Superior scapular location: An overlooked albeit frequent finding in elastofibroma dorsi.

PURPOSE: To explore the frequency of superior scapular elastofibroma dorsi in a large patient series with elastofibroma dorsi. METHODS: 136 chest CTs from January 2016 to July 2022 reporting elastofibroma dorsi were retrospectively analyzed. Three radiologists assessed the number, size, and location of elastofibroma dorsi. Continuous variables underwent two-tailed t-tests with p < 0.05. Inter-observer agreement was assessed by using Cohen's Kappa values. RESULTS: In 136 patients (mean age, 75.9 +/- 9.8 years; 117 female), 330 elastofibroma dorsi were found. Six (4.4 %) patients had single, 87 (64 %) double, 22 (16.2 %) triple and 21 (15.4 %) quadruple lesions. All single and double lesions were in the inferior scapular regions. 43 (31.6 %) patients had superior scapular lesions in addition to inferior scapular elastofibroma dorsi. Inferior scapular elastofibroma dorsi was significantly larger than superior scapular elastofibroma dorsi. The probability of a right superior lesion was significantly higher in patients with a larger right inferior lesion. Inter-observer agreement was very good for experienced radiologist (κ = 94.1) and good for other radiologists (κ = 79.4 and κ = 78). CONCLUSION: In contrast to current belief, superior scapular elastofibroma dorsi accompanying the typical inferior scapular lesions is not uncommon and can even manifest bilaterally. To the best of our knowledge, this is the first case series reporting prevalence of quadruple elastofibroma dorsi.

Three-dimensional evaluation of the transverse rotator cuff muscle's resultant force angle in relation to scapulohumeral subluxation and glenoid vault morphology in nonpathological shoulders.

BACKGROUND: Static posterior subluxation of the humeral head (SPSH) results in glenohumeral osteoarthritis. Treatment strategies for SPSH with or without resulting osteoarthritis remain challenging. There is growing interest in evaluating the rotator cuff muscle volume, fatty infiltration, or forces in osteoarthritic shoulders with SPSH, mainly due to a possible transverse force imbalance. In nonpathological shoulders, the transverse angle of the rotator cuff muscle's resultant force may be associated with scapulohumeral alignment and glenoid vault morphology, despite an assumed transverse force balance. The purpose of this study was to assess the transverse rotator cuff muscle's resultant force angle (TRFA) and its relationship with the scapulohumeral subluxation index (SHSI) and selected glenoid vault parameters using computer modeling. METHODS: Computed tomography scans of 55 trauma patients (age 31 ± 13 years, 36 males) with nonpathological shoulders were analyzed and all measurements performed in 3-dimension. We placed landmarks manually to determine the humeral head center and the rotator cuff tendon footprints. The contours of the rotator cuff muscle cross-sectional areas were automatically predicted in a plane perpendicular to the scapula. Each rotator cuff muscle was divided into virtual vector fibers with homogeneous density. The resultant force vector direction for each muscle, corresponding to the rotator cuff action line, was calculated by vectorially summing the normalized fiber vectors for each muscle, weighted by the muscle trophic ratio. The resultant force vector was projected on the axial plane, and its angle with the mediolateral scapular axis was used to determine TRFA. The SHSI according to Walch, glenoid version angle (GVA), glenoid anteroposterior offset angle (GOA), glenoid depth, glenoid width, and glenoid radius were also evaluated. RESULTS: The mean values for TRFA, SHSI, GVA, GOA, glenoid depth, glenoid width, and glenoid radius were 7.4 ± 4.5°, 54.3 ± 4.8%, -4.1 ± 4.4°, 5.1 ± 10.8°, 3.3 ± 0.6 mm, 20 ± 2 mm, and 33.6 ± 4.6 mm, respectively. The TRFA correlated strongly with SHSI (R = 0.731, P < .001) and GVA (R = 0.716, P < .001) and moderately with GOA (R = 0.663, P < .001). The SHSI was strongly negatively correlated with GVA (R = -0.813, P < .001) and moderately with GOA (R = -0.552, P < .001). The GVA correlated strongly with GOA (R = 0.768, P < .001). In contrast, TRFA, SHSI, GVA, and GOA did not correlate with glenoid depth, width, or radius. CONCLUSION: Despite an assumed balance in the transverse volume of the rotator cuff muscles in nonpathological shoulders, variations exist regarding the transverse resultant force depending on the SHSI, GVA, and GOA. In healthy/nonosteoarthritic shoulders, an increased glenoid retroversion is associated with a decreased anterior glenoid offset.

