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1.
Arch Orthop Trauma Surg ; 144(8): 3313-3322, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39105835

RESUMEN

BACKGROUND: The aim of this study was to evaluate the interobserver reliability of measurements of the Acromiohumeral Distance (AHD) first described by Golding et al., the Critical Shoulder Angle (CSA), the Acromion Index with Glenoid Humeral (GH) and Glenoid Acromial (GA) distances, following the measuring method by Nyffeler et al., the Lateral Acromion Angle (LAA), as well as the morphology of the acromion according to Bigliani and the humeral head position according to Maloney in X-rays and MRI. Furthermore, the study assessed the correlation of measurement results in X-ray with those in MRI for AHD, CSA, GA, GH, AI, and LAA. METHODS: A total of 187 patients who underwent shoulder joint X-ray and MRI examinations from 09/2016 to 05/2023 were included in the study. Patients with poor imaging quality, arthrosis or radical prior surgeries, like shoulder prosthetic surgery, status post humerus fractures, that have undergone surgery and therefore changed the anatomical features were excluded, what lead to a total study population of 78. X-ray measurements were performed by two observers in the true anteroposterior view, so that the humeral head and the glenoid are shown without overlap, providing a clear view into the joint space. MRI measurements were performed in oblique coronal MRI slices, using the most accurately depicted glenoid surface as a landmark. RESULTS: Interobserver measurement results showed a significance with p < 0.001 for the assessment of acromion type according to Bigliani, humeral head offset assessment according to Maloney, and AHD. No significance was found for interobserver reliability in measuring LAA. Additionally, there was a high correlation of measurement results in X-ray with measurements in MRI for, CSA, GH/GA, and consequently AI, a good correlation for AHD but no correlation could be shown for LAA. CONCLUSIONS: These findings provide valuable insights into the robustness of radiological parameters for evaluating shoulder pathology, offering promising prospects for clinical applications and further research. Nevertheless, the specific methodological considerations and patient characteristics should be taken into account when interpreting the results to ensure their accurate application in clinical practice.


Asunto(s)
Acromion , Imagen por Resonancia Magnética , Variaciones Dependientes del Observador , Articulación del Hombro , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Femenino , Articulación del Hombro/diagnóstico por imagen , Persona de Mediana Edad , Adulto , Reproducibilidad de los Resultados , Anciano , Acromion/diagnóstico por imagen , Acromion/anatomía & histología , Radiografía/métodos , Adulto Joven
2.
Ann Ital Chir ; 95(4): 708-714, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39186344

RESUMEN

AIM: Rotator cuff tears (RCTs) are a major cause of shoulder pain and disability, affecting millions worldwide. Understanding the risk factors and developing reliable predictive measures for RCTs is essential for early diagnosis, targeted prevention, and effective treatment of this patient population. This study seeks to enhance our understanding by analyzing the acromiohumeral distance (AHD) and Constant-Murley Score (CMS) in patients with and without RCTs, thereby aiding the development of a predictive model aimed at improving clinical outcomes and prevention strategies in rotator cuff pathology. METHODS: This retrospective analysis involved 201 patients with shoulder pain, categorized into RCT (n = 72) and no RCTs (N-RCTs, n = 129) groups based on Magnetic Resonance Imaging (MRI) findings. We compared demographics, AHD, CMS, and rotator cuff status between groups and utilized logistic regression for identifying RCT predictors, leading to the development of a multifactorial predictive model. RESULTS: The mean AHD was 6.60 ± 1.12 mm. The RCT group showed a marginally higher AHD than the N-RCT group (p = 0.669). CMS scores were significantly lower in the RCT group (p < 0.001). Dominant side involvement (Odds Ratio (OR) 2.244), type III acromion (OR 6.106), and lower CMS (OR 0.938) significantly correlated with RCTs. The predictive model demonstrated an area under the curve (AUC) of 0.701 for RCT diagnosis. CONCLUSIONS: Reduced CMS, dominance of the affected side, and type III acromion emerged as key risk factors for RCTs. Our predictive model, incorporating these factors, holds promise for RCT diagnosis, with future studies needed for further validation.


Asunto(s)
Lesiones del Manguito de los Rotadores , Humanos , Estudios Retrospectivos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Factores de Riesgo , Masculino , Femenino , Persona de Mediana Edad , Anciano , Imagen por Resonancia Magnética , Dolor de Hombro/etiología , Medición de Riesgo/métodos , Adulto , Acromion/diagnóstico por imagen , Acromion/lesiones
3.
Clin Orthop Surg ; 16(4): 578-585, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39092296

