Anthropometric study of the scapula in a contemporary population from granada. Sex estimation and glenohumeral osteoarthritis prevalence.

Anthropometric studies of the scapula have been rare in Spanish populations, nevertheless they are of current interest in forensic anthropology for estimation of sex. Although the estimation of sex is usually carried out on the pelvis and skull, other measurements related to the scapula can be helpful when the skeletal remains are incomplete. Glenohumeral osteoarthritis development is influenced, among others, by the morphology of the scapula, which is one of the less studied aspects. We carried out a descriptive study of anthropometric parameters in a series of 157 scapulae (82 individuals) on bone remains dated to the 20th century from a population of Granada (Southern Spain). Seventy seven (49%) were right-side and 80 (51%) left-side; 72 (45.9%) were from males and 85 (54.1%) from females, and the mean age at death was 70.76±11.7 years. The objective was to develop a discrimination function for sex estimation based on anthropometric parameters of the scapula other than those considered to date, and to analyze the prevalence of glenohumeral osteoarthritis in relation to selected anthropometric parameters. A logistic regression model based on parameters of the upper-external segment of the scapula was done. The obtained formula: 1/1+e^ (- (-57.911 + 0.350*B + 0283*C + 0.249*b + 0.166*a +-0.100*ß) classifies male sex with 98.3% accuracy and female sex with 92.1%. Glenohumeral osteoarthritis was detected in 16.6% of individuals and was related to age (p<0.05), scapular length (p<0.05), glenoid width (p<0.05), glenopolar angle (p<0.05), and α angle (p<0.05) in bivariate analyses but showed no significant associations in multivariate analyses. This approach can be useful for anthropological-forensic identification when scapula remains are incomplete. Glenohumeral osteoarthritis is significantly associated with a smaller α angle.

Evolutionary anatomical and functional characteristics of the intrinsic shoulder and brachial muscles in the northern anteater (Tamandua mexicana).

Tamandua mexicana is an anteater species native from Mexico to Peru. This species is of great evolutionary interest because it belongs to one of the oldest clades of placental mammals in the American continent. This study aimed to describe the origin, insertion, and arterial supply of the intrinsic shoulder and brachial muscles of T. mexicana. We also compared the masses of the functional groups. Gross dissections were performed on both thoracic limbs of 13 cadavers. ANOVA followed by Tukey's test was used for statistical analyses. The subscapularis muscle presents a hiatus to the common tendon of the caput breve of the biceps brachii and coracobrachialis muscles. A variant accessory muscle, the m. articularis humeri lateralis, was found on the lateral surface of the shoulder joint. M. deltoideus pars acromialis has two bellies. The teres major muscle is perforated by the aponeurotic origin of the m. tensor fasciae antebrachii. The triceps brachii has two capita longi. The caput mediale is fused with the m. anconeus medialis. The caput laterale can have an accessory belly as an anatomical variant. Among the functional groups, a significant difference was found between the elbow extensors and flexors, with the latter having the lowest mass. In conclusion, the intrinsic muscles of T. mexicana presented unique features for the species, as well as arrangements in mass distribution that evidence a possible evolutionary convergence among species of the Superorder Xenarthra.

Morphological and radiological study of the shoulder and elbow joints of the giant anteater (Myrmecophaga tridactyla).

The giant anteater (Myrmecophaga tridactyla) has specialized thoracic limbs to forage by breaking the walls of anthills and termite mounds. They also play critical roles in defense posture and locomotion. This study aimed to provide a morphological and radiographic description of the shoulder joint and elbow joint of the giant anteater. Both joints of 13 tamanduas were assessed by morphological dissections and histological evaluation and radiographies without and with positive contrast. The radiographic projections selected to this study were the mediolateral and craniocaudal projections. The radiographic and anatomical findings were compared with the following results: the shoulder joint had a continuous joint capsule with the tendon sheaths of the short head and long head of the biceps brachii muscle, which could be visualized with an injection of 3 ml of intra-articular contrast. The shoulder joint arthrography was performed with the needle positioned cranially to the joint for contrast injection. The elbow joint presented three articular compartments, and the insertion of the joint capsule was proximal to the radial fossa and distal to the radial tuberosity in the radial notch of the ulna, which were possible to identify with 2 ml of intra-articular contrast. The elbow joint arthrography was performed with the needle positioned laterally to the joint for contrast injection. Moreover, the joint capsule presented a caudomedial distention and fat pads. The powerful muscles of the forelimb play a fundamental role in maintaining the shoulder joint and elbow joint stability due to bony adaptations and the absence of usual ligaments. The morphological and radiological study provided relevant information on the soft-tissue characteristics of shoulder and elbow joints, which may aid clinical-surgical and diagnostic imaging procedures.

Morphological determination of glenohumeral joint and acromioclavicular joint with computed tomography / Determinación morfológica de la articulación glenohumeral y la articulación acromioclavicular con tomografía computarizada

SUMMARY: Although acute and chronic pathologies of the glenohumeral and acromioclavicular joints are frequently encountered in the population, the anatomy and morphometry are not fully known. The aim of this study is to determine the measurements of morphometric parameters according to age groups and sex in a large series of Turkish population. Nine hundred and forty-one shoulders computed tomography (CT) images were screened and those of subjects with healthy anatomical structure were included. Humeral head diameter (HDD) was measured on CT images. Measurements were made using 3D-CT images of: width (GW) and height (GH) of the glenoid cavity; width (CW) and height (CH) of the distal clavicular joint surface; and width (AW) and height (AH) of the acromial joint surface. Data were compared, stratified by age and sex. Images of 223 patients (118 men, 105 women) were analyzed. The following mean measurements were determined: HDD, 41.77±3.77 mm; GH, 34.66±3.26 mm; GW, 25.50±2.90 mm; CW, 14.85±3.51 mm; CH, 8.49±2.27 mm; AW, 12.97±2.94 mm; AH, 7.01±1.77 mm. When startified by sex, HDD (p<0.001), GH (p<0.001), GW (p<0.001), CW (p<0.001), CH (p=0.002), AW (p<0.001) and AH (p<0.001) measurements were significantly different and mean values were greater in men. Similarly for age, significant differences were found for GH (p=0.028), CW (p<0.001), AW (p<0.001), AH (p<0.001). The parametric values we have obtained in the Turkish population we measure differ from the measurements made in different populations according to age groups and sex. Knowing these features will contribute to treatment planning, implant and prosthesis applications.