Advances in Oncologic Shoulder Girdle Resection and Reconstruction.

The bony shoulder girdle consists of the clavicle, humerus, and scapula, which work synergistically to form a complex articulation that is essential for use of the upper extremity. The shoulder girdle is the most common location for primary and secondary bone tumors in the upper extremity, and following resection of these tumors, reconstruction of the upper extremity is challenging. Compared with those in the lower extremity, reconstructive techniques in the upper extremity have historically been unreliable and fraught with complications and poor functional outcomes. Newer reconstructive techniques using reverse total shoulder arthroplasty and functional muscle flaps have shown promise to improve outcomes while reducing complications for proximal humerus reconstructions. Despite these advancements, reconstruction following scapulectomy remains challenging and is still associated with more frequent complications and compromised function.

Defining shoulder function and dysplasia in patients with longitudinal deficiencies of the upper limb.

BACKGROUND: Phenotypic differences and functional limitations in children with congenital radial and ulnar longitudinal deficiencies (RLD/ULD) are well understood for the forearm and hand. However, anatomical features of shoulder elements in these pathologies have only been scarcely reported. Moreover, shoulder function has not been assessed in this patient population. Therefore, we aimed to define radiologic features and shoulder function of these patients at a large tertiary referral center. METHODS: We prospectively enrolled all patients with RLD and ULD (minimum age: 7 years) for this study. Eighteen patients (12 RLD, 6 ULD) with a mean age of 17.9 years (range, 8.5-32.5) were evaluated using clinical examination (shoulder motion and stability), patient-reported outcome measures (Visual Analog Scale, Pediatric/Adolescent Shoulder Survey, Pediatric Outcomes Data Collection Instrument), and radiologic grading of shoulder dysplasia (including length and width discrepancy of the humerus, glenoid dysplasia in the anteroposterior and axial view [Waters classification], and scapular and acromioclavicular dysplasia assessment). Descriptive statistics and Spearman correlation analyses were performed. RESULTS: Despite five (28%) cases having anterioposterior shoulder instability and five (28%) cases with decreased motion, outcome scores indicated an overall excellent function of the shoulder girdle, with mean Visual Analog Scale of 0.3 (range, 0-5), mean Pediatric/Adolescent Shoulder Survey of 97 (range, 75-100), and mean Pediatric Outcomes Data Collection Instrument Global Functioning Scale of 93 (range, 76-100). The humerus was, on average, 15 mm shorter (range, 0-75), and metaphyseal and diaphyseal diameters both reached 94% of the contralateral side. Glenoid dysplasia was detected in nine (50%) cases, with increased retroversion evident in 10 (56%) cases. However, scapular (n = 2) and acromioclavicular (n = 1) dysplasia were rare. Based on radiographic findings, a radiologic classification system for dysplasia types IA, IB, and II was developed. CONCLUSIONS: Adolescent and adult patients with longitudinal deficiencies exhibit various mild-to-severe radiologic abnormalities around the shoulder girdle. Nevertheless, these findings did not seem to negatively affect shoulder function as the overall outcome scores were excellent.

Preoperative computed tomography-guided transscapular sens-cure needle localization for pulmonary nodule located behind the scapula.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is an approach that is commonly used to resect pulmonary nodules (PNs). However, when these PNs are located behind the scapula, a transscapular access approach is generally required. In this study, the safety, efficacy, and feasibility of preoperative computed tomography (CT)-guided Sens-cure needle (SCN) localization was assessed for PNs located behind the scapula. METHODS: From January 2020 - June 2022, a total of 122 PN patients in our hospital underwent preoperative CT-guided SCN localization and subsequent VATS resection, of whom 12 (9.8%) exhibited PNs behind the scapula necessitating a transscapular approach for this localization procedure. RESULTS: This study included 12 patients, each of whom had one PN located behind the scapula. The CT-guided transscapular SCN localization approach was successful in all patients, and no complications near the operative site were observed. The median localization time was 12 min, and 2 (16.7%) and 1 (8.3%) patients respectively developed pneumothorax and pulmonary hemorrhage after the localization procedure was complete. Wedge resection procedures for these PNs achieved technical success in all cases. Four patients were diagnosed with invasive adenocarcinomas and subsequently accepted lobectomy and systematic lymph node dissection. The median VATS duration and the median blood loss was 80 min and 10 mL, respectively. In total, 3, 5, and 4 PNs were respectively diagnosed as benign, mini-invasive adenocarcinomas, and invasive adenocarcinomas. CONCLUSION: Preoperative CT-guided transscapular SCN localization represents a safe, straightforward, and effective means of localizing PNs present behind the scapula.

