Acceptance of Students with Physical Disabilities in Medical Schools in Saudi Arabia: Perception, Experience, and Recommendation.

Introduction: Physical disability is seen as a burden in many countries, and it has been a challenge to create a healthy environment and a fair living experience for all people with physical disability. For a long time, the number of students accepted to medical school has been limited, and the number of successful experiences for doctors with disabilities is inadequate worldwide. This study aims to investigate the perception of the public, medical educators, and medical students about the acceptance of students with physical disabilities in medical schools in Saudi Arabia. Methods: The study uses two methodological strategies: a quantitative cross-sectional survey and a qualitative interview with a young female doctor with a physical disability to discuss her educational experience and work journey in Saudi Arabia and abroad. The study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Results: The perception survey results showed a broad acceptance of the public, medical educators, and medical students regarding the enrollment of students with physical disabilities in medical schools and regarding being treated by doctors with physical disabilities. The participants also believed that students with physical disabilities are compatible with most doctors' jobs. Conclusion: Students with physical disabilities should be able to study and practice medicine. Educational and health institutions should apply more effort and commitment to provide the necessary accommodations to accept students and doctors with physical disabilities based on their cognitive ability but not their physical disability.

The morphometric parameters of the biceps brachii: cadaveric study.

BACKGROUND: The biceps brachii (BB) is a fusiform muscle comprising of two muscular bellies located in the anterior compartment of the arm. Its primary function includes elbow flexion and forearm supination. PURPOSE: The study aimed to examine the morphometric parameters of the BB in adult cadaveric specimens. METHODS: This dissection-based study examined the anatomy of the BB in 40 arms taken from 20 Thiel embalmed European cadavers, including 13 males with an average age of 81 years and seven females with an average age of 84 years. The investigation included an observational inspection of the BB morphology and collected 19 parameters, comprising the lengths and widths of the short and long head tendons and muscle bellies. RESULTS: The observation analysis showed that the anatomy of the BB consisted mainly of two muscle bellies: a short head and a long head. An additional third humeral head, originating from the anteromedial aspect of the mid of the humerus and inserted into the common biceps tendon, was observed in four (10%) specimens. The average lengths of the short head and long head were 35.98 ± 3.44 cm and 38.90 ± 3.40 cm, respectively. There was no difference in the BB parameters according to the arm sides. However, the male specimens showed greater BB parameters than the female specimens. CONCLUSION: The short head had a greater muscle belly, while the long head had a longer origin and insertion tendons. The BB parameters were correlated positively with the humerus length.

The association between a rotator cuff tendon tear and a tear of the long head of the biceps tendon: Chart review study.

Rotator cuff (RC) and long head of the biceps tendon (LHBT) tears are common shoulder problems presented to the orthopedic clinic. The aim of this study was to assess the association between RC and LHBT tears among a Saudi population sample. A total of 243 patients who were diagnosed with shoulder pain due to RC or LHBT tear between 2016 and 2018 using a magnetic resonance imaging scan were included in this study. Females comprised 66% of the sample, and 59% (n = 143) of the shoulders were on the right side. The mean age of the patients was 58 ± 11 years, ranging from 23 to 88 years. A significant association was detected between the LHBT and RC tears (P < 0.001). Out of 26 cases showing RC and LHBT tears, 81% had a full thickness tear, whereas 19% had a partial tear. The LHBT tears were presented significantly in 48% of cases with at least two completely torn RC compared to 10% in cases with one completely torn RC (P < 0.001). The LHBT tear was significantly observed in shoulders with RC tears including the tendons of subscapularis, supraspinatus, and infraspinatus, but not the teres minor (P < 0.001). Both types of tears were presented significantly in senior patients aged more than 65 years compared to younger patients (P < 0.01). Thus, the LHBT should be assessed carefully in shoulders with more than one RC tear or in chronic cases.

Prevalence of Eustachian Tube Dysfunction and Its Associated Factors Among the General Public in Al-Madinah, Saudi Arabia.