Aunque las patologías agudas y crónicas de las articulaciones glenohumeral y acromioclavicular son frecuentes en la población, la anatomía y morfometría no se conocen por completo. El objetivo de este estudio fue determinar las medidas de los parámetros morfométricos según grupos de edad y sexo en una serie de individuos de población turca. Se examinaron 941 imágenes de tomografía computarizada (TC) de hombro y se incluyeron las de sujetos con una estructura anatómica sana. El diámetro de la cabeza humeral (HDD) se midió en imágenes de TC. Las mediciones se realizaron utilizando imágenes 3D-CT de: ancho (GW) y altura (GH) de la cavidad glenoidea; anchura (CW) y altura (CH) de la superficie articular clavicular; y anchura (AW) y altura (AH) de la superficie articular acromial. Los datos fueron comparados, estratificados por edad y sexo. Se analizaron imágenes de 223 pacientes (118 hombres, 105 mujeres). Se determinaron las siguientes medidas medias: HDD, 41,77±3,77 mm; GH, 34,66 ± 3,26 mm; GW, 25,50±2,90 mm; CW, 14,85±3,51 mm; CH, 8,49±2,27 mm; AW, 12,97±2,94 mm; AH, 7,01±1,77 mm. Cuando se inicia por sexo, HDD (p<0,001), GH (p<0,001), GW (p<0,001), CW (p<0,001), CH (p=0,002), AW (p<0,001) y AH (p <0,001) las mediciones fueron significativamente diferentes y los valores medios fueron mayores en los hombres. De igual forma para la edad se encontraron diferencias significativas para GH (p=0,028), CW (p<0,001), AW (p<0,001), AH (p<0,001). Los valores paramétricos que hemos obtenido en la población turca difieren de las medidas realizadas en diferentes poblaciones según grupos de edad y sexo. El conocimiento de estas características contribuirá a la planificación del tratamiento, aplicaciones de implantes y prótesis.

Estimating glenoid fossa width for instability - related bone loss with CT scan in a Chilean sample / Estimación del ancho de la fosa glenoidea para la pérdida ósea relacionada con inestabilidad con tomografía computarizada en una muestra chilena

SUMMARY: Glenoid fossa bone loss has been associated with recurrence and failure after glenoid labrum repair for shoulder instability. Quantification of glenoid fossa bone loss is critical for the successful treatment of glenohumeral instability. The aim of this paper was to estimate a linear regression model based on glenoid height in CT scan adjusted for age and sex to calculate glenoid fossa width in a healthy Chilean sample. CT scans of 101 shoulders were reviewed. The mean age was 51.96 years (SD 19.16; range, 15-88 years) with 53 females and 48 male patients. Studies with signs of bone loss, instability, fracture, or arthritis were excluded. After 3D-CT reconstruction, the height and width of each glenoid fossa was measured using the Owens methodology. All landmarks for the 2 measurements were placed on the most lateral surface of the glenoid fossa margin. Measurements for all shoulders were recorded by 3 observers and repeated on a subset (n = 20) of shoulders, under blinded conditions, by the same observer, at least 2 weeks after the initial measurements. Descriptive statistics, intraclass correlation and regression coefficients were calculated with Stata BE 17® software. A p- value of 0.05 was considered significant. A linear regression model was estimated resulting in the formula "Width = 10.97 + 0.02 * Age + 0.41 * Height - 1.95 * Sex (1=Female, 0=Male)". This model presented all coefficients with p <0.05 and an adjusted R2 of 0.73. Furthermore, it fulfilled the assumption of linearity, normal distribution of errors, independence of errors, and homoscedasticity. Regarding the intraobserver correlation, ICC was 0.76 for height and 0.91 for width; the interobserver ICC was 0.93 for height and 0.86 for width. A 3D-CT specific formula was developed to predict glenoid fossa width based on height with sufficient accuracy to be clinically valuable.

RESUMEN: La pérdida de hueso de la fosa glenoidea se ha asociado con recurrencia y falla después de la reparación del labrum glenoideo por inestabilidad del hombro. La cuantificación de la pérdida ósea glenoidea es fundamental para el tratamiento exitoso de la inestabilidad glenohumeral. El objetivo de este trabajo fue estimar un modelo de regresión lineal basado en la altura glenoidea en una tomografía computarizada ajustada por edad y sexo para calcular el ancho de la fosa glenoidea en una muestra chilena sana. Se revisaron las tomografías computarizadas de 101 hombros. La edad media fue de 51,96 años (DE 19,16; rango, 15- 88 años) con 53 mujeres y 48 hombres. Se excluyeron los estudios con signos de pérdida ósea, inestabilidad, fractura o artritis. Después de la reconstrucción 3D-CT, se midió la altura y el ancho de cada fosa glenoidea utilizando la metodología de Owens. Todos los puntos de referencia para las 2 mediciones se colocaron en la superficie más lateral del margen glenoideo. Las mediciones de todos los hombros fueron registradas por 3 observadores y repetidas en un subconjunto (n = 20) de hombros, en condiciones ciegas, por el mismo observador, al menos 2 semanas después de las mediciones iniciales. La estadística descriptiva, la correlación intraclase y los coeficientes de regresión se calcularon con el software Stata BE 17®. Se consideró significativo un valor de p de 0,05. Se estimó un modelo de regresión lineal que resultó en la fórmula "Ancho = 10,97 + 0,02 * Edad + 0,41 * Altura - 1,95 * Sexo (1 = Mujer, 0 = Hombre)". Este modelo presentó todos los coeficientes con p <0.05 y un R2 ajustado de 0.73. Además, cumplió con los supuestos de linealidad, distribución normal de errores, independencia de errores y homocedasticidad. En cuanto a la correlación intraobservador, el CCI fue de 0,76 para la altura y 0,91 para la anchura; el ICC interobservador fue de 0,93 para la altura y 0,86 para la anchura. Se desarrolló una fórmula específica de 3D-CT para predecir el ancho glenoideo en función de la altura con suficiente precisión para ser clínicamente valiosa.

