Shoulder MRI evaluation of the association of os acromiale with supraspinatus and infraspinatus injury / 中国骨伤

OBJECTIVE@#To explore the MRI findings of os acromiale and to analyze the relationship between os acromiale and the supraspinatus and infraspinatus injury.@*METHODS@#From January 2010 to August 2020, 21 patients with os acromiale (os arcomiale group) were compared with 21 subjects with no evidence of os acromiale (no os arcomiale group). There were 14 males and 7 females in the os arcomiate group, aged from 29 to 77 years old, mean aged (55.5±11.5) years old. While in the control group, there were 10 males and 11 females in no os arcomiale group, aged from 31 to 70 years old, mean aged (51.1±10.0) years old. The os acromiales were classified as edematous os acromiale or non-edematous os acromiale based on whether the presence of marrow edema, and as displaced os acromiale or non-displaced os acromiale based on whether the presence of displacement of the os acromiale. The MRI features of os acromiale were analyzed. Statistical analyses were performed to identify the differences between the os arcomiale group and no os arcomiale group regarding rotator cuff tear, supraspinatus and infraspinatus injury. Differences in the supraspinatus and infraspinatus tear between the edematous and non-edematous os acromiale group, the displaced and non-displaced os acromiale group, the displaced os acromiale and no os arcomiale group were also assessed.@*RESULTS@#On MRI, all the 21 os acromiales appeared as a triangular or irregular bone fragment of the distal acromion, and forms a pseudo-acromioclavicular joint with the acromion. Eleven cases were edematous os acromiale, 11 cases were displaced os acromiale. In the os arcomiale group, 17 had supraspinatus tear, 1 had supraspinatus tendinitis, 11 had infraspinatus tear, and 4 had infraspinatus tendinitis. In the no os arcomiale group, 11 had supraspinatus tear, 2 had supraspinatus tendinitis, 5 had infraspinatus tear, and 1 had infraspinatus tendinitis. No statistically significant difference between the os arcomiale group and no os arcomiale group regarding the rotator cuff tear, supraspinatus and infraspinatus injury (P>0.05). In the 11 cases of edematous os arcomiale, 10 had supraspinatus tear and 7 had infraspinatus tear. In the 10 cases of non-edematous os acromiale, 7 had supraspinatus tear and 4 had infraspinatus tear. No statistically significant difference was noted between the edematous os acromiale and non-edematous os acromiale in terms of supraspinatus and infraspinatus tear (P>0.05). In the 11 cases of displaced os acromiale, 11 had supraspinatus tear and 9 had infraspinatus tear. In the 10 cases of non-displaced os acromiale, 6 had supraspinatus tear and 2 had infraspinatus tear. In the no os arcomiale group, 11 had supraspinatus tear and 5 had infraspinatus tear. There was a statistically significant increases in the prevalence of supraspinatus and infraspinatus tear in the displaced os acromiale group compared with non-displaced os acromiale group, the displaced os acromiale group and no os arcomiale group(P<0.05).@*CONCLUSION@#Shoulder MRI can very well depict os acromiale and can reveal associated abnormalities such as adjacent bone marrow edema, displaced deformity, and rotator cuff tear, and it can be used to assess the stability of the os acromiale. The presence of os acromiale may not increase the risk of supraspinatus and infraspinatus tear significantly. However, the presence of displaced os acromiale is at greater risk of supraspinatus and infraspinatus tear.

Diminutive Incision Acromioplasty Assisted with Arthroscopy in the Treatment of Chinese Patients with Subacromial Impingement Syndrome / Acromioplastia de Incisión Diminuta Asistida con Artroscopia en el Tratamiento de Pacientes Chinos con Síndrome de Pinzamiento Subacromial