Objectives To determine the association between patient demographics including gender, age, family history of hearing loss, and eustachian tube dysfunction (ETD) in the Al-Madinah region. Methods This is a cross-sectional observational study that was conducted using an online survey in the Al-Madinah region of Saudi Arabia from March 2022 to August 2022. Data were collected using a self-administered questionnaire (ETDQ-7) that was designed based on previous studies and frameworks. It consists of seven items, each with a score ranging from 1 to 7, for a total score of between 7 and 49 points. A total score of 14.5 or above, or a mean domain score of 2.5 or above, is considered abnormal, with higher scores indicating greater severity of symptoms. The analysis was carried out using SPSS v23. Results About 380 participants were included in the current study. The mean age of the participants was 29.2 ± 8.7 years old. About 13 (3.4%) of the participants had a history of ETD. The prevalence of ETD among the study population was 41.3%. Gender was significantly associated with the prevalence of ETD (p-value=0.004), with females tending to have the condition more frequently than males. Moreover, the history of ETD was also significant (p=0.001) Conclusion A higher prevalence of ETD was found in the current study when compared to international studies, gender and history of ETD were found to be linked with increased prevalence of EDT.

Cytological Changes and Immunocytochemistry Expression of P53 in Oral Mucosa Among Waterpipe Users in the Kingdom of Saudi Arabia.

Objective In this study, we aimed to assess cytological changes and p53 expression in oral mucosa among waterpipe users in the Kingdom of Saudi Arabia (KSA). Methodology A case-control study was conducted in KSA from January to October 2022. Two cytologic oral smear samples each were taken from 500 volunteers; 300 were waterpipe users (case) while 200 did not use a waterpipe (control). They were then stained using the Papanicolaou staining procedure and immunocytochemical method to show the expression of P53. Results The interpretation of the Papanicolaou staining outcomes showed the presence of four results with different proportions: inflammation, infection, atypia, and keratinization. Cytological inflammation was identified among 77/300 (25.6%) waterpipe smokers, which was higher than that among non-users (12/200, 6%). The reverse cytological infection and atypia were also higher in waterpipe smokers compared with controls (9% vs. 4.5% and 4.3% vs. 0.5%, respectively), and keratinization was detected only in waterpipe users (3.6%) compared with controls. Waterpipe users had higher p53 protein expression than non-users. Conclusion Using a waterpipe is an effective way to change the oral mucosa. In atypia and keratinization, there was high p53 expression. These results could indicate that p53 is involved in both the change from normal to cancerous cells and the growth of new cells, but the presence or absence of p53 staining could not be used to predict the outcome of potentially cancerous oral mucosal lesions.

Hand Grip Strength as an Index of Health Does Not Associate With Insomnia: A Cross-Sectional Study.

Introduction Insomnia is one of the most prevalent diseases globally, with many adults around the world suffering from at least one of its symptoms. It has a significant effect on the body's normal physiology and may lead to the development of chronic diseases that impair the main functional domains of health and cognition if left untreated. Handgrip strength (HGS) has previously been linked to several diseases that occur in tandem with insomnia. Thus, this study aimed to investigate the association between HGS and insomnia. Materials and methods This is a cross-sectional study in which the involved participants were approached in different locations. The participants were surveyed using the Insomnia Severity Index (ISI) to evaluate the presence of insomnia. A hydraulic hand dynamometer was used to measure the HGS of the participants' right and left hands. Results A total of 494 questionnaires were collected, including 365 (74%) males and 129 females (26%). About 16% of females had insomnia, compared to 15% of males. There was no significant association between gender and insomnia (P=0.873). The difference between the mean HGS for the right and left hands among males and females was not statistically significant (P>0.05). The correlation coefficients of the right and left HGS scores with insomnia were r=0.019 and r=0.018, respectively, which showed no statistically significant association (P>0.05). Conclusions The study found no significant association between HGS and insomnia. The study recommends conducting further large-scale studies focusing on specific groups in the population to understand the relationship between HGS and chronic sleep disturbance.

The Influence of Diet, Water Intake, Exercise, Education Level, and Income on the Quality of Sleep in the Saudi Population: A Cross-Sectional Study.

BACKGROUND: Sleep quality is known to affect and be affected by multiple factors in one's life through physiological and psychological manners. The study aimed to assess the influence of diet, water intake, exercise, level of education, and income on the quality of sleep of the Saudi population. MATERIALS AND METHODS: The study was a cross-sectional design that used a validated standardized fact-based questionnaire developed based on the Insomnia Severity Index. The data collection continued for three months, during which subjects were approached and interviewed in many locations, ensuring the Saudi population's best representation. RESULTS: The study included 496 subjects, of whom 74% were men. Most of the participants (51.4%) were aged between 18 and 25 years old and were unmarried (64.2%). The education level of participants was between high school and bachelor's level (45-43%), respectively. Around 53% believed that they were following an unhealthy diet, although 42% of the total had a normal BMI. About 44% of participants consumed about 1-2 L of water daily, and 42% never exercised. The majority (39%) earned an income of >5000 Saudi Riyals. Forty-two percent of the participants reported subthreshold insomnia. The data analysis showed that social status and diet were significantly related to sleeping quality (P = 0.051, P = 0.027). Additionally, the level of education was found to be an important confounding factor. CONCLUSION: Diet and social status were significantly related to insomnia, and educational level served as a significant confounding factor. Neither water intake, exercise, BMI category, age, nor gender were associated with insomnia.