RESUMEN

Background: Morphological differences among various ethnicities can significantly impact the reliability of acromiohumeral interval (AHI) measurements in diagnosing massive rotator cuff tears. This variation raises questions about the generalizability of AHI studies conducted in Western populations to the Asian population. Consequently, the primary objective of this study was to develop a novel parameter that can enhance the diagnosis of massive rotator cuff tears, irrespective of morphometric disparities between individuals of different ethnic backgrounds. Methods: A 10-year retrospective analysis of shoulder arthroscopic surgery patients was conducted, categorizing them into 3 groups based on intraoperative findings: those without rotator cuff tears, those with non-massive tears, and those with massive tears. AHI-glenoid ratio (AHIGR) was measured by individuals with varying academic backgrounds, and its diagnostic performance was compared to AHI. Sensitivity, specificity, accuracy, and intra- and inter-rater reliability were evaluated. Results: AHIGR exhibited significantly improved sensitivity, specificity, and accuracy as a diagnostic tool for massive rotator cuff tears, compared to AHI. A proposed cut-off point of AHIGR ≤ 0.2 yielded comparable results to AHI < 7 mm. Intra- and inter-rater reliability was excellent among different observers. Conclusions: AHIGR emerges as a promising diagnostic tool for massive rotator cuff tears, offering improved sensitivity and specificity compared to AHI. Its reproducibility among diverse observers underscores its potential clinical utility. While further research with larger and more diverse patient cohorts is necessary, AHIGR offers significant potential as a reference for enhancing the assessment of massive rotator cuff tears.


Asunto(s)
Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Acromion/diagnóstico por imagen , Artroscopía , Adulto , Húmero/diagnóstico por imagen , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Articulación del Hombro/diagnóstico por imagen
4.
Acta Orthop Traumatol Turc ; 58(3): 167-170, 2024 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-39165221

RESUMEN

The purpose of this study was to identify the relationship between scapula morphology and rotator cuff tears (RCT). Hundred seventeen shoulders with and 87 shoulders without RCTs were included in this retrospective study. The critical shoulder angle (CSA) and lateral acromion angle in the coronal view, and the acromial coverage angle (ACA) and coracoid and scapular spine angle (CSSA) in the sagittal view were evaluated using 3-dimensional computed tomography. The glenoid anterior tilt, anterior acromial projection angle (AAPA), coracoid process angle, scapular spine angle (SSA), and inferior angle angle (IAA) with respect to the scapular plane were measured in the sagittal view. In univariate logistic regression analysis, CSA, ACA, AAPA, SSA, and IAA were significantly greater in shoulders with RCTs, whereas CSSA was greater in shoulders without RCTs. In multivariate logistic regression analysis, CSA and IAA were greater in shoulders with RCT and were significantly associated with this condition (P=.00073, P=.0032). This study has shown us that RCTs were associated with a greater curvature of the scapular body and greater CSA and IAA.


Asunto(s)
Imagenología Tridimensional , Lesiones del Manguito de los Rotadores , Escápula , Tomografía Computarizada por Rayos X , Humanos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Escápula/diagnóstico por imagen , Escápula/anatomía & histología , Femenino , Estudios Retrospectivos , Masculino , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Imagenología Tridimensional/métodos , Anciano , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/anatomía & histología , Adulto , Acromion/diagnóstico por imagen , Acromion/anatomía & histología , Manguito de los Rotadores/diagnóstico por imagen
5.
Acta Chir Orthop Traumatol Cech ; 91(3): 164-169, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38963895

RESUMEN

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.


Asunto(s)
Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Ultrasonografía , Humanos , Ultrasonografía/métodos , Masculino , Femenino , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/fisiopatología , Persona de Mediana Edad , Adulto , Acromion/diagnóstico por imagen , Estudios de Casos y Controles , Dolor de Hombro/etiología , Dolor de Hombro/diagnóstico por imagen , Dolor de Hombro/fisiopatología , Tendinopatía/diagnóstico por imagen , Tendinopatía/fisiopatología , Dimensión del Dolor/métodos
6.
BMC Musculoskelet Disord ; 25(1): 589, 2024 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-39060988

RESUMEN

BACKGROUND: This study validated the accuracy of the acromion marker cluster (AMC) and scapula spinal marker cluster (SSMC) methods compared with upright four-dimensional computed tomography (4DCT) analysis. METHODS: Sixteen shoulders of eight healthy males underwent AMC and SSMC assessments. Active shoulder elevation was tracked using upright 4DCT and optical motion capture system. The scapulothoracic and glenohumeral rotation angles calculated from AMC and SSMC were compared with 4DCT. Additionally, the motion of these marker clusters on the skin with shoulder elevation was evaluated. RESULTS: The average differences between AMC and 4DCT during 10°-140° of humerothoracic elevation were - 2.2° ± 7.5° in scapulothoracic upward rotation, 14.0° ± 7.4° in internal rotation, 6.5° ± 7.5° in posterior tilting, 3.7° ± 8.1° in glenohumeral elevation, - 8.3° ± 10.7° in external rotation, and - 8.6° ± 8.9° in anterior plane of elevation. The difference between AMC and 4DCT was significant at 120° of humerothoracic elevation in scapulothoracic upward rotation, 50° in internal rotation, 90° in posterior tilting, 120° in glenohumeral elevation, 100° in external rotation, and 100° in anterior plane of elevation. However, the average differences between SSMC and 4DCT were - 7.5 ± 7.7° in scapulothoracic upward rotation, 2.0° ± 7.0° in internal rotation, 2.3° ± 7.2° in posterior tilting, 8.8° ± 7.9° in glenohumeral elevation, 2.0° ± 9.1° in external rotation, and 1.9° ± 10.1° in anterior plane of elevation. The difference between SSMC and 4DCT was significant at 50° of humerothoracic elevation in scapulothoracic upward rotation and 60° in glenohumeral elevation, with no significant differences observed in other rotations. Skin motion was significantly smaller in AMC (28.7 ± 4.0 mm) than SSMC (38.6 ± 5.8 mm). Although there was smaller skin motion in AMC, SSMC exhibited smaller differences in scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation compared to 4DCT. CONCLUSION: This study demonstrates that AMC is more accurate for assessing scapulothoracic upward rotation and glenohumeral elevation, while SSMC is preferable for evaluating scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation, with smaller differences compared to 4DCT.