ABSTRACT Background: Many causes can lead to shoulder pain and subacromial impingement syndrome (SIS) is the most frequently recorded disorders. The aim of this study was to evaluate the clinical effects of diminutive incision acromioplasty assisted with arthroscopy for the treatment of Chinese patients with subacromial impingement syndrome. Subject and Methods: Twenty-two patients with 24-painful shoulders subacromial impingement syndrome were enrolled. All painful shoulders were in Grades II (8) and III (16) according to Neer's classification. Detailed physical examination was performed. Conventional radiography and subsequent magnetic resonance imaging (MRI) of the shoulder region of all patients were done. The University of California at Los Angeles Shoulder (UCLA) score system was used for all patients to evaluate their satisfaction after surgery. The preoperative recordings of the UCLA scores were collected and all enrolled cases including 24-painful shoulders were available for follow-up in 1, 3, 6, 12 months after surgery. Results: According to the UCLA scoring system, the symptom of all painful shoulders were improved after one year postoperatively. The average score before surgery from 15.4 points increased to 31.2 points postoperatively, showing a statistical difference (p < 0.05). Conclusions: A diminutive incision acromioplasty assisted with arthroscopy is a reliable approach to treat Chinese patients with subacromial impingement syndrome. All painful shoulders were obviously improved in one year after surgery.

ABSTRACT Antecedentes: Muchas causas pueden provocar dolor de hombro y síndrome de compresión subacromial (SIS) es el trastorno más frecuentemente registrado. El objetivo de este estudio fue evaluar la clínica. Efectos de la acromioplastia con incisión diminuta asistida con artroscopia para el tratamiento de Pacientes chinos con síndrome de pinzamiento subacromial. Sujeto y métodos: Se incluyeron veintidós pacientes con síndrome de afectación subacromial de 24-hombros dolorosos. Todos los hombros dolorosos estaban en Grados II (8) y III (16) de acuerdo con la clasificación de Neer. Se realizó examen físico detallado. Se realizaron radiografías convencionales y, posteriormente, imágenes de resonancia magnética (IRM) de la región del hombro de todos los pacientes. El sistema de puntuación de la Universidad de California en Los Angeles Shoulder (UCLA) se utilizó para que todos los pacientes evaluaran su satisfacción después de la cirugía. Los registros preoperatorios de las puntuaciones de UCLA se recopilaron y todos los casos incluidos, incluidos 24-hombros dolorosos, estaban disponibles para el seguimiento en 1, 3, 6 y 12 meses después de la cirugía. Resultados: De acuerdo con el sistema de puntuación de UCLA, el síntoma de todos los hombros dolorosos mejoró después de un año después de la operación. La puntuación promedio antes de la cirugía de 15.4 puntos aumentó a 31.2 puntos después de la operación, mostrando una diferencia estadística (p < 0.05) Conclusiones: Una acromioplastia de incisión diminuta asistida con artroscopia es un enfoque confiable para tratar a pacientes chinos con síndrome de pinzamiento subacromial. Todas las lesiones dolorosas se mejoraron obviamente en un año después de la cirugía.

Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study / Associação entre o ângulo crítico do ombro e lesão do manguito rotador: um estudo epidemiológico retrospectivo

ABSTRACT OBJECTIVE: To perform a retrospective epidemiological study of radiographs in order to evaluate the relationship between the anatomy of the scapula and the development of rotator cuff injuries (RCIs). METHODS: This study retrospectively evaluated the relation of the critical shoulder angle (CSA) and RCIs from January 2011 to November 2013; patients were examined in the Orthopedics and Traumatology Department of a university hospital. The CSA was measured by radiographic standardization of two groups: a control group of 34 asymptomatic shoulders and a study group of 44 shoulders with complete RCIs. RESULTS: The mean age in the control group was 59.97 years (45-84) and the mean age in the group with RCIs was 59.75 years (45-84). Regarding the CSA, the control group had a mean angle of 33.59° (±3.37) and the group with RCIs had a mean angle of 39.75° (±5.35; p< 0.007). CONCLUSION: There is an association between CSA and RCIs.

RESUMO OBJETIVO: Fazer um estudo epidemiológico retrospectivo em radiografias para avaliar a relação entre a anatomia da escápula e o desenvolvimento de lesões do manguito rotador (LMR). MÉTODOS: O presente estudo avaliou retrospectivamente a relação do ângulo crítico do ombro (ACO) e LMR de janeiro de 2011 a novembro de 2013, em pacientes atendidos em um hospital universitário pelo Departamento de Ortopedia e Traumatologia. Para tanto, o ACO foi medido após a padronização radiográfica de dois grupos, um grupo controle de 34 ombros assintomáticos e um segundo grupo de 44 ombros com LMR. RESULTADOS: A média de idade no grupo controle foi de 59,97 anos (45-84) e de 59,75 anos no grupo com LMR (45-84). Em relação ao ACO, os pacientes do grupo controle tiveram média de 33,59 graus de angulação (± 3,37) e o grupo de pacientes com LMR apresentou uma média de 39,75 graus de angulação (± 5,35; p < 0,007). CONCLUSÃO: Há uma relação entre ACO e LMR.