The association between coracoacromial ligament morphology and rotator cuff tears: A cadaveric study.

To determine the association between coracoacromial ligament (CAL) morphology and rotator cuff tears. The present study is a prospective cohort study based on the dissection of 172 shoulders from 86 (46 female, 40 male) formalin embalmed European Caucasian cadavers, with a median age of 82 years. The anatomy of CAL was examined, including its morphology and parametric measurements, while the rotator cuff tendons were inspected for the presence of tears. Gross examination of the CAL in 155 shoulders revealed a variable number of bands as follows: 28 (18%) had one band, 56 (36%) two bands and 71 (46%) three or more bands. Inspection of the rotator cuff tendons showed the presence of tears in 77 (50%) shoulders, of which 37 (24%) were partial and 40 (26%) were full-thickness tears. Statistical analysis showed a significant association (P < 0.05) between CAL band number and the prevalence of a rotator cuff tear. A high proportion of rotator cuff tears were observed in shoulders with two (52%) and three or more CAL bands (56%) compared to single band ligaments (29%). Parametric assessment of the CAL in shoulders with rotator cuff tears showed significantly greater (P < 0.05) attachment widths and ratios, thicker ligament bands, and larger cross-sectional areas compared to the control group. Coracoacromial ligaments with more than a single band have a strong association with rotator cuff tears.

Literature Review of Anatomical Variations: Clinical Significance, Identification Approach, and Teaching Strategies.

This article is a comprehensive literature review on anatomical variations, shedding some light on their clinical significance, identification approaches, and teaching strategies. Anatomical variation is a normal presentation of body structure with morphological features different from those that have been classically described in several anatomy textbooks. Under normal circumstances, it has no impact on the function of the structure. However, it may influence different aspects of clinical practice. As a result, accurate knowledge of common anatomical variations in the treated area may improve clinical practice outcomes. On the other hand, anatomical variations are usually identified during routine dissection and clinical practice, including preoperative imaging and surgical procedures. Additionally, scientific research, such as observational studies using cadaveric dissection, medical images, and evidence-based anatomy, are effective approaches to identify anatomical variations. With regard to the teaching of anatomical variations, cadaveric dissection is the most commonly used and recommended learning tool for teaching anatomy and relevant variations in medical schools. However, the literature emphasizes introducing anatomical variations in the clinical phase of medical curricula and postgraduate training of surgical and radiological programs. The current study suggests creating a registry of anatomical variations encountered during practice that may enhance best care and prevent any confusion about those variations. In addition, there is a need to conduct more educational studies to research the best learning strategies for teaching and assessing anatomical variations in the medical curricula.

Introducing free response short answer questions in anatomy spot tests: experiment study.

PURPOSE: A spot test is commonly used to assess practical knowledge through a series of specific questions related to the marked anatomical structures on cadavers. However, the continuous reviewing and developing of the medical curricula demands the need to improve the assessment method of the practical examination of anatomical knowledge. Therefore, the aim of the study was to examine the effectiveness of a free response short-answer questions (FRSAQs) test and traditional questions on medical students' performance. METHODS: This is an experimental study using a Randomized Posttest-Only Control Group Design to compare the mean of students' performance in addition to their perceptions about the two versions of the spot tests. Two hundred and ninety preclinical-year medical students were invited to participate in this study. RESULTS: Only 109 (38%) students participated in this study. The data analysis showed a significant improvement in students' performance in the FRSAQs test (5.3 ± 2.7) than the traditional spot test (4.7 ± 2.6), (P = 0.04). The majority of the students (70%) preferred the FRSAQs spot test, citing that it is good test to assess practical knowledge. The psychometric analysis revealed that the FRSAQs produced more ideal stations (60%) when compared to the traditional spot test (10%). CONCLUSION: The current study found that the FRSAQs spot test had a significant impact on students' performance, and it was considered an ideal, flexible, and stress-free assessment method when compared to the traditional spot test. Implementation of the strategy in teaching and in assessment is recommended.