Asunto(s)
Acromion , Tomografía Computarizada Cuatridimensional , Rango del Movimiento Articular , Escápula , Articulación del Hombro , Humanos , Masculino , Escápula/diagnóstico por imagen , Escápula/fisiología , Tomografía Computarizada Cuatridimensional/métodos , Adulto , Fenómenos Biomecánicos/fisiología , Acromion/diagnóstico por imagen , Acromion/fisiología , Rango del Movimiento Articular/fisiología , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiología , Adulto Joven , Rotación
7.
J Am Acad Orthop Surg ; 32(15): 712-718, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38739868

RESUMEN

INTRODUCTION: This study evaluates the role of anatomic scapular morphology in acromion and scapular spine fracture (SSAF) risk after reverse shoulder arthroplasty (RSA). METHODS: Twelve scapular measurements were captured based on pilot study data, including scapular width measurements at the acromion (Z1), middle of the scapular spine (Z2), and medial to the first major angulation (Z3). Measurements were applied to 3D-CT scans from patients who sustained SSAF after RSA (SSAF group) and compared with those who did not (control group). Measurements were done by four investigators, and the intraclass correlation coefficient was calculated. Regression analysis determined trends in fracture incidence. RESULTS: One hundred forty-nine patients from two separate surgeons (J.L., A.M.) were matched by age and surgical indication of whom 51 sustained SSAF after reverse shoulder arthroplasty. Average ages for the SSAF and control cohorts were 78.6 and 72.1 years, respectively. Among the SSAF group, 15 were Levy type I, 26 Levy type II, and 10 Levy type 3 fractures. The intraclass correlation coefficient of Z1, Z2, and Z3 measurements was excellent (0.92, 0.92, and 0.94, respectively). Zone 1 and 3 measurements for the control group were 18.6 ± 3.7 mm and 3.2 ± 1.0 mm, respectively, compared with 22.5 ± 5.9 mm and 2.0 ± 0.70 mm in the SSAF group, respectively. The fracture group trended toward larger Z1 and smaller Z3 measurements. The average scapular spine proportion (SSP), Z1/Z3, was significantly greater in the control 6.20 ± 1.80 versus (12.60 ± 6.30; P < 0.05). Regression analysis showed a scapular spine proportion of ≤5 was associated with a fracture risk <5%, whereas an SSP of 9.2 correlated with a 50% fracture risk. DISCUSSION: Patients with a thicker acromions (Z1) and thinner medial scapular spines (Z3) have increased fracture risk. Understanding anatomic scapular morphology may allow for better identification of high-risk patients preoperatively.


Asunto(s)
Artroplastía de Reemplazo de Hombro , Escápula , Humanos , Escápula/anatomía & histología , Escápula/diagnóstico por imagen , Anciano , Artroplastía de Reemplazo de Hombro/efectos adversos , Masculino , Femenino , Tomografía Computarizada por Rayos X , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Anciano de 80 o más Años , Persona de Mediana Edad , Acromion/anatomía & histología , Acromion/diagnóstico por imagen , Proyectos Piloto , Imagenología Tridimensional
8.
J Orthop Surg (Hong Kong) ; 32(1): 10225536241248708, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38682374

RESUMEN

Background: Os acromiale (OA) is an uncommon pathology with a variable prevalence rate among different populations. Objectives: The aim of this study was to report the frequency of OA utilizing shoulder MRI of patients with shoulder pathology. Methods: It was a retrospective study. After obtaining our IRB approval, we gathered all shoulder and upper arm MRIs from the radiology department and evaluated them. Results: The prevalence of OA was found to be 3.32%. The mean age of the affected patients was 50.87 years (25-81). Conclusion: The rate of OA in patients presenting with shoulder pain is 3.32% in Saudi Arabia, which correlates with what has been previously reported in the literature.