Glenoid size and orientation in the Chilean population / Tamaño y orientación glenoidea en la población chilena

Glenoid morphology is a key factor in determining the success of shoulder surgery. The purpose of this experimental study was to precisely determine the anatomical size and orientation of the glenoid in the Chilean population. 122 CT scans from asymptomatic Chilean patients were obtained. The mean age was 43.8 years (SD 12.3; range, 17-53 years) with 63 female and 59 male patients. For each of the scapulae, were obtained the glenoid version and inclination, maximum glenoid width and height, superior glenoid width, glenoid surface area, glenoid vault depth, and maximum scapular width. The glenoid size showed an average width of 26 ± 2.7 mm, a height of 40.3 ± 3.5 mm and a vault depth of 26.5 ± 3.7 mm. There were significant differences between men and women. The glenoid orientation showed an average of -13.9 ± 4.8° of retroversion and a superior inclination of 11.1 ± 4.7°. Significant differences between men and women were seen only for version. We conclude, that in this Chilean sample the morphological parameters of the glenoid correspond to the published literature, however, some characteristics in this cohort must be further confirmed using other methods.

La morfología glenoidea es un factor clave para determinar el éxito de la cirugía de hombro. El propósito de este estudio experimental fue determinar con precisión el tamaño anatómico y la orientación de la glenoides en la población chilena. Se obtuvieron 122 tomografías computarizadas de pacientes chilenos asintomáticos. La edad media fue de 43,8 años (DE 12,3; rango, 17-53 años) con 63 pacientes femeninos y 59 masculinos. Para cada una de las escápulas, se obtuvieron la versión glenoidea y la inclinación, el ancho y la altura glenoidea máxima, el ancho glenoideo superior, el área de superficie glenoidea, la profundidad de la bóveda glenoidea y el ancho escapular máximo. El tamaño glenoideo mostró un ancho promedio de 26 ± 2,7 mm, una altura de 40,3 ± 3,5 mm y una profundidad de bóveda de 26,5 ± 3,7 mm. Hubo diferencias significativas entre hombres y mujeres. La orientación glenoidea mostró un promedio de -13,9 ± 4,8 ° de retroversión y una inclinación superior de 11,1 ± 4,7 °. Se observaron diferencias significativas entre hombres y mujeres solo para la versión. Concluimos que en esta muestra chilena los parámetros morfológicos de la glenoides corresponden a la literatura publicada, sin embargo, algunas características de esta cohorte deben confirmarse aún más utilizando otros métodos.

Avaliação anatômica, radiográfica e ultrassonográfica da articulação escápulo-umeral em equinos / Anatomical, radiografic and ultrasonographic evaluation of the scapulohumeral joint in horses / Evaluación anatómica, radiográfica y ultrasonográfica de la articulación escapulohumeral en equinos

O diagnóstico das claudicações altas é considerado um desafio para a maioria dos veterinários de equinos nas rotinas de atendimentos a campo; bem como, em ambiente hospitalar de referência. Esse fato se relaciona principalmente a extensa massa muscular que circunda a articulação escápulo-umeral, efusões, sinovites, assimetrias e estreito espaço articular. A avaliação adequada da claudicação do ombro é baseada na compreensão das características anatômicas da articulação escápulo-umeral e da região adjacente. A compreensão da anatomia é fundamental para o entendimento da biomecânica dessa articulação, bem como na interpretação dos exames clínico e de imagem. Portanto, objetiva-se descrever a anatomia da articulação escápulo-umeral, a metodologia e interpretação detalhada das técnicas de imagem radiográfica e ultrassonográfica. Como demonstrado nesse trabalho, a articulação escápulo-umeral é uma região complexa e de bastante relevância na biomecânica dos membros torácicos. Portanto, o conhecimento anatômico e a realização de técnicas adequadas de exames de imagem são essenciais para um bom diagnóstico das enfermidades que acometem essa articulação.

The diagnosis of upper limb lameness is considered a challenge for most equine veterinarians in field care routines; as well as in a reference hospital. This fact is related mainly to the extensive muscular mass that surrounds the scapulohumeral joint, effusions, sinovites, asymmetries and narrow joint space. Adequate assessment of shoulder lameness is based on understanding the anatomical leatures of the scapulohumeral joint and adjacent region. The understanding of the anatomy is fundamental for the understanding of the biomechanics of this joint, as well as the interpretation of the clinical and imaging exams. Therefore, the objective of this work is to describe the anatomy of the shoulder joint, the methodology and detailed interpretation of the techniques of radiographic and ultrasonographic imaging. As demonstrated in this work, the shoulder joint is a complex region and of great relevance in the biomechanics of the thoracic limbs. Therefore, the anatomical knowledge and the accomplishment of adequate imaging techniques are essential for a good diagnosis of the diseases that affect this articulation.

El diagnóstico de las claudicaciones altas se considera un desafío para la mayoría de los veterinarios de equinos en las rutinas de atendimiento al campo; así como en los hospitales de referencia. Este hecho se relaciona principalmente a la extensa masa muscular que circunda la articulación escapulohumeral, elusiones, sinovitis, asimetrías y estrecho espacio articular. La evaluación más eficiente de la claudicación del hombro está basada en la comprensión de las características anatómicas de la articulación escapulohumeral y de la región adyacente. La comprensión de la anatomía es fundamental para el entendimiento de la biomecánica de esa articulación, así como en la interpretación de las pruebas clínicas y de imagen. Por lo tanto, se objetiva describir la anatomía de la articulación escapulohumeral, la metodología e interpretación detallada de las técnicas de radiografía y ultrasonografía. Como se demuestra en esta investigación, la articulación escapulohumeral es una región compleja y muy importante en la biomecánica de los miembros torácicos. Así que, el conocimiento anatómico y la realización de técnicas adecuadas de pruebas de imagen son esenciales para un buen diagnóstico de las enfermedades asociadas a esa articulación.