Multi-modality management of chondrosarcoma of scapula: A case report and review of literature.

Chondrosarcoma are malignant tumours in which neoplastic cells produce cartilage. The most commonly affected sites are pelvis, femur, humerus and ribs. Scapula involvement is relatively rare. Surgery remains the primary modality of treatment for chondrosarcoma. Radiotherapy is used as an adjuvant therapy in high grade tumours and in cases of residual disease. Present study reports a rare case of scapular chondrosarcoma in a 37 year old male, managed with multimodality treatment and discusses briefly the prognostic parameters and treatment modalities. Only few studies have discussed about scapular chondrosarcoma and more studies with larger number of patients are needed to develop an evidence-based treatment and follow-up protocol for these patients.

Clinical and functional outcome after partial or total claviculectomy without reconstruction for oncologic causes.

BACKGROUND: To achieve clear margins in rare malignant clavicular neoplasms, claviculectomy may become necessary. This study aimed to review clinical, functional, and oncologic outcomes following partial or total claviculectomy without reconstruction. METHODS: This study retrospectively included 15 patients from 2 tertiary sarcoma centers (mean age, 42.6 ± 20.3 years; 66.7% male patients). The median length of clinical and oncologic follow-up was 48.0 months (interquartile range [IQR], 24.0-83.5 months). Functional follow-up (Musculoskeletal Tumor Society score and QuickDASH score [short version of the Disabilities of the Arm, Shoulder and Hand questionnaire]) was available in 9 patients at a median of 36.0 months (IQR, 20.0-100.0 months). RESULTS: Of the 15 patients, 7 underwent total claviculectomy; 5, partial lateral claviculectomy; and 3, partial medial claviculectomy. No postoperative complications emerged. The median Musculoskeletal Tumor Society and QuickDASH scores at latest follow-up amounted to 26.0 points (IQR, 24.0-29.0 points) and 18.0 points (IQR, 11.0-22.0 points), respectively. Notably, scores tended to be lower in patients who underwent total claviculectomy (n = 2) in comparison to partial claviculectomy (n = 7). CONCLUSION: Satisfactory clinical and functional results can be achieved following partial or total claviculectomy without reconstruction, with a low complication rate and acceptable mid- to long-term function.

Phosphoglyceride Crystal Deposition Disease of the Scapula: A Case Report and Literature Review.

CASE: A 76-year-old woman presented with a 2-month history of right shoulder pain with no apparent cause. Radiography revealed an ill-defined osteolytic lesion in the right scapular spine with a pathological fracture. Malignant bone tumor was suspected, and a biopsy was performed. Pathological examination with gold hydroxamic acid staining revealed phosphoglyceride crystal deposition. Lesion curettage was performed, and her symptoms improved. No recurrence was observed at the 3-year postoperative follow-up. CONCLUSION: Phosphoglyceride crystal deposition in the bone is an extremely rare disease. The gold hydroxamic acid staining method might be useful for the diagnosis of this condition.

Prospective Evaluation of Posterior Glenoid Bone Loss After First-time and Recurrent Posterior Glenohumeral Instability Events.