Asunto(s)
Acromion , Imagen por Resonancia Magnética , Humanos , Arabia Saudita/epidemiología , Acromion/diagnóstico por imagen , Acromion/anomalías , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Masculino , Anciano , Femenino , Anciano de 80 o más Años , Prevalencia , Dolor de Hombro/diagnóstico por imagen , Dolor de Hombro/etiología , Dolor de Hombro/epidemiología , Articulación del Hombro/diagnóstico por imagen
9.
PLoS One ; 19(3): e0301066, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38547302

RESUMEN

BACKGROUND: Subacromial spurs are considered the one of the pathology underlying shoulder impingement syndrome. Furthermore, few studies have focused on the morphology of the subacromial spurs in normal Chinese people. This study aimed to study the spur distribution and to illustrate the morphology of spurs, which may help guide the extent of acromioplasty. METHODS: A total of 93 normal individuals were enrolled, and both shoulders of all enrolled individuals were analyzed. The subjects were divided and classified into three different groups by ages: group I = 18-40 years, group II = 41-60 years, and group III ≥ 61 years. The osteophyte distribution, osteophyte area, subacromial surface area and osteophyte area/subacromial surface area ratio were measured and illustrated using Mimics and 3-matic software. The shape of the acromion was classified according to the Bigliani and Morrison classification system. The acromial angle was also classified. Then, the relationship between osteophytes, acromial classification and acromial angle was analyzed. RESULTS: Type II (curved shape) was the most common type of acromion, and the hooked shape was a rare form. A significant increase in the left subacromial surface area in males was observed in group III compared with group I (P < 0.001) and group II (P = 0.004). The total spur/subacromial area ratio was significantly higher in group II than I. An obvious increase in the right subacromial area was observed in group III compared with group I (P = 0.004). Furthermore, there was a significant increase in the right spur area (P = 0.021) and total spur/subacromial area ratio (P = 0.006) in females in group II compared with group I. Fewer spurs were observed on the left than on the right side (p = 0.0482). One spur was most common among type II acromions (29/36) (80.56%) on the left side and the right side (34/52, 65.38%). CONCLUSIONS: Spurs osteophytes are mainly distributed with an irregular shape and mostly run through the medial and lateral sides of the subacromial surface in normal subjects. The characteristics of subacromial spurs are so diverse that a surgeon must conduct subacromial decompression completely based on the morphology of individual spurs.


Asunto(s)
Acromion , Pueblos del Este de Asia , Osteofito , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Acromion/diagnóstico por imagen , Acromion/anatomía & histología , Artroplastia , Osteofito/diagnóstico por imagen , Osteofito/patología , Síndrome de Abducción Dolorosa del Hombro/diagnóstico por imagen , Persona de Mediana Edad
10.
J Shoulder Elbow Surg ; 33(6S): S1-S8, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38237722

RESUMEN

BACKGROUND: Glenoid-sided lateralization in reverse shoulder arthroplasty (RSA) decreases bony impingement and improves rotational range of motion, but has been theorized to increase the risk of acromial or scapular spine fractures (ASFs). The purpose of this study was to assess if glenoid-sided lateralization even up to 8 mm increases the risk for stress fracture following RSA with a 135° inlay humeral component. METHODS: A retrospective review was performed from a multicenter prospectively collected database on patients who underwent primary RSA from 2015 to 2021. All RSAs were performed with a 135° inlay humeral component. Varying amounts of glenoid lateralization were used from 0 to 8 mm. Preoperative radiographs were reviewed for the presence of acromial thinning, acromiohumeral distance (AHD), and inclination. Postoperative implant position (distalization, lateralization, and inclination) as well as the presence of ASF was evaluated on minimum 1-year postoperative radiographs. Regression analyses were performed on component and clinical variables to assess for factors predictive of ASF. RESULTS: Acromial or scapular spine fractures were identified in 26 of 470 shoulders (5.5%). Glenoid-sided lateralization was not associated with ASF risk (P = .890). Furthermore, the incidence of fracture did not vary based on glenoid-sided lateralization (0-2 mm, 7.4%; 4 mm, 5.6%; 6 mm, 4.4%; 8 mm, 6.0%; P > .05 for all comparisons). RSA on the dominant extremity was predictive of fracture (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.20-5.75; P = .037), but there was no relationship between patient age, sex, preoperative acromial thinning, or diagnosis and risk of fracture. Although there was no difference in mean postoperative AHD between groups (P = .443), the pre- to postoperative delta AHD was higher in the stress fracture group (2.0 ± 0.7 cm vs. 1.7 ± 0.7 cm; P = .015). For every centimeter increase in delta AHD, there was a 121% increased risk for fracture (OR 2.21, 95% CI 1.33-3.68; P = .012). Additionally, for every 1-mm increase in inferior glenosphere overhang, there was a 19% increase in fracture risk (P = .025). CONCLUSION: Up to 8 mm of glenoid-sided metallic lateralization does not appear to increase the risk of ASF when combined with a 135° inlay humeral implant. Humeral distalization increases the risk of ASF, particularly when there is a larger change between pre- and postoperative AHD or higher inferior glenosphere overhang. In cases of pronounced preoperative superior humeral migration, it may be a consideration to avoid excessive postoperative distalization, but minimizing bony impingement via glenoid-sided lateralization appears to be safe.