The prevalence of acromial spurs in relation to study type and specimens examined

Advanced cases of subacromial impingement syndrome usually present with acromial spurs. However, previous studies have reported variations in the prevalence of acromial spurs in shoulders with or without subacromial impingement syndrome as well as with age, sex, and side. Therefore, this study is aimed at investigating the prevalence of acromial spurs in cadaveric shoulders and reviewing the factors leading to the reported variable frequencies. The study examined 220 cadaveric shoulders (110 male and 110 female), with a median age of 82 years (with a range of 53 to 102 years). In 155 shoulders, the rotator cuff tendons were evaluated for tears; acromial spurs were observed in 95 shoulders (43%). No significant association was observed between the prevalence of acromial spurs and sex or side. However, a significant prevalence of spurs (57%) was observed in the oldest-old group, aged ≥ 85 years. Those with acromial spurs also tended to be older (84 years) than those without spurs (81 years). A significant difference in the prevalence of acromial spurs was observed in shoulders with rotator cuff tears compared to those without them: 80% compared to 20%, respectively. Analysis showed a significant number of acromial spurs in shoulders with full-thickness tears (46%) and partial tears (34%). A significant prevalence of acromial spurs was found in shoulders with rotator cuff tears, as well as in aged shoulders. In relevant literature, the prevalence of acromial spurs varies with the type of study undertaken, age, prevalence of rotator cuff tears, and type of radiograph examined

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Three-dimensional Virtual Reality as an Innovative Teaching and Learning Tool for Human Anatomy Courses in Medical Education: A Mixed Methods Study.

Introduction Poor knowledge retention is one reason for medical student attrition in learning and has been a huge concern in medical education. Three-dimensional virtual reality (3D-VR)-based teaching and learning in medical education has been promoted to improve student learning outcomes. This study aimed to determine the effectiveness of 3D-VR in knowledge retention in human anatomy courses as compared to traditional teaching methods among medical students. Methods A convergent mixed methods design was utilized to evaluate learning outcomes in terms of short- and long-term knowledge retention scores among students using 3D-VR and those using traditional models and to describe students' experiences and views of the use of 3D-VR as a teaching and learning tool. Results Male students who used the 3D-VR tool had significantly higher short- and long-term knowledge scores than males who used the traditional methods. Meanwhile, females who used traditional methods showed significantly higher short-term knowledge scores than females who used 3D-VR. Conclusion Medical students described 3D-VR as a learning tool with a great deal to offer for learning human anatomy as compared to traditional methods. Therefore, we recommend adding the use of 3D-VR in the anatomy curriculum. However, several 3D-VR limitations were also identified, which may hinder its utilization for teaching and learning. These concerns must be addressed before 3D-VR tools are considered for implementation in medical education human anatomy courses.

Exposure to cell phones reduces heart rate variability in both normal-weight and obese normotensive medical students.

BACKGROUND: We investigated and compared the effect of the radiofrequency electromagnetic field (RF-EM) emitted by a cell phone on the electrocardiogram and heart rate variability (HRV) of normotensive normal-weight and obese medical students. METHOD: Twenty medical student volunteers, normal weight (age = 23 ± 2, BMI = 23.05 ± 1.72) or obese (age = 24 ± 2, BMI = 32.39 ± 4.78), were exposed to a cell phone (1) close to the heart in silent mode, no ringing or vibrating; (2) close to the heart in ring and vibration mode; (3) next to the ear (brain) while listening; and (4) next to the ear while listening and speaking. RESULTS: The average basal HR of obese students significantly increased, while the PR interval; time domains, including standard deviation (SD) of all normal R-R intervals (SDNN), mean of the SD of all normal R-R intervals (SDNNi), SD of the average of normal R-R intervals (SDANN), and percentage of R-R intervals at least 50 ms different from the previous interval (pNN50); and high-power frequency (HF) decreased. The LF/HF ratio also significantly increased. The SDNN, SDNNi, SDANN, pNN50, and HF levels significantly decreased and the LF/HF significantly increased in normal-weight and obese individuals only when the phone was near the apex of the heart in ring and vibration mode. All changes were more profound in obese students. CONCLUSION: Keeping the phone in a chest pocket reduced the HRV of normal-weight and obese medical students and exaggerated the effect of obesity on sympathetic activation.