Avaliação anatômica, radiográfica e ultrassonográfica da articulação escápulo-umeral em equinos / Anatomical, radiografic and ultrasonographic evaluation of the scapulohumeral joint in horses / Evaluación anatómica, radiográfica y ultrasonográfica de la articulación escapulohumeral en equinos

O diagnóstico das claudicações altas é considerado um desafio para a maioria dos veterinários de equinos nas rotinas de atendimentos a campo; bem como, em ambiente hospitalar de referência. Esse fato se relaciona principalmente a extensa massa muscular que circunda a articulação escápulo-umeral, efusões, sinovites, assimetrias e estreito espaço articular. A avaliação adequada da claudicação do ombro é baseada na compreensão das características anatômicas da articulação escápulo-umeral e da região adjacente. A compreensão da anatomia é fundamental para o entendimento da biomecânica dessa articulação, bem como na interpretação dos exames clínico e de imagem. Portanto, objetiva-se descrever a anatomia da articulação escápulo-umeral, a metodologia e interpretação detalhada das técnicas de imagem radiográfica e ultrassonográfica. Como demonstrado nesse trabalho, a articulação escápulo-umeral é uma região complexa e de bastante relevância na biomecânica dos membros torácicos. Portanto, o conhecimento anatômico e a realização de técnicas adequadas de exames de imagem são essenciais para um bom diagnóstico das enfermidades que acometem essa articulação.(AU)

The diagnosis of upper limb lameness is considered a challenge for most equine veterinarians in field care routines; as well as in a reference hospital. This fact is related mainly to the extensive muscular mass that surrounds the scapulohumeral joint, effusions, sinovites, asymmetries and narrow joint space. Adequate assessment of shoulder lameness is based on understanding the anatomical leatures of the scapulohumeral joint and adjacent region. The understanding of the anatomy is fundamental for the understanding of the biomechanics of this joint, as well as the interpretation of the clinical and imaging exams. Therefore, the objective of this work is to describe the anatomy of the shoulder joint, the methodology and detailed interpretation of the techniques of radiographic and ultrasonographic imaging. As demonstrated in this work, the shoulder joint is a complex region and of great relevance in the biomechanics of the thoracic limbs. Therefore, the anatomical knowledge and the accomplishment of adequate imaging techniques are essential for a good diagnosis of the diseases that affect this articulation.(AU)

El diagnóstico de las claudicaciones altas se considera un desafío para la mayoría de los veterinarios de equinos en las rutinas de atendimiento al campo; así como en los hospitales de referencia. Este hecho se relaciona principalmente a la extensa masa muscular que circunda la articulación escapulohumeral, elusiones, sinovitis, asimetrías y estrecho espacio articular. La evaluación más eficiente de la claudicación del hombro está basada en la comprensión de las características anatómicas de la articulación escapulohumeral y de la región adyacente. La comprensión de la anatomía es fundamental para el entendimiento de la biomecánica de esa articulación, así como en la interpretación de las pruebas clínicas y de imagen. Por lo tanto, se objetiva describir la anatomía de la articulación escapulohumeral, la metodología e interpretación detallada de las técnicas de radiografía y ultrasonografía. Como se demuestra en esta investigación, la articulación escapulohumeral es una región compleja y muy importante en la biomecánica de los miembros torácicos. Así que, el conocimiento anatómico y la realización de técnicas adecuadas de pruebas de imagen son esenciales para un buen diagnóstico de las enfermedades asociadas a esa articulación.(AU)

Change in the Distance From the Axillary Nerve to the Glenohumeral Joint With Shoulder External Rotation or Abduction Position.

BACKGROUND: This study investigated whether axillary nerve (AN) distance to the inferior border of the humeral head and inferior glenoid would change while placing the glenohumeral joint in different degrees of external rotation and abduction. METHODS: A standard deltopectoral approach was performed on 10 fresh-frozen cadaveric specimens. The distance between AN and the inferior border of the humeral head and inferior glenoid while placing the shoulder in 0°, 45°, and 90° of external rotation or abduction was measured. Continuous variables for changes in AN position were compared with paired 2-tailed Student t test. RESULTS: The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of external rotation and 0° of abduction was 13.77 mm (SD 4.31), 13.99 mm (SD 4.12), and 16.28 mm (SD 5.40), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of external rotation was 16.33 mm (SD 3.60), 15.60 mm (SD 4.19), and 16.43 (SD 5.35), respectively. The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of abduction and 0° of external rotation was 13.76 mm (SD 4.31), 10.68 mm (SD 4.19), and 3.81 mm (SD 3.08), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of abduction was 16.33 mm (SD 3.60), 17.66 mm (SD 5.80), and 12.44 mm (SD 5.57), respectively. CONCLUSIONS: The AN position relative to the inferior aspect of the glenohumeral joint does not significantly change despite position of external rotation. Increasing shoulder abduction over 45° decreases the distance from the glenohumeral joint to the AN and should be avoided.

Inervación de la cabeza larga del músculo tríceps braquial / Innervation of the long head of triceps brachii muscle

Clásicamente, la inervación del músculo tríceps braquial se atribuye al nervio radial. Sin embargo, reportes clínicos han observado parálisis de la cabeza larga del músculo tríceps braquial posterior a lesiones del nervio axilar, ocurridas luego de una luxación de la articulación glenohumeral, poniendo en duda la inervación de la cabeza larga del músculo tríceps braquial. El objetivo del presente estudio es verificar la inervación de la cabeza larga del músculo tríceps braquial por parte del nervio axilar. Se disecaron 12 regiones posteriores de hombro y brazo, previamente fijadas en solución fijadora conservadora, identificando ramos de inervación del nervio axilar hacia la cabeza larga del músculo tríceps braquial, luego se obtuvieron muestras para estudio histológico con Hematoxilina-Eosina. Fue posible identificar en todos los casos ramos del nervio axilar, penetrando en la mitad superior de la cabeza larga del músculo tríceps braquial. El estudio histológico mostró una imagen compatible con tejido nervioso en todas las muestras analizadas. Estos resultados contrastan con las descripciones realizadas en textos clásicos respecto a la inervación del músculo tríceps braquial, el cual podría presentar una doble inervación proveniente de los nervios radial y axilar, o una inervación diferente para cada cabeza. Los hallazgos presentados aportan información a la hora de analizar las lesiones del nervio axilar post luxaciones de hombro, al realizar procedimientos quirúrgicos en esta región o en la planificación de la rehabilitación de estos pacientes.