BACKGROUND: Although posterior glenohumeral instability is becoming an increasingly recognized cause of shoulder pain, the role of posterior glenoid bone loss on outcomes remains incompletely understood. PURPOSES: To prospectively determine the amount of bone loss associated with posterior instability events and to determine predisposing factors based on preinstability imaging. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 1428 shoulders were evaluated prospectively for ≥4 years. At baseline, a subjective history of shoulder instability was ascertained for each patient, and bilateral noncontrast magnetic resonance imaging (MRI) scans of the shoulders were obtained regardless of any reported history of shoulder instability. The cohort was prospectively followed during the study period, and those who were diagnosed with posterior glenohumeral instability were identified. Postinjury MRI scans were obtained and compared with the screening MRI scans. Glenoid version, perfect-circle-based bone loss was measured for each patient's pre- and postinjury MRI scans using previously described methods. RESULTS: Of the 1428 shoulders that were prospectively followed, 10 shoulders sustained a first-time posterior instability event and 3 shoulders sustained a recurrent posterior instability event. At baseline, 11 of 13 shoulders had some amount of glenoid dysplasia and/or bone loss. The change in glenoid bone loss was 5.4% along the axis of greatest loss (95% CI, 3.8%-7.0%; P = .009), 4.4% at the glenoid equator (95% CI, 2.7%-6.2%; P = .016), and 4.2% of total glenoid area (95% CI, 2.9%-5.3%; P = .002). Recurrent glenoid instability was associated with a greater amount of absolute bone loss along the axis of greatest loss compared with first-time instability (recurrent: 16.8% ± 1.1%; 95% CI, 14.6%-18.9%; first-time: 10.0% ± 1.5%; 95% CI, 7.0%-13.0%; P = .005). Baseline glenoid retroversion ≥10° was associated with a significantly greater percentage of bone loss along the axis of greatest loss (≥10° of retroversion: 13.5% ± 2.0%; 95% CI, 9.6%-17.4%; <10° of retroversion: 8.5% ± 0.8%; 95% CI, 7.0%-10.0%; P = .045). CONCLUSIONS: Posterior glenohumeral instability events were associated with glenoid bone loss of 5%. The amount of glenoid bone loss after a recurrent posterior glenohumeral instability event was greater than that after first-time instability. Glenoid retroversion ≥10° was associated with a greater amount of posterior glenoid bone loss after a posterior instability event.

Subscapular elastofibrolipoma treated with marginal resection: two case reports.

BACKGROUND: Elastofibroma dorsi is a rare benign tumor of soft tissue, typically under the lower angle of the scapula. Its specific location and distinctive clinical symptoms can provide enough information for diagnosis. Nevertheless, pathological confirmation by biopsy may be needed to rule out other malignancies. CASE PRESENTATION: Here, we present two cases of 63-year-old and 49-year-old female Asian patients who came to us with the chief complaint of pain and bulging in their shoulders. Both patients had rubbery and mobile masses. Also, shoulder movements were not restricted in the examination; however, the patients expressed pain during movements. Computed tomography scans were compatible with the diagnosis of elastofibroma dorsi. Surgical excision was performed for both cases owing to the symptomatic nature of the masses, and histopathological findings confirmed the diagnosis. CONCLUSION: Elastofibroma dorsi is a benign pseudotumor presenting with an uncomfortable feeling in the shoulder with movement in older females. In typical symptom-free cases of elastofibroma dorsi, observation is sufficient, while in symptomatic patients or if there is suspicion of malignancy, complete resection with marginal resection is the treatment of choice.

Oncologic and functional outcomes of different reconstruction modalities after resection of chondrosarcoma of the scapula: a medium- to long-term follow-up study.

OBJECTIVES: To evaluate the oncologic and functional results of scapular reconstruction after partial or total scapulectomy for chondrosarcoma. MATERIALS AND METHODS: Twenty-one patients with chondrosarcoma who underwent partial or total scapulectomy between January 2005 and July 2019 were reviewed retrospectively. RESULTS: At a mean follow-up of 62.6 months (range, 13-123 months), four patients developed local recurrence, and three developed distant metastases, one of which developed both recurrence and metastasis. The overall survival rate of patients at 5 years was 84.6%, the disease-free survival rate was 69.3%, and the complication rate was 19% (4/21). The 1993 American Musculoskeletal Tumor Society (MSTS93) scores of patients in the partial scapulectomy group, total scapulectomy + humeral suspension group and prosthetic reconstruction group were 26.50 ± 1.38, 19.00 ± 2.58, and 21.38 ± 2.62, respectively. There was a statistically significant difference between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group ( P = 0.006 and 0.0336, respectively). The range of motion of the shoulder joint for forward flexion was 80.83° ± 11.14°, 51.25° ± 21.36°, and 52.50° ± 11.02°, respectively. The p-values for the comparison between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group were 0.0493 and 0.0174, respectively. And the range of motion of abduction was 75.00° ± 10.49°, 32.50° ± 11.90°, 41.88° ± 11.63°, respectively. Patients in the partial scapulectomy group had significantly better postoperative shoulder abduction function than the total scapulectomy + humeral suspension or prosthetic reconstruction group (P = 0.0035 and 0.0304, respectively). There was no significant difference in MSTS93 scores and flexion and abduction function of the shoulder joint in the upper extremity after total scapulectomy with humeral suspension or prosthetic reconstruction (P > 0.05). CONCLUSIONS: Surgical treatment of chondrosarcoma of the scapula can achieve a satisfactory prognosis and shoulder function. Total scapulectomy followed by prosthetic reconstruction or humeral suspension are both feasible treatments.