Asunto(s)
Acromion , Artroplastía de Reemplazo de Hombro , Fracturas por Estrés , Humanos , Artroplastía de Reemplazo de Hombro/efectos adversos , Estudios Retrospectivos , Femenino , Masculino , Fracturas por Estrés/etiología , Fracturas por Estrés/diagnóstico por imagen , Anciano , Acromion/diagnóstico por imagen , Persona de Mediana Edad , Escápula/diagnóstico por imagen , Escápula/lesiones , Articulación del Hombro/cirugía , Articulación del Hombro/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Prótesis de Hombro/efectos adversos , Diseño de Prótesis
11.
Am J Sports Med ; 52(2): 474-484, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38197156

RESUMEN

BACKGROUND: Knowledge of acromioclavicular (AC) joint kinematics and distance may provide insight into the biomechanical function and development of new treatment methods. However, accurate data on in vivo AC kinematics and distance between the clavicle and acromion remain unknown. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate 3-dimensional AC kinematics and distance during arm elevation in abduction, scaption, and forward flexion in a healthy population. It was hypothesized that AC kinematics and distance would vary with the elevation angle and plane of the arm. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 19 shoulders of healthy participants were enrolled. AC kinematics and distance were investigated with a combined dual fluoroscopic imaging system and computed tomography. Rotation and translation of the AC joint were calculated. The AC distance was measured as the minimum distance between the medial border of the acromion and the articular surface of the distal clavicle (ASDC). The minimum distance point (MDP) ratio was defined as the length between the MDP and the posterior edge of the ASDC divided by the anterior-posterior length of the ASDC. AC kinematics and distance between different elevation planes and angles were compared. RESULTS: Progressive internal rotation, upward rotation, and posterior tilt of the AC joint were observed in all elevation planes. The scapula rotated more upward relative to the clavicle in abduction than in scaption (P = .002) and flexion (P = .005). The arm elevation angle significantly affected translation of the AC joint. The acromion translated more laterally and more posteriorly in scaption than in abduction (P < .001). The AC distance decreased from the initial position to 75° in all planes and was significantly greater in flexion (P < .001). The MDP ratio significantly increased with the elevation angle (P < .001). CONCLUSION: Progressive rotation and significant translation of the AC joint were observed in different elevation planes. The AC distance decreased with the elevation angle from the initial position to 75°. The minimum distance between the ASDC and the medial border of the acromion moved anteriorly as the shoulder elevation angle increased. CLINICAL RELEVANCE: These results could serve as benchmark data for future studies aiming to improve the surgical treatment of AC joint abnormalities to restore optimal function.


Asunto(s)
Articulación Acromioclavicular , Articulación del Hombro , Humanos , Fenómenos Biomecánicos , Imagenología Tridimensional , Húmero , Escápula , Acromion/diagnóstico por imagen , Articulación Acromioclavicular/diagnóstico por imagen , Articulación Acromioclavicular/cirugía , Rango del Movimiento Articular
12.
Clin Rheumatol ; 43(1): 527-532, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37935986

RESUMEN

INTRODUCTION: The suprascapular notch lies in the superior border of the scapula and is a passageway for the suprascapular nerve that is sensory to the shoulder joint. Suprascapular nerve block involves injection of local anaesthetic into the suprascapular notch, either ultrasound guided or blind, using the spine of scapula and/or the medial border of the acromion as surface landmarks. AIM: To investigate the anatomic variations that exist between the distance of the notch from the spine of scapula and acromion. METHOD: Ninety-two dry scapulae were measured with a digital calliper for their length of the spine, distance between the midpoint of the spine and base of the suprascapular notch and distance between the medial border of the acromion and the base of the suprascapular notch. These measurements were compared for variations in the scapular bony landmarks, the spine and the acromion to determine the site for the injection. RESULTS: Measurement reliability was assessed by intraclass correlation, Cronbach's alpha being 0.99, 0.97 and 0.91 for length of spine, distance from spine and distance from acromion respectively. The distance from the acromion had less variation in measurement (3.73 ± 0.42 cm) but a flatter distribution when compared to distance from the spine of the scapula (3.32 ± 0.39 cm). CONCLUSION: Length of the spine of the scapula appeared not to influence either distance from the acromion or distance from the spine of scapula. There is potential for greater variability in placement of nerve blocks that use acromion as the bony reference. Key Points • Dry scapular measurement using electronic Vernier callipers is accurate (0.91-0.97). • There is potential for greater variability in placement of blind nerve blocks that use acromion as the bony reference to locate the suprascapular notch.