Primarily, innervation of the triceps brachii muscle has been attributed to the axillary nerve. However, clinical reports have observed paralysis from the long head of the triceps brachii muscle following axillary nerve lesions which occurred after dislocation of the glenohumeral joint. This has raised questions about the innervation of the long head of triceps brachii muscle. The objective of this study was to verify the innervation of the long head of the triceps brachii muscle by the axillary nerve. Twelve previously fixed posterior areas of shoulder and arm were dissected and branches of innervation of the axillary nerve towards the long head of triceps brachii muscle were identified. Subsequently, samples were taken for histological hematoxylin-eosin study. In all cases, we observed branches of the axillary nerve penetrating the upper half of the long head of the triceps brachii muscle. The histological study showed an image compatible with nerve tissue in each sample analyzed. The results contrast with the description in classic texts regarding innervation of the triceps brachii muscle, which could present with double innervation from the radial and axillary nerves, or a separate innervation for each head. These results provide information for axillary nerve lesion analysis following shoulder dislocation, at the time of performing surgical procedures in the area, or when planning rehabilitation for these patients.

Arthrographic Anatomy of the Biceps Tendon Sheath: Potential Implications for Selective Injection.

The purpose of this investigation was to better define the anatomical features of the biceps tendon sheath, including the distance the sheath extends below the inferior margin of the subscapularis tendon and below the termination of the bony bicipital groove. A total of 110 magnetic resonance and computed tomography arthrograms performed during 1-year period at our institution were retrospectively reviewed, and the length of the biceps tendon sheath and distances from the inferior margin of the subscapularis tendon and from the termination of the bicipital groove to the inferior margin of the biceps tendon sheath were measured by 3 radiologists. The mean length of the biceps tendon sheath was 47.5mm. The mean distances from the inferior margin of the subscapularis tendon and from the inferior margin of the bicipital groove to the distal extent of the biceps tendon sheath were 24.5mm and 11.9mm, respectively. The relationships among these 3 anatomical measurements and biological confounders of sex and age were investigated while controlling for measurement variability. The anatomical relationships between the biceps tendon sheath and surrounding structures may have implications for needle placement when attempting to inject into the biceps tendon sheath for diagnostic or therapeutic purposes.

Avaliação morfológica e morfométrica da articulação umerorradioulnar em cães através de exames radiográficos e por tomografia computadorizada / Radiographic and tomographic study of the elbow joint in dogs

Este estudo teve como objetivo apresentar de forma detalhada dados morfológicos e morfométricos da articulação umerorradioulnar de cães de raça definida avaliados por meio de exames físicos, radiográficos e tomográficos. A amostra dessa pesquisa constituiu-se de 44 cotovelos de cães com idades variadas. Para análise de informações obtidas, o coeficiente kappa e de correlação interclasse e associação foram realizados. Constatou-se que o desempenho individual de cada projeção radiográfica teve pobre concordância com o exame tomográfico; não houve concordância entre os observadores para as mensurações do ângulo da incisura ulnar ao exame radiográfico e tomográfico. Porém houve boa/moderada concordância para mensuração da incongruência radioulnar no plano sagital entre os observadores. Concluiu-se que nenhuma das cinco incidências radiográficas foi superior para análise radiográfica, uma vez que cada projeção apresentou melhor identificação de um compartimento do cotovelo. Medidas ao exame tomográfico para incongruência radioulnar não apresentaram reprodutibilidade no plano de reconstrução frontal, entretanto no corte sagital apresentaram boa e moderada concordância entre os observadores e que a mensuração do ângulo da incisura ulnar não apresentou repetibilidade ao exame radiográfico e nem reprodutibilidade ao exame tomográfico. Esses resultados contribuem para melhor utilização de cada exame de acordo com a região a ser avaliada bem como ressaltam a necessidade da somatória de múltiplos exames de imagem para a correta avaliação desta afecção.(AU)

Elbow dysplasia disease includes an united anconeal process, fragmented medial coronoid process, osteochondrosis of humeral trochlea, articular incongruity and degenerative joint disease. The aim of this study was to present detailed morphologic and morphometric aspects of the elbow joint in dog in clinical and correlate with radiographic and tomographic (CT) exam. Inter-observer variation for articular incongruity measurements by CT, comparative analysis in the radiographic exam, angle in ulnar notch and its comparative analysis between radiographic and tomographic agreement examination in 44 elbow of dogs with different ages were evaluated. The statistics analyses included the kappa coefficient and interclass correlation and Fischer's test and McNemar's test. It was evidenced that individual performance of each radiographic incidence had poor agreement with the tomographic exam, suggesting that the accomplishment of more than two radiograph views are needed. There was no agreement between the three evaluators in the ulnar notch angle at radiographic and tomographic exams. However, there was good/moderate agreement for articular incongruity measurement in the sagittal plane between evaluators. It was possible to conclude that none of the five radiographic incidences was better than the others for radiographic analysis because each incidence had a better identification of a particular elbow compartment; measurements at the tomographic exam to evaluate radioulnar incongruity had no reproductiveness in the frontal plane, but in sagittal plan had a good/moderate agreement between observers and the angle in ulnar notch presented no repeatability at radiographic exam and no reproductiveness at tomographic exam.(AU)

The effect of intra-articular levobupivacaine on shoulder cartilage at different doses - experimental study / O efeito de levobupivacaína intra-articular na cartilagem do ombro em doses diferentes-estudo experimental