[Application of three-dimensional printed total scapula for reverse shoulder arthroplasty in treatment of scapular tumors].

Objective: To investigate the effectiveness of three-dimensional (3D) printed total scapula for reverse shoulder arthroplasty in the treatment of scapular tumors. Methods: Between November 2017 and December 2021, 5 patients with scapular tumors were treated by reverse shoulder arthroplasty with 3D printed total scapula. There was 1 male and 4 females. The age ranged from 44 to 59 years, with an average of 50.4 years. There were 2 cases of chondro sarcoma, 1 case of high-grade osteosarcoma, 1 case of lung cancer with scapular metastasis, and 1 case of ligamentoid fibromatosis recurrence. The disease duration was 4-8 months, with an average of 5.8 months. According to the Musculoskeletal Tumor Society (MSTS) scapular girdle classification criteria, 4 cases of tumors involved both S1 and S2 zones, and 1 case involved S2 zone. The tumor diameters ranged from 4.2 to 11.2 cm, with an average of 6.1 cm. The operation time, intraoperative blood loss, and blood transfusion were recorded. During follow-up, the MSTS score was used to evaluate the recovery of limb function of the patients. The sink depth of the affected shoulder, complications, and oncological outcomes were observed. The position of the prosthesis was reviewed by imaging. Results: The operation time ranged from 155 to 230 minutes, with an average of 189 minutes. The intraoperative blood loss was 100-1 500 mL, with a median of 600 mL. Two patients were received blood transfusion of 800 mL and 1 850 mL respectively during operation. All incisions healed by first intention, and no complications such as infection occurred. All patients were followed up 4-22 months, with an average of 13 months. Two patients died at 8 and 15 months after operation respectively due to multiple metastases and organ failure. At last follow-up, the MSTS score of all patients was 73%-83%, with an average of 77.4%. The affected shoulder was 2-4 cm lower than the contralateral side, with an average of 3 cm. Imaging examinations showed that no prosthesis loosening, dislocation, or fracture occurred during follow-up. Conclusion: Reverse shoulder arthroplasty with 3D printed total scapula can obtain good shoulder function and appearance. Patients have high acceptance and satisfaction with this surgical method.

Outcome of Scapular Ewing Sarcoma.

BACKGROUND/AIM: Ewing sarcoma is a common primary bone tumor, often located in the distal femur or pelvis. Although the scapula is a flat bone similar to the pelvis, scapular Ewing sarcoma is rare. The aim of this study was to review our institution's experience with the management of scapular Ewing sarcomas. PATIENTS AND METHODS: We reviewed 9 patients with an Ewing sarcoma of the scapula, which included 5 males and 4 females with a mean age of 19±6 years. All patients were treated with chemotherapy and local control. Local control included surgical resection (n=7) and definitive radiotherapy (n=2). Mean follow-up was 6 years. RESULTS: Prior to induction chemotherapy, the mean tumor size and volume were 10±2 cm and 181±112 cm3, respectively. Following induction chemotherapy, there was a reduction in the mean tumor size (6±3, p=0.02) and volume (20±12 cm3, p<0.01). The mean tumor necrosis in patients undergoing resection was 72±23%. The median survival was 30-months, and the 5-year disease specific survival was 38%. At most recent follow-up, the mean Musculoskeletal Tumor Society Score was 79±14%. CONCLUSION: Scapular Ewing sarcoma is a rare, aggressive tumor. Even with chemotherapy and local control with surgery or definitive radiotherapy, patient survival is poor.

Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis.