Acromial morphometric analysis using imaging software / Análisis morfométrico del acromion usando software de imágenes

The aim of this study was to accurately measure acromial morphology in order to describe the anatomical patterns of its subtypes and to conduct a survey of the literature regarding the relationships between morphological subtypes and their related diseases. We photographed scapulae from the Institute of Anatomy, University Severino Sombra, and analyzed the images using Image-J Software®. The average acromial angle was 139.23° ± 2.781, with no significant difference between the right and left sides. There was a positive correlation between the acromial angle and the angle of the spine of the scapula. The correlation mentioned above plays an important role in disorders of the shoulder-particularly impingement syndrome-which reinforces the importance of acromial morphology studies.

El objetivo de este estudio fue medir con precisión la morfología acromial para describir los patrones anatómicos de sus subtipos y llevar a cabo un estudio de la literatura sobre las relaciones entre los subtipos morfológicos y las enfermedades relacionadas. Tomamos fotografías de la escápula del Instituto de Anatomía de la Universidad Sombra Severino, y se analizaron las imágenes con el Software Image-J®. El ángulo acromial medio fue de 139,23 ± 2,781°, no habiendo diferencias significativas entre los lados derecho e izquierdo. De observó una correlación positiva entre el ángulo acromial y el ángulo de la columna vertebral de la escápula. La correlación mencionada anteriormente, juega un papel importante en los trastornos de la inflamación del hombro, especialmente el síndrome, lo cual refuerza la importancia de los estudios de la morfología acromial.

Anatomical basics and variations of the scapula in Turkish adults

To analyze the anatomical basis of the scapula, acromion, os acromiale, coracoid process, coraco-acromial arch, and glenoid cavity in Turkish adults. We performed the study at the Faculty of Medicine, Akdeniz University, Turkey between January 2004 and December 2005. A total of 90 dry bones of the scapula from human cadavers were randomly selected. The length, width, and anterior thickness of the acromion and the acromial facet of the acromioclavicular joint were measured with an electronic caliber and was examined visually. For the radiological evaluation, the posterior anterior and the lateral shoulder radiographs of 90 consecutive adult patients with normal findings were used. These films were evaluated and grouped according to the acromial arch morphology. The distribution of the acromial morphologic types according to slope was type I [flat] 10%, type II [curved] 73%, type III [hooked] 17%. Type I was seen in 11%, type II 66%, type III 23% of the specimens. The morphological shape of the tip of the acromion was 31% cobra shaped, 13% square shaped, and 56% intermediate type. The scapulas, coracoid process and the coraco acromial arch were measured. In 72% of the specimen, the glenoid notch of the scapulas were absent and oval shaped, whereas in 28% the notch was well expressed and the glenoid cavity was pear shaped. The mean vertical length of the glenoid cavity was 36.3 +/- 3 mm, and the mean transverse length was 24.6 +/- 2.5 mm. Os acromiale is a rare anatomical condition. Its incidence has been documented in radiographic and anatomical studies to be between 1-15%. The presence of os acromiale was 1% in shoulder radiographs [os pre-acromiale], and in dry bones [os meta-acromiale]. We reported the exact morphological measurements of the bone structures of the scapula in Turkish adult population. Our results present an instructive figures of anatomical preparations and radiological cases that can be used to make a more precise radiological and a differential diagnoses

Arthroscopic subacromial decompression

A study group composed of 11 shoulders in 10 patients underwent arthroscopic subacromial decompression for impingement syndrome. There were no biceps tendon ruptures, acromioclavicular arthritis or glenohumeral instability. Eight men and two women ranging in age from 17 to 65 years (mean age 38.7) with dominant arm involvement in 9/10 were evaluated for an average follow-up of 19.4 months (range 12-26) postoperatively. Based on the University of California at Los Angeles shoulder rating scale, nine (82%) shoulders had satisfactory results and the remaining two (18%) had unsatisfactory results. This is a preliminary report of our early experience in this rather new method of treatment, but the results are encouragingly good.