Abstract Background and objectives: In this study it was aimed to examine the histological and morphometric effects on cartilage structure of intra-articular application of levobupivacaine to the shoulder joint. Methods: In twenty New Zealand adult male rabbits, 35 shoulders were used for the study and prepared in 5 groups of 7. These groups were defined as Groups L1, L2, L3 and L4 which were right shoulders administered with 0.25% and 0.5% levobupivacaine, Group C which were left shoulders as the control group and Groups S1 and S2 which were left shoulders administered with 0.9% saline. On the 2nd and 15th days the animals were killed, the glenohumeral joints were evaluated macroscopically then cartilage samples were taken. These samples were evaluated with Mankin score, and histomorphometrically by measuring the thickness of the cartilage between the superficial cartilage layer and the tidemark and the thickness of calcified cartilage between the tidemark and the subchondral bone. Results: Macroscopically, on the 15th day the joint fluid was seen to have reduced in all the groups. After microscopic evaluation, the highest Mankin score (mean: 3.14 ± 2.1/14) was in the L4 group (15th day 0.5% levobupivacaine) and was found to be statistically significant (p < 0.05). No statistically significant difference was determined between the other groups. Conclusions: Histologically, as the highest Mankin score was in the L4 group, this indicates that in a single intra-articular injection of levobupivacaine a low concentration should be selected. Level of evidence: Level 5, animal study.

Resumo Justificativa e objetivo: Neste estudo o objetivo foi examinar os efeitos histológicos e morfométricos sobre a estrutura da cartilagem da aplicação intra-articular de levobupivacaína em articulação do ombro. Métodos: Trinta e cinco ombros de 20 coelhos New Zealand, machos e adultos, foram usados para o estudo e divididos em cinco grupos de sete. Os grupos foram definidos como L1, L2, L3 e L4, consistiram em ombros direitos nos quais levobupivacaína a 0,25% e 0,5% foi administrada; o Grupo C, que consistiu em ombros esquerdos, foi o grupo controle; os grupos S1 e S2, que consistiram em ombros esquerdos, receberam solução salina a 0,9%. Os animais foram sacrificados no segundo e no 15º dia; as articulações glenoumerais foram avaliadas macroscopicamente e, em seguida, amostras de cartilagem foram coletadas. As amostras foram avaliadas com o escore de Mankin e histomorfometricamente. Mediu-se a espessura da cartilagem entre a camada superficial e a "linha de maré" (tidemark) e a espessura da cartilagem calcificada entre a tidemark e o osso subcondral. Resultados: Macroscopicamente, observou-se no 15º dia que o líquido articular havia reduzido em todos os grupos. Após a avaliação microscópica, o maior escore de Mankin (média: 3,14 ± 2,1/14) foi observado no grupo L4 (15º dia levobupivacaína a 0,5%), considerado estatisticamente significativo (p < 0,05). Nenhuma diferença estatisticamente significativa foi determinada entre os outros grupos. Conclusões: Histologicamente, como o maior escore de Mankin foi observado no Grupo L4, isso indica que em uma única injeção intra-articular de levobupivacaína uma concentração baixa deve ser selecionada. Nível de evidência: Nível 5, estudo em animais.

Avaliação morfológica e morfométrica da articulação umerorradioulnar em cães através de exames radiográficos e por tomografia computadorizada / Radiographic and tomographic study of the elbow joint in dogs

Elbow dysplasia disease includes an united anconeal process, fragmented medial coronoid process, osteochondrosis of humeral trochlea, articular incongruity and degenerative joint disease. The aim of this study was to present detailed morphologic and morphometric aspects of the elbow joint in dog in clinical and correlate with radiographic and tomographic (CT) exam. Inter-observer variation for articular incongruity measurements by CT, comparative analysis in the radiographic exam, angle in ulnar notch and its comparative analysis between radiographic and tomographic agreement examination in 44 elbow of dogs with different ages were evaluated. The statistics analyses included the kappa coefficient and interclass correlation and Fischers test and McNemars test. It was evidenced that individual performance of each radiographic incidence had poor agreement with the tomographic exam, suggesting that the accomplishment of more than two radiograph views are needed. There was no agreement between the three evaluators in the ulnar notch angle at radiographic and tomographic exams. However, there was good/moderate agreement for articular incongruity measurement in the sagittal plane between evaluators. It was possible to conclude that none of the five radiographic incidences was better than the others for radiographic analysis because each incidence had a better identification of a particular elbow compartment; measurements at the tomographic exam to evaluate radioulnar incongruity had no reproductiveness in the frontal plane, but in sagittal plan had a good/moderate agreement between observers and the angle in ulnar notch presented no repeatability at radiographic exam and no reproductiveness at tomographic exam.(AU)

Este estudo teve como objetivo apresentar de forma detalhada dados morfológicos e morfométricos da articulação umerorradioulnar de cães de raça definida avaliados por meio de exames físicos, radiográficos e tomográficos. A amostra dessa pesquisa constituiu-se de 44 cotovelos de cães com idades variadas. Para análise de informações obtidas, o coeficiente kappa e de correlação interclasse e associação foram realizados. Constatou-se que o desempenho individual de cada projeção radiográfica teve pobre concordância com o exame tomográfico; não houve concordância entre os observadores para as mensurações do ângulo da incisura ulnar ao exame radiográfico e tomográfico. Porém houve boa/moderada concordância para mensuração da incongruência radioulnar no plano sagital entre os observadores. Concluiu-se que nenhuma das cinco incidências radiográficas foi superior para análise radiográfica, uma vez que cada projeção apresentou melhor identificação de um compartimento do cotovelo. Medidas ao exame tomográfico para incongruência radioulnar não apresentaram reprodutibilidade no plano de reconstrução frontal, entretanto no corte sagital apresentaram boa e moderada concordância entre os observadores e que a mensuração do ângulo da incisura ulnar não apresentou repetibilidade ao exame radiográfico e nem reprodutibilidade ao exame tomográfico. Esses resultados contribuem para melhor utilização de cada exame de acordo com a região a ser avaliada bem como ressaltam a necessidade da somatória de múltiplos exames de imagem para a correta avaliação desta afecção.(AU)

The effect of intra-articular levobupivacaine on shoulder cartilage at different doses-experimental study.