BACKGROUND: While the glenoid track concept presents a useful prediction for recurrent glenohumeral instability, little is known about the humeral head bony architecture as it relates to glenoid erosion in the setting of bipolar bone loss. PURPOSE: To (1) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSLs) in a cohort of patients with anterior instability using 3-dimensional imaging software and (2) assess the relationships between GBL and HSL characteristics. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients were identified who had anterior shoulder instability with a minimum 5% GBL and evidence of HSL confirmed on computed tomography. Unilateral 3-dimensional models of the ipsilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using MIMICS software (Materialise NV). GBL surface area, width, defect length, and glenoid track width were quantified. The volume, surface area, width, and depth of identified HSLs were quantified with their location (medial, superior, and inferior extent) on the humeral head. Severity of GBL was defined as percentage glenoid bone surface area loss and categorized as low grade (5%-10%), moderate grade (>10% to 20%), high grade (>20% to 30%), and extensive (>30%). Analysis of variance was then computed to determine significance (P < .05) between severity of GBL and associated HSL parameters. RESULTS: In total, 100 patients met inclusion criteria (mean age, 27.9 years; range, 18-43 years), which included 58 right shoulders and 42 left shoulders (84 male, 16 female). Among groups, there were 32 patients with low-grade GBL (mean GBL = 6.1%), 38 with moderate grade (mean GBL = 16.2%), 17 with high grade (mean GBL = 23.7%), and 13 with extensive (mean GBL = 34.0%), with an overall mean GBL of 18.1% (range, 5%-39%). Patients with 5%-10% GBL had significantly narrower HSLs (average and maximum width; P < .03) and deeper HSLs (average depth; P = .002) as compared with all other GBL groups, while greater GBL was associated with wider and shallower HSLs. GBL width, percentage width loss, defect length, and glenoid track width all significantly differed across the 4 GBL groups (P < .05). CONCLUSION: HSLs had significantly different morphological characteristics depending on the severity of GBL, indicating that GBL was directly related to the characteristics of HSLs. Patients presenting with smaller glenoid defects had significantly narrower and deeper HSLs with less humeral head surface area loss, while greater GBL was associated with wider and shallower HSLs.

The association between anterior shoulder joint capsule thickening and glenoid deformity in primary glenohumeral osteoarthritis.

BACKGROUND: Anterior shoulder joint capsule thickening is typically present in osteoarthritic shoulders, but its association with specific patterns of glenoid wear is incompletely understood. We sought to determine the relationship between anterior capsular thickening and glenoid deformity in primary glenohumeral osteoarthritis. METHODS: We retrospectively identified 134 consecutive osteoarthritic shoulders with magnetic resonance imaging and computed tomography scans performed. Axial fat-suppressed magnetic resonance imaging slices were used to quantify the anterior capsular thickness in millimeters, measured at its thickest point below the subscapularis muscle. Computed tomography scans were used to classify glenoid deformity according to the Walch classification, and an automated 3-dimensional software program provided values for glenoid retroversion and humeral head subluxation. Multinomial and linear regression models were used to characterize the association of anterior capsular thickening with Walch glenoid type, glenoid retroversion, and posterior humeral head subluxation while controlling for patient age and sex. RESULTS: The anterior capsule was thickest in glenoid types B2 (5.5 mm, 95% confidence interval [CI]: 5.0-6.0) and B3 (6.1 mm, 95% CI: 5.6-6.6) and thinnest in A1 (3.7 mm, 95% CI: 3.3-4.2; P < .001). Adjusted for age and sex, glenoid types B2 (odds ratio: 4.4, 95% CI: 2.3-8.4, P < .001) and B3 (odds ratio: 5.4, 95% CI: 2.8-10.4, P < .001) showed the strongest association with increased anterior capsule thickness, compared to glenoid type A1. Increased capsular thickness correlated with greater glenoid retroversion (r = 0.57; P < .001) and posterior humeral head subluxation (r = 0.50; P < .001). In multivariable analysis, for every 1-mm increase in anterior capsular thickening, there was an adjusted mean increase of 3.2° (95% CI: 2.4-4.1) in glenoid retroversion and a 3.8% (95% CI: 2.7-5.0) increase in posterior humeral head subluxation. CONCLUSIONS: Increased thickening of the anterior shoulder capsule is associated with greater posterior glenoid wear and humeral head subluxation. Additional research should determine whether anterior capsular disease plays a causative role in the etiology or progression of eccentric glenohumeral osteoarthritis.

