on a 3D-CT scan helps improve the preoperative planning and prediction of outcomes of the stabilisation procedure. Key words: glenohumeral instability, Bankart defect, Hill-Sachs lesion, Bankart repair, remplissage, arthroscopy.
- MeSH
- artroskopie metody MeSH
- Bankartova léze * chirurgie MeSH
- dospělí MeSH
- lidé MeSH
- luxace ramenního kloubu * chirurgie MeSH
- nestabilita kloubu * etiologie chirurgie MeSH
- ramenní kloub * diagnostické zobrazování chirurgie MeSH
- rameno MeSH
- recidiva MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
ABSTRACT: In this dynamic protocol, ultrasound examination of the shoulder using different maneuvers is described for several/relevant shoulder problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) will help musculoskeletal physicians perform a better and uniform/standard approach.
Tříletá fena boerboela byla předvedena pro 3 týdny trvající intermitentní kulhání na pravou hrudní končetinu. Přesná lokalizace nebyla klinickým vyšetřením možná. Screeningové rentgenové vyšetření odhalilo abnormality kostního podkladu glenoidu pravé lopatky (miskovité části) a volný plyn v kloubní štěrbině. Pomocí počítačové tomografie byla jako hlavní nález zjištěna osteochondróza kaudálního glenoidu lopatky. Terapií volby bylo artroskopické ošetření léze. Tři měsíce po zákroku majitelka hodnotila výsledek léčby jako dobrý.
A 3-year-old female boerboel dog was presented for 3 weeks lasting intermittent limping on right front leg. Physical examination was without specific findings. Screening X-ray examination revealed abnormality of the right glenoid of scapula and free gas in joint space. The main finding of CT study was osteochondrosis of the caudal glenoid of the right scapula. The lesion was treated by arthroscopic surgery. The owner claimed good outcome 3 months after surgery.
- MeSH
- artroskopie veterinární MeSH
- lopatka * chirurgie diagnostické zobrazování patologie MeSH
- osteochondróza * chirurgie diagnostické zobrazování patologie veterinární MeSH
- počítačová rentgenová tomografie veterinární MeSH
- psi MeSH
- ramenní kloub chirurgie diagnostické zobrazování patologie MeSH
- zchromnutí zvířat chirurgie patologie MeSH
- zobrazování trojrozměrné veterinární MeSH
- zvířata MeSH
- Check Tag
- psi MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY Shoulder instability is often times accompanied by associated injuries caused by the humeral head displacement. These are primarily bone lesions on the head and socket of the glenohumeral joint. The purpose of this study was to evaluate the frequency, morphology and clinical significance of bone lesions in shoulder instabilities in a group of patients operated in our department for glenohumeral instability between 2012 and 2019. MATERIAL AND METHODS The ongoing evaluation included 373 patients with trauma and habitual instability who had undergone surgery in our department in the period from 2012 to 2019. All patients underwent a preoperative 3D CT scan of the shoulder joint. Subsequently, the morphology and clinical significance of individual bone lesions were evaluated based on the older Burkhart s concept of engaging/nonengaging lesions and the newer concept of glenoid track by Yamamoto and Di Giacomo of 2007, 2014 or 2020. RESULTS The frequency of Hill-Sachs lesion was 83.4% (311) in our group of patients. In nearly two thirds (211 cases) also a bone defect on glenoid was detected (59.3%). When comparing the basic types of instabilities, in the TUBS group the Hill-Sachs lesions were present up to twice as often as in the group with AMBRI instability. Clinically significant Hill-Sachs lesions according to the older concept of engaging/ nonengaging lesions of Burkhart were reported in 104 cases (34%). Clinically significant lesions according to the newer concept of Yamamoto and DiGiacomo (the so-called off-track lesions) were observed in 173 cases (55.6%). Classified as critical were the clinically insignificant lesions (the so-called on-track lesions), which by their location were near the glenoid track. These lesions were found in 80 patients. After adding up the significant (off-track) and critical on-track lesions, we arrived at 253 (81.4%) clinically significant lesions based on the updated Yamamoto concept. DISCUSSION The frequency of Hill-Sachs lesions and glenoid defects identified by us is close to the upper limit of the range described in literature (8 to 100%). Based on the recent study by Yamamoto, added to these defects were the so-called peripheral ontrack defects, the clinical significance of which is currently indisputable. The oldest classification into engaging/nonengaging lesions revealed only 34% of the significant lesions, but this concept does not evaluate the glenoid defect. The newer concept by Yamamoto/DiGiacomo resulted in detecting 55.6% of significant Hill-Sachs lesions. The latest modification of the glenoid track of 2020, which includes also the on-track lesions in the critical zone among the significant lesions, in our group of patients classified 81% of lesions as clinically significant. CONCLUSIONS Our study confirmed the very frequent occurrence of clinically significant Hill-Sachs lesions in shoulder instabilities. Therefore, for the sake of successful shoulder stabilisation surgery detailed preoperative planning with 3D CT of the shoulder joint and evaluation of the associated bone lesions are necessary. The highest detection of clinically significant lesions was achieved by the latest modification of the glenoid track concept. Future studies will have to prove the effect of this classification on the result of surgical treatment. Key words: shoulder instability, glenoid track; bone defects, Hill-Sachs lesion; bipolar lesions; 3D CT evaluation.
- MeSH
- Bankartova léze * MeSH
- incidence MeSH
- lidé MeSH
- luxace ramenního kloubu * diagnostické zobrazování epidemiologie MeSH
- nestabilita kloubu * diagnostické zobrazování epidemiologie etiologie MeSH
- počítačová rentgenová tomografie MeSH
- ramenní kloub * diagnostické zobrazování chirurgie MeSH
- rameno MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
This guide to ultrasound examination of the shoulder describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is placed on the rotator cuff, biceps tendon, subacromial-subdeltoid bursa, and joint recesses evaluation. This article also describes some common pitfalls to avoid when starting with shoulder ultrasonography (e.g. always determine the relevance of ultrasound findings in the context of clinical examination). Key words: tendons, bursa, synovial, shoulder, musculoskeletal, protocol, examination, ultrasound imaging, sonography, rotator cuff, acromioclavicular joint, shoulder impingement syndrome, learning curve.
- MeSH
- klouby ruky diagnostické zobrazování patologie MeSH
- kolenní kloub diagnostické zobrazování patologie MeSH
- kyčelní kloub diagnostické zobrazování patologie MeSH
- lidé MeSH
- loketní kloub diagnostické zobrazování patologie MeSH
- magnetická rezonanční tomografie MeSH
- nestabilita kloubu * diagnostické zobrazování etiologie prevence a kontrola MeSH
- pooperační péče MeSH
- ramenní kloub diagnostické zobrazování patologie MeSH
- zápěstní kloub diagnostické zobrazování patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- biomechanika MeSH
- biomedicínský výzkum metody trendy MeSH
- lidé MeSH
- mrtvola MeSH
- odběr tkání a orgánů MeSH
- ortopedické výkony * metody MeSH
- poranění rotátorové manžety * diagnóza chirurgie MeSH
- poranění šlachy MeSH
- přenos šlachy * metody MeSH
- prsní svaly chirurgie transplantace MeSH
- ramenní kloub diagnostické zobrazování chirurgie MeSH
- statistika jako téma MeSH
- svalová síla - dynamometr MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