BACKGROUND AND OBJECTIVES: In this study it was aimed to examine the histological and morphometric effects on cartilage structure of intra-articular application of levobupivacaine to the shoulder joint. METHODS: In twenty New Zealand adult male rabbits, 35 shoulders were used for the study and prepared in 5 groups of 7. These groups were defined as Groups L1, L2, L3 and L4 which were right shoulders administered with 0.25% and 0.5% levobupivacaine, Group C which were left shoulders as the control group and Groups S1 and S2 which were left shoulders administered with 0.9% saline. On the 2nd and 15th days the animals were killed, the glenohumeral joints were evaluated macroscopically then cartilage samples were taken. These samples were evaluated with Mankin score, and histomorphometrically by measuring the thickness of the cartilage between the superficial cartilage layer and the tidemark and the thickness of calcified cartilage between the tidemark and the subchondral bone. RESULTS: Macroscopically, on the 15th day the joint fluid was seen to have reduced in all the groups. After microscopic evaluation, the highest Mankin score (mean: 3.14±2.1/14) was in the L4 group (15th day 0.5% levobupivacaine) and was found to be statistically significant (p<0.05). No statistically significant difference was determined between the other groups. CONCLUSIONS: Histologically, as the highest Mankin score was in the L4 group, this indicates that in a single intra-articular injection of levobupivacaine a low concentration should be selected. LEVEL OF EVIDENCE: Level 5, animal study.

An age- and gender-related three-dimensional analysis of rotator cuff transverse force couple volume ratio in 304 shoulders.

PURPOSE: The rotator cuff transverse force couple (RCTFC) is fundamental in the shoulder biomechanics, as the balance of its muscle components (the subscapularis relative to the infraspinatus and teres minor) provides stability to the joint. The chronic progression of rotator cuff tears usually present alterations in muscle volume, along with atrophy and compensatory hypertrophy, which can be determined using imaging techniques. The aim of this study was to quantify RCTFC muscle volume in a large sample taking into account the age and gender of the participants involved. METHODS: An observational, retrospective, cross-sectional, descriptive and comparative study was conducted, evaluating thoracic computed tomography scans from 152 patients (304 shoulders) of indistinct gender, with ages ranging between 18 and 85 years. The RCTFC muscle volume was quantified with an oblique/multiplanar segmentation technique. Measuring time was also documented. RESULTS: We observed that muscle volume decreases among the different age (p < 0.04) and gender (p < 0.001) groups. However, the RCTFC volume ratio remained constant at 1.02 ± 0.18 without significant differences throughout all age and gender groups evaluated (p > 0.298). CONCLUSION: The decrease in the RCTFC muscle volume is proportional during the different stages of life, maintaining a constant ratio between its components (physiological RCTFC muscle atrophy). The time-saving segmentation method and volume ratio formula proposed in this study contribute to the management and understanding of rotator cuff tear/pathology.

Tenodesis del biceps: comparación de técnica supra-pectoral artroscópica versus sub-pectoral abierta / Biceps tenodesis. Arthroscopic supra-pectoral versus mini-open sub-pectoral technique

Introducción: La biotenodesis es la técnica preferida para el manejo de la patología del tendón de la porción larga del bíceps en personas jóvenes, deportistas, trabajadores, y aquellos que desean evitar alguna deformidad estética. El objetivo de nuestro trabajo es evaluar los resultados clínico funcionales, la satisfacción personal del paciente, y las posibles complicaciones de dos técnicas diferentes de tenodesis: Supra-pectoral Artroscopica y Sub-pectoral Abierta Materiales y Métodos: De enero de 2009 a enero de 2012 evaluamos en forma retrospectiva 81 pacientes con patología del tendón largo del biceps tratados con dos técnicas de tenodesis diferentes. Grupo A: 61 pacientes con técnica de biotenodesis artroscópica suprapectoral y Grupo B: 20 pacientes con técnica mini abierta subpectoral utilizando tornillo interferencial. Utilizamos los escores de ASES, Rowe, Simple Shoulder Test, Constant Murley y VAS, y el grado de satisfacción personal en cuanto a estética y dolor local en la cicatriz se evaluo mediante entrevistas personales y telefónicas. El tiempo promedio de seguimiento fue de 12 meses. Resultados: Grupo A: Rowe de 86 puntos, ASES de 81 puntos, el SST de 9 puntos, y Constant Murley de 87 puntos. VAS: escaso dolor post quirúrgico (2/10). El grado de satisfacción fue muy bueno. Grupo B: Rowe de 85 puntos, ASES de 82 puntos, el SST de 8,5 puntos, y el Constant Murley de 85 puntos. VAS: 3/10, mayor en el sitio del abordaje subpectoral. Molestias estéticas sobre la cicatriz en 4 casos, todos estos de sexo femenino. Conclusión: Una tenodesis íntegramente artroscópica es técnicamente mas desafiante y requiere inicialmente una curva de aprendizaje de mayor duración para realizar con éxito este procedimiento. La tenodesis subpectoral es un procedimiento más rápido, sencillo pero su elección estaría únicamente ligada a una cuestión de ahorro de tiempo quirúrgico...

Introduction: The biotenodesis is the preferred technique for handling the pathology of the long head of the biceps tendon in younger people, athletes, workers, and those wishing to avoid any cosmetic deformity. The aim of our study was to evaluate the functional clinical outcomes, patient satisfaction, staff, and possible complications of two different tenodesis techniques: Supra pectoral pectoral Sub Arthroscopic and Open. Materials and methods: From January 2009 to January 2012 retrospectively evaluated 81 patients with pathology of the long biceps tendon treated with two different tenodesis techniques. Group A: 61 patients with arthroscopic technique suprapectoral biotenodesis and Group B: 20 patients with mini open technique using subpectoral interference screw. We used the scores of ASES , Rowe, Simple Shoulder Test , Constant Murley and VAS , and the degree of personal satisfaction in terms of aesthetics and local pain at the scar was assessed through personal and telephone interviews. The average follow-up time was 12 months. Results: Group A: 86 points Rowe, ASES 81 points, 9 points SST , Constant and Murley 87 puntos.VAS : poor postsurgical pain (2/10). The degree of satisfaction was very good...