Impact of tumour stage on the surgical outcomes of scapular chondrosarcoma.

PURPOSE: Chondrosarcomas are common primary bone tumours in adults, often affecting the flat bones. Oncologic outcomes are often tied to tumour grade; however, grade is only a factor in the aggressiveness of a tumor. Extracompartmental extension, or tumor stage, has been found to be predictive of a poor outcome in other flat bone chondrosarcomas; however, this relationship has not been identified in the scapula. The purpose of the current study was to analyze the impact of tumour stage on the outcome of patients with scapular chondrosarcoma. METHODS: Thirty-nine patients (26 males:13 females) with a mean age of 46 ± 17 undergoing surgical resection of a scapular chondrosarcomas were reviewed. Most patients had grade 1 (n = 24) tumors, with 26 (67%) having extracompartmental extension. The mean follow-up was eight years. RESULTS: The ten year disease-specific survival was 77%. High-grade tumours (HR 18.15, p < 0.01) were associated with death due to disease. The ten year local recurrence- and metastatic-free survival were 77% and 74%. Positive surgical margins (HR 8.85, p < 0.01) were associated with local recurrence, and local recurrence was associated with metastatic disease (HR3.37, p = 0.04). All disease recurrences and death due to disease occurred in patients with extracompartmental extension (p < 0.05). CONCLUSION: Extracompartmental extension was associated with a worse oncologic outcome in patients with scapular chondrosarcomas. Positive margins were associated with local recurrence, which was associated with metastatic disease; wide local excision with negative margins should be a goal for all patients, regardless of tumour grade.

Novel anterior coracoglenoid line utilizing magnetic resonance imaging (MRI) corresponds with critical glenoid bone loss.

OBJECTIVE: Glenoid bone loss is estimated using a best-fit circle method and requires software tools that may not be available. Our hypothesis is that a vertical reference line drawn parallel to the long axis of the glenoid and passing through the inflection point of the coracoid and glenoid will represent a demarcation line of approximately 20% of the glenoid. Our aim is to establish a more efficient method to estimate a surgical threshold for glenoid insufficiency. METHODS: Fifty patients with normal glenoid anatomy were randomly chosen from an orthopedic surgeon's database. Two orthopedic surgeons utilized T1-weighted sagittal MRIs and the coracoglenoid line technique to determine the percentage of bony glenoid anterior to vertical line. Two musculoskeletal radiologists measured the same 50 glenoids using the circle technique. Differences were determined using dependent t test. Reliability was compared using interclass correlation coefficient and Kappa. Validity was compared using Pearson correlation coefficient. RESULTS: Mean surface area of the glenoid anterior to the vertical line was on average 21.69% ± 3.12%. Surface area of the glenoid using the circle method was on average 20.86% ± 2.29%. Inter-rater reliability of the circle method was 0.553 (fair). Inter-rater reliability of the vertical line technique was 0.83 (excellent). There was a linear relationship between circle and vertical line measurements, r = 0.704 (moderate to high). CONCLUSION: The coracoglenoid line appears to represent a line of demarcation of approximately 21% of glenoid bone anterior to the coracoglenoid line. Our technique was found to be reliable, valid, and accurate.

Reporting of glenoid bone loss measurement in clinical studies and the need for standardization : a systematic review.

AIMS: The amount of glenoid bone loss is an important factor in deciding between soft-tissue and bony reconstruction when managing anterior shoulder instability. Accurate and reproducible measurement of glenoid bone loss is therefore vital in evaluation of shoulder instability and recommending specific treatment. The aim of this systematic review is to identify the range methods and measurement techniques employed in clinical studies treating glenoid bone loss. METHODS: A systematic review of the PubMed, MEDLINE, and Embase databases was undertaken to cover a ten-year period from February 2011 to February 2021. We identified clinical studies that incorporated bone loss assessment in the methodology as part of the decision-making in the management of patients with anterior shoulder instability. The Preferred Reporting Items for Systematic Reviews (PRISMA) were used. RESULTS: A total of 5,430 articles were identified from the initial search, of which 82 studies met the final inclusion criteria. A variety of imaging methods were used: three studies did not specify which modality was used, and a further 13 used CT or MRI interchangeably. There was considerable heterogeneity among the studies that specified the technique used to quantify glenoid bone loss. A large proportion of the studies did not specify the technique used. CONCLUSION: This systematic review has identified significant heterogeneity in both the imaging modality and method used to measure glenoid bone loss. The recommendation is that as a minimum for publication, authors should be required to reference the specific measurement technique used. Without this simple standardization, it is impossible to determine whether any published paper should influence clinical practice or should be dismissed. Cite this article: Bone Joint J 2022;104-B(1):12-18.