Asunto(s)
Acromion , Articulación del Hombro , Humanos , Acromion/diagnóstico por imagen , Reproducibilidad de los Resultados , Escápula/diagnóstico por imagen , Hombro , Articulación del Hombro/diagnóstico por imagen
13.
J Shoulder Elbow Surg ; 33(5): 1150-1156, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-37944744

RESUMEN

BACKGROUND: Acromion and scapular spine fractures (ASFs) following reverse total shoulder arthroplasty (RSA) have been reported at a rate of 3.9%. The location of the fracture has been shown to be an important factor in determining the outcomes of nonoperative treatment, with medial fractures having worse outcomes than lateral fractures. As the debate between operative and nonoperative treatment continues, a more precise understanding of the location of the fracture is necessary for effective management. The purpose of this study was to use 3-dimensional computed tomography (CT) reconstruction to characterize the exact location of ASFs after RSA. METHODS: A retrospective review of 2 separate institutional shoulder and elbow repositories was performed. Patients with post-RSA ASFs documented by post-fracture CT scans were included. The query identified 48 patients who sustained postoperative ASFs after RSA between July 2008 and September 2021. CT scans of patients with ASFs were segmented using Mimics software. Eight patients were excluded because of poor image quality. Each bone model was manipulated using 3-Matic Medical software to align the individual scapula with an idealized bone model to create a view of scapular fracture locations on a normalized bone model. This model was used to classify the fractures using the modified Levy classification. RESULTS: The study cohort consisted of 40 patients with a diagnosis of postoperative ASF after RSA. The median age at the time of surgery was 76 years (interquartile range, 73-79 years). The cohort comprised 32 women (80%) and 8 men (20%), with a median body mass index of 27.8. Only 10 patients (25%) had a previous diagnosis of osteoporosis and 6 (13%) had a diagnosis of inflammatory arthritis; 53% of patients underwent RSA owing to rotator cuff tear arthropathy. The distribution of fracture locations was similar within the cohort. However, lateral fractures were slightly more prevalent. The most common fracture location was the type I zone, with 12 fracture lines (29%). There were 11 fracture lines (26%) in the type IIa zone, 10 (23%) in the type IIb zone, 0 in the type IIc zone, and 9 (21%) in the type III zone. CONCLUSION: ASFs after RSA occur in 4 predictable clusters. No fractures appeared to distinctly cluster in the type IIc zone, which may not represent a true fracture zone. Understanding the distribution of these fractures will help to enable the future design of implants and devices to stabilize the fractures that require fixation.


Asunto(s)
Artroplastía de Reemplazo de Hombro , Fracturas del Hombro , Articulación del Hombro , Masculino , Humanos , Femenino , Anciano , Acromion/diagnóstico por imagen , Acromion/cirugía , Artroplastía de Reemplazo de Hombro/efectos adversos , Artroplastía de Reemplazo de Hombro/métodos , Resultado del Tratamiento , Escápula/diagnóstico por imagen , Escápula/cirugía , Estudios Retrospectivos , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Fracturas del Hombro/diagnóstico por imagen , Fracturas del Hombro/cirugía , Fracturas del Hombro/etiología
14.
Chin J Traumatol ; 27(2): 121-124, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37210253

RESUMEN

A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.


Asunto(s)
Acromion , Fracturas Óseas , Masculino , Humanos , Persona de Mediana Edad , Acromion/diagnóstico por imagen , Acromion/cirugía , Acromion/lesiones , Apófisis Coracoides/diagnóstico por imagen , Apófisis Coracoides/cirugía , Escápula/lesiones , Escápula/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Fijación Interna de Fracturas
15.
In Vivo ; 38(1): 506-510, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38148094

RESUMEN

BACKGROUND/AIM: Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm that typically occurs in the ends (epiphyses) of long bones of young adults. Flat bones are uncommon sites of involvement. Herein, we describe an unusual case of pathologically proven GCT of the acromion. CASE REPORT: The patient was a 39-year-old woman with no history of trauma who presented with a 3-month history of right posterior shoulder pain. Physical examination revealed mild swelling and tenderness in the posterior aspect of the right shoulder. Plain radiograph showed a purely lytic lesion, suggestive of a bone tumor. Computed tomography demonstrated an intraosseous lytic lesion with associated cortical thinning and lack of periosteal reaction. On magnetic resonance imaging, the lesion exhibited slightly higher signal intensity compared to skeletal muscle on T1-weighted sequences and heterogeneous high signal intensity on T2-weighted sequences. Strong enhancement was observed following gadolinium administration. The lesion was treated by extensive curettage with adjuvant therapy comprising ethanol and the remaining cavity was filled with polymethylmethacrylate bone cement. Histologically, the lesion was composed of round or spindle-shaped mononuclear cells admixed with numerous osteoclast-like giant cells. Immunohistochemically, the mononuclear neoplastic cells were diffusely positive for H3.3 G34W. The patient was asymptomatic and there was no evidence of local recurrence or distant metastasis 5 months after surgery. CONCLUSION: Although rare, acromial GCTB should be considered in the differential diagnosis of posterior shoulder pain, especially in young and early middle-aged adults.