Tenodesis del biceps: comparación de técnica supra-pectoral artroscópica versus sub-pectoral abierta / Biceps tenodesis. Arthroscopic supra-pectoral versus mini-open sub-pectoral technique

Introducción: La biotenodesis es la técnica preferida para el manejo de la patología del tendón de la porción larga del bíceps en personas jóvenes, deportistas, trabajadores, y aquellos que desean evitar alguna deformidad estética. El objetivo de nuestro trabajo es evaluar los resultados clínico funcionales, la satisfacción personal del paciente, y las posibles complicaciones de dos técnicas diferentes de tenodesis: Supra-pectoral Artroscopica y Sub-pectoral Abierta Materiales y Métodos: De enero de 2009 a enero de 2012 evaluamos en forma retrospectiva 81 pacientes con patología del tendón largo del biceps tratados con dos técnicas de tenodesis diferentes. Grupo A: 61 pacientes con técnica de biotenodesis artroscópica suprapectoral y Grupo B: 20 pacientes con técnica mini abierta subpectoral utilizando tornillo interferencial. Utilizamos los escores de ASES, Rowe, Simple Shoulder Test, Constant Murley y VAS, y el grado de satisfacción personal en cuanto a estética y dolor local en la cicatriz se evaluo mediante entrevistas personales y telefónicas. El tiempo promedio de seguimiento fue de 12 meses. Resultados: Grupo A: Rowe de 86 puntos, ASES de 81 puntos, el SST de 9 puntos, y Constant Murley de 87 puntos. VAS: escaso dolor post quirúrgico (2/10). El grado de satisfacción fue muy bueno. Grupo B: Rowe de 85 puntos, ASES de 82 puntos, el SST de 8,5 puntos, y el Constant Murley de 85 puntos. VAS: 3/10, mayor en el sitio del abordaje subpectoral. Molestias estéticas sobre la cicatriz en 4 casos, todos estos de sexo femenino. Conclusión: Una tenodesis íntegramente artroscópica es técnicamente mas desafiante y requiere inicialmente una curva de aprendizaje de mayor duración para realizar con éxito este procedimiento. La tenodesis subpectoral es un procedimiento más rápido, sencillo pero su elección estaría únicamente ligada a una cuestión de ahorro de tiempo quirúrgico...(AU)

Introduction: The biotenodesis is the preferred technique for handling the pathology of the long head of the biceps tendon in younger people, athletes, workers, and those wishing to avoid any cosmetic deformity. The aim of our study was to evaluate the functional clinical outcomes, patient satisfaction, staff, and possible complications of two different tenodesis techniques: Supra pectoral pectoral Sub Arthroscopic and Open. Materials and methods: From January 2009 to January 2012 retrospectively evaluated 81 patients with pathology of the long biceps tendon treated with two different tenodesis techniques. Group A: 61 patients with arthroscopic technique suprapectoral biotenodesis and Group B: 20 patients with mini open technique using subpectoral interference screw. We used the scores of ASES , Rowe, Simple Shoulder Test , Constant Murley and VAS , and the degree of personal satisfaction in terms of aesthetics and local pain at the scar was assessed through personal and telephone interviews. The average follow-up time was 12 months. Results: Group A: 86 points Rowe, ASES 81 points, 9 points SST , Constant and Murley 87 puntos.VAS : poor postsurgical pain (2/10). The degree of satisfaction was very good...(AU)

Ejercicios pendulares en el síndrome del hombro doloroso / Pendulum Exercises in Painful Shoulder Syndrome

Se realizó un breve recuento de las estructuras anatómicas que conforman la articulación del hombro, así como, del síndrome del hombro doloroso, su definición y su caracterización clínica epidemiológica. La presente revisión abordó dentro de la kinesioterapia pasiva, los diferentes ejercicios pendulares empleados en el tratamiento fisioterapéutico del síndrome del hombro doloroso. Los objetivos del artículo fueron: la descripción de su técnica de aplicación, la fundamentación de la utilidad de su aplicación, indicaciones y contraindicaciones. Se concluyó que los ejercicios pendulares mantienen su eficacia en el restablecimiento de la movilidad articular en los padecimientos del hombro, sin embargo, existe desconocimiento de sus variedades, así como de su correcta técnica de aplicación.(AU)

A brief account of the anatomical structures of the shoulder joint and the painful shoulder syndrome, its definition and clinical epidemiological characterization was performed. This review addressed within the passive physiotherapy, different pendulum exercises used in the physiotherapy treatment of shoulder pain syndrome. The objectives of the paper were: the description of the technical implementation, the basis for the usefulness of its application, indications and contraindications. The authors concluded that pendulum exercises will maintain the effectiveness in restoring joint mobility in shoulder conditions; however, there is lack of its varieties, and its correct application technique.(AU)

Validation and repeatability of a shoulder biomechanics data collection methodology and instrumentation.

The purpose of our study was to establish criterion-related validity and repeatability of a shoulder biomechanics testing protocol involving an electromagnetic tracking system (Flock of Birds [FoB]). Eleven subjects completed humeral elevation tasks in the sagittal, scapular, and frontal planes on two occasions. Shoulder kinematics were assessed with a digital inclinometer and the FoB. Intrasession and intersession repeatability for orthopedic angles, and humeral and scapular kinematics ranged from moderate to excellent. Correlation analyses revealed strong relationships between inclinometer and FoB measures of humeral motion, yet considerable mean differences were noted between the measurement devices. Our results validate use of the FoB for measuring humeral kinematics and establish our testing protocol as reliable. We must continue to consider factors that can impact system accuracy and the effects they may have on kinematic descriptions and how data are reported.