Clinical and Imaging Features of Tumors in the Scapula.

BACKGROUND: The scapula is a small irregular-shaped flat bone, which may suffer from a variety of tumors or tumor-like lesions. As the imaging manifestations are complex and changeable, correct imaging diagnosis is difficult. INTRODUCTION: At present, there are few related radiology literatures, and it is necessary to fully analyze the imaging signs of different types of benign and malignant tumors in scapula to guide clinical treatment. This study was to investigate clinical and imaging presentations of tumors and tumor- like lesions in the scapula so as to increase the diagnostic accuracy of diseases in the scapula. METHODS: Patients with scapular tumors confirmed by pathology were enrolled. The imaging and clinical data were analyzed. RESULTS: Among 108 patients, benign tumors were in 53 (49.1%) cases, intermediate in seven (6.5%), and malignant in 48 (44.4%) involving 16 diseases. Osteochondroma was the first benign tumors in 45 cases accounting for 84.9% of all benign scapular tumors, followed by chondroma in four cases (7.5%). The intermediate tumors were mainly eosinophilic granuloma in four cases. Metastatic tumors were the commonest malignant tumor (27 cases or 56.2% of all malignant tumors), followed by chondrosarcoma (in 13 cases). Except for the one case of chondroblastoma in which the lesion involved the glenoid cavity, all the other cartilaginous tumors were located in the scapular body and processes. The type of lesions in the bony processes is the same as in the scapular body, the common lesions in the central area of the body were malignant tumors, and the commonest lesions in the glenoid area were metastasis. Common imaging features of malignant scapular tumors were ill-defined margins, cortical destruction and soft tissue involvement. The imaging features of chondrosarcoma lack specificity except for calcification. Benign lesions usually had a clear boundary and marginal sclerosis. CONCLUSION: A wide variety of benign and malignant tumors may occur in the scapula with mostly cartilaginous and metastatic tumors, and the location and distribution of lesions are similar in the scapula to those in the long bones.

Foramen escapular osificado en una muestra poblacional colombo-chilena / Ossified scapular foramen in a Colombian-Chilean population sample

RESUMEN: Ocasionalmente la incisura escapular puede ser reemplazada por un foramen óseo producto de la osificación del ligamento transverso superior de la escápula. Esta formación ósea se considera un factor precipitante de la compresión del nervio supraescapular. Ciento noventa y cinco escápulas de individuos adultos pertenecientes a osteotecas de universidades de Colombia (114 escápulas) y de Chile (81 escápulas), fueron estudiadas macroscópicamente para determinar la presencia de un foramen escapular óseo. Ambas escápulas de un mismo individuo colombiano (1,75 % del total) presentaban el foramen escapular y una escápula izquierda (1,23 %) presentaba esta formación en un individuo chileno. La prevalencia de la osificación del ligamento transverso superior de la escápula es muy variable en los distintos estudios y tiende a situarse inferior al 10 %, sin embargo, puede constituirse en un factor de riesgo debido al atrapamiento o compresión del nervio supraescapular, hecho conocido como neuropatía supraescapular.

SUMMARY: Occasionally the scapular notch can be replaced by a bony foramen product of the ossification of the superior transverse scapular ligament. This bone formation is considered a precipitating factor for compression of the suprascapular nerve. One hundred and ninety-five adult scapulae from Colombian (114 scapulae) and Chilean (81 scapulae) university osteotheques were studied macroscopically to determine the presence of a bony scapular foramen. Both scapulae of the same Colombian individual (1.75% of the total) presented the scapular foramen and one left scapula (1.23%) presented this formation in a Chilean individual. The prevalence of ossification of the superior transverse scapular ligament is highly variable in the different studies and tends to be less than 10%; however, it can become a risk factor due to entrapment or compression of the suprascapular nerve, a fact known as suprascapular neuropathy.