Asunto(s)
Neoplasias Óseas , Tumor Óseo de Células Gigantes , Femenino , Persona de Mediana Edad , Adulto Joven , Humanos , Adulto , Acromion/diagnóstico por imagen , Acromion/cirugía , Acromion/patología , Dolor de Hombro/diagnóstico , Dolor de Hombro/etiología , Tumor Óseo de Células Gigantes/cirugía , Tumor Óseo de Células Gigantes/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , Radiografía
16.
Orthop Surg ; 16(2): 471-480, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38112436

RESUMEN

BACKGROUND: Arthroscopic surgery has been established as an efficacious intervention for the treatment of rotator cuff tears. The primary aim of this study was to analyze the modifications in the lateral acromial angle (LAA) subsequent to rotator cuff repair surgery using single-row rivet fixation and double-row rivet fixation techniques. Furthermore, we sought to investigate the influence of LAA on the prognosis of rotator cuff repair surgery. METHOD: This observational study retrospectively enrolled 105 patients diagnosed with degenerative rotator cuff tears who underwent arthroscopic rotator cuff repair between 2016 and 2019. Following the exclusion of two patients with subscapularis or superior labrum anterior and posterior (SLAP) tears, as well as three patients who were lost to follow-up, a cohort of 100 patients was included for clinical and imaging evaluation. Among these individuals, 50 were assigned to the double-row repair group, whereas the remaining 50 comprised the single-row repair group. Bilateral shoulder magnetic resonance imaging (MRI) scans were conducted no less than 24 months post-surgery. Experienced arthroscopic surgeons, blinded to the LAA measurements, assessed the rotator interval (RI) using a control MRI. Functional assessment was performed using the University of California, Los Angeles (UCLA) quick disability of the shoulder and arm, shoulder and hand (qDASH) score. The Wilcoxon signed-rank test for dependent samples was employed to compare data between the pre- and post-intervention groups. Pearson correlation coefficients were calculated to evaluate the relationship between different parameters. RESULTS: The study population consisted of 73 female patients and 27 male patients, with a mean age of 58.32 ± 5.29 years and a mean follow-up duration of 25.88 ± 8.11 months. Preoperatively, the mean LAA was 75.81° ± 11.28°, RI was 4.78 ± 0.62, UCLA score was 17.54 ± 2.44, and qDASH score was 2.45 ± 0.25. The average tear size was 8.95 ± 2.11 mm. A statistically significant difference in LAA was observed between the preoperative and postoperative measurements, with the double-row repair group exhibiting a greater LAA than the single-row repair group. Finally, a significant correlation was identified between LAA, RI, and qDASH scores after a 24-month follow-up period. CONCLUSION: According to our findings, the utilization of double-row rivet fixation has a greater LAA angle than single-row rivet fixation. Moreover, this preservation of LAA is significantly associated with the functional recovery of the shoulder joint.


Asunto(s)
Lesiones del Manguito de los Rotadores , Humanos , Masculino , Femenino , Persona de Mediana Edad , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Acromion/diagnóstico por imagen , Acromion/cirugía , Estudios Retrospectivos , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/cirugía , Hombro , Artroscopía/métodos , Imagen por Resonancia Magnética , Resultado del Tratamiento
17.
Curr Med Imaging ; 20: e260423216209, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37170976

RESUMEN

BACKGROUND: The etiology of rotator cuff tears (RCTs) have been investigated for years and many underlying causes have been identified. Shoulder joint morphology is one of the extrinsic causes of RCTs. AIM: Morphometric measurements on MRI sections determined which parameters are an important indicator of RCT in patients with shoulder pain. The aim of this study was to determine the risk factors in the etiology of RCTs by evaluating the shoulder joint morphology with the help of previously defined radiological parameters. METHOD: Between January 2019-December 2020, 408 patients (40-70 years old) who underwent shoulder MRI and met the criteria were included in the study. There were 202 patients in the RCT group and 206 patients in the control group. Acromion type, acromial index (AI), critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral acromial angle (LAA), acromial angulation (AA), acromion-greater tuberosity impingement index (ATI), and glenoid version angle (GVA) were measured from the MRI images of the patients. RESULTS: AI (0.64 vs. 0.60, p = 0.003) CSA (35.3° vs. 32.4°, p = 0.004), ATI (0.91 vs. 0.83, P < 0.001), and AA (13.6° vs. 11.9°, p = 0.011) values were higher in the RCT group than in the control group and the difference was significant. AHD (8.1 mm vs. 9.9 mm, P < 0.001), LAA (77.2° vs. 80.9°, p = 0.004) and GVA (-3.9° vs. -2.5°, P < 0.001) values were lower in the RCT group than in the control group, and again the difference was significant. According to the receiver operating characteristic curve analysis, the cutoff values were 0.623 for AI and 0.860 for ATI. CONCLUSION: Acromion type, AI, CSA, AHD, LAA, AA, ATI, and GVA are suitable radiological parameters to evaluate shoulder joint morphology. High AI, CSA, AA, ATI, GVA and low AHD and LAA are risk factors for RCT.


Asunto(s)
Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Adulto , Persona de Mediana Edad , Anciano , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/anatomía & histología , Manguito de los Rotadores/diagnóstico por imagen , Escápula/anatomía & histología , Acromion/diagnóstico por imagen , Acromion/anatomía & histología
18.
BMC Musculoskelet Disord ; 24(1): 888, 2023 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-37968608

RESUMEN

BACKGROUND: The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES: This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS: Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS: CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION: Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE: III.


Asunto(s)
Lesiones del Manguito de los Rotadores , Síndrome de Abducción Dolorosa del Hombro , Articulación del Hombro , Humanos , Acromion/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Manguito de los Rotadores/diagnóstico por imagen , Hombro , Síndrome de Abducción Dolorosa del Hombro/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen
19.
Eur J Radiol ; 168: 111083, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37714046

RESUMEN

BACKGROUND: The Critical Shoulder Angle Related Acromion Morphological Parameter (CSA- RAMP) is a valuable tool in the analyzing the etiology of the rotator cuff tears (RCTs). However, its clinical application has been limited by the time-consuming and prone to inter- and intra-user variability of the measurement process. OBJECTIVES: To develop and validate a deep learning algorithm for fully automated assessment of shoulder anteroposterior radiographs associated with RCTs and calculation of CSA-RAMP. METHODS: Retrospective analysis was conducted on radiographs obtained from computed tomography (CT) scans and X-rays performed between 2018 and 2020 at our institution. The development of the system involved the utilization of digitally reconstructed radiographs (DRRs) generated from each CT scan. The system's performance was evaluated by comparing it with manual and semiautomated measurements on two separate test datasets: dataset I (DRRs) and dataset II (X-rays). Standard metrics, including mean average precision (AP), were utilized to assess the segmentation performance. Additionally, the consistency among fully automated, semiautomated, and manual measurements was comprehensively evaluated using the Pearson correlation coefficient and Bland-Altman analysis. RESULTS: A total of 1080 DRRs generated from 120 consecutive CT scans and 159 X-ray films were included in the study. The algorithm demonstrated excellent segmentation performance, with a mean AP of 57.67 and an AP50 of 94.31. Strong inter-group correlations were observed for all CSA-RAMP measurements in both test datasets I (automated versus manual, automated versus semiautomated, and semiautomated versus manual; r = [0.990---0.997], P < 0.001) and dataset II (r = [0.984---0.995], P < 0.001). Bland-Altman analysis revealed low bias for all CSA-RAMP measurements in both test datasets I and II, except for CD (with a maximum bias of 2.49%). CONCLUSIONS: We have successfully developed a fully automated algorithm capable of rapidly and accurately measuring CSA-RAMP on shoulder anteroposterior radiographs. A consistent automated CSA- RAMP measurement system may accelerate powerful and precise studies of disease biology in future large cohorts of RCTs patients.


Asunto(s)
Aprendizaje Profundo , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Acromion/diagnóstico por imagen , Hombro , Radiografía , Lesiones del Manguito de los Rotadores/diagnóstico por imagen
20.
Am J Sports Med ; 51(12): 3211-3216, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37732534

RESUMEN

BACKGROUND: The influence of bony morphology on the development of posterior shoulder instability is not well known. PURPOSE: To determine if acromial morphology, as measured on magnetic resonance imaging (MRI), is associated with posterior or anterior shoulder instability. DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: MRI measurements of posterior acromial coverage (PAC), posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for 3 separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability <40 years of age without multidirectional instability, glenoid bone loss >13.5%, or glenoid retroversion >10%. RESULTS: Overall, 37 patients were included in each group. PAC was significantly less in the posterior instability group than in the anterior instability and comparison groups (68.3° vs 88.7° vs 81.7°; P < .001). PAH was significantly greater in the posterior group than in the anterior instability group (11.0 mm vs -0.1 mm; P < .001) and comparison group (0.7 mm; P < .001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (P = .45 and P = .05, respectively). PAT was significantly smaller in the posterior instability group than the comparison group (55.2° vs 62.2°; P = .026). The anterior and comparison groups were not significantly different in PAH or PAT (P = .874 and P = .067, respectively) but were significantly different in AAC (P = .026). CONCLUSION: A higher and flatter posterior acromion, as measured on preoperative MRI, appears to be associated with patients who require arthroscopic capsulolabral repair due to posterior shoulder instability. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.


Asunto(s)
Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Acromion/diagnóstico por imagen , Acromion/cirugía , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Hombro , Estudios Transversales , Imagen por Resonancia Magnética/métodos , Artroscopía/métodos
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