Morphometric parameters of the glenoid labrum

The glenoid labrum has an important role in glenohumeral joint stability, yet its morphometric parameters are seldom reported. This study aimed to (I) investigate the thickness and height of the glenoid labrum, and (ii) determine whether there is any significant difference between side and sex. A total of 140 shoulders (30 male and 40 female cadavers, average age of 81.5 years) were obtained for this study. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were inspected and then removed to expose the glenoid fossa with the labrum attached. Measurement of labral height and thickness at the superior (12 o'clock), anterior (3 o'clock), inferior (6 o'clock) and posterior (9 o'clock) regions were taken. Gender, side and thickness and height measurements of the glenoid labrum were double- entered into the Statistical Package for Social Sciences. ANOVA and MANOVA tests were conducted to determine statistical significance, which was set at P<0.05. Significant differences in thickness (at the superior, inferior and posterior aspects) and height (at the superior and inferior aspects) of the glenoid labrum were observed between males and females, being thicker and taller in males in all regions. Based on the side of the limb, no differences in labral thickness and height were observed with respect to side. The current observations confirm that the glenoid labrum height and thickness are associated with sex, but not with side

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Is the existence of sublabral foramen age-related?

Although a sublabral foramen does not require treatment, its association with age, sex or side remains unknown. Therefore, the aim of the current study was to investigate the incidence of a sublabral foramen and age, sex and side in a British population. A total of 140 shoulders (30 male and 40 female cadavers, with an average age of 81.5 years), were obtained from the Centre for Anatomy and Human Identification University of Dundee, in accordance with the Human Tissue (Scotland) Act 2006. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were inspected and then removed to expose the glenoid fossa with the glenoid labrum attached. The gender, age, side and presence of a sublabral foramen were double-entered into the Statistical Package for Social Sciences (Version 21; IBM, Armonk, NY, USA). Chi Square tests were conducted to determine statistical significance, which was set at P<0.05. A sublabral foramen was observed in 28.6% (n=40) of shoulders, being marginally more in females than males. A sublabral foramen was more common in elderly individuals (>70 years old), no significant difference being observed between the presence of a sublabral foramen and age. It was also more common on the right than the left side in both genders with no significant difference between the presence of a sublabral foramen and sex or side. The current observations confirm that a sublabral foramen was more common in older individuals, but was not significantly different from other age groups

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Examining changes in acromial morphology in relation to spurs at the anterior edge of acromion.

BACKGROUND: Although acromial morphology is classified as flat, curved, and hooked, whether the morphology is primary or acquired is debated. There have been no investigations on the effect of acromial spurs on acromial morphology. This study therefore aimed to evaluate acromial morphology in relation to spur formation at the anterior edge of the acromion. MATERIALS AND METHODS: Acromial morphology was investigated in 40 scapulae taken from 20 cadavers (10 male and 10 female), with a median age of 82 years (range 62-97 years). Ink prints of the anteroposterior aspect of the acromion were used to evaluate acromial slope angle and curvature height in relation to spur incidence, length, and shape at the anterior edge of the acromion. RESULTS: Differences were observed in acromial morphology and acromial curvature in relation to acromial spurs (incidence, size, and shape). A hooked acromion was observed as a primary structure in 25% of specimens, which increased to 43% when acromial spurs were involved. No differences were observed in relation to sex or side, while a significant correlation was observed between acromial curvature and the age of the specimens. CONCLUSION: Acromial spurs increase acromial curvature and therefore change acromion morphology. Nevertheless, it is concluded that a hooked acromion occurs as a primary formed structure. LEVEL OF EVIDENCE: Basic science study, anatomy, cadaver dissection.

Origin of the long head of biceps brachii from the supraglenoid tubercle and glenoid labrum

The long head of the biceps tendon (LHBT) provides stability to the glenohumeral joint. Although it has been observed to arise from the supraglenoid tubercle and glenoid labrum, its mode of attachment to the glenoid labrum is variable. This study therefore aimed to (I) identify the origin of the LHBT, and (II) investigate if there are differences in attachment related to age, gender and side. A total of 140 shoulders from 30 male and 40 female cadavers were examined: the glenoid fossa with the glenoid labrum and LHBT attached were exposed. The classification of Vangsness et al. (1994) was adopted to determine the mode of attachment of the LHBT. Gender, age, side and type of attachment were double-entered into the Statistical Package for Social Sciences. Chi square tests were conducted to determine statistical significance, which was set at P<0.05. Type I was the most common attachment (47.7%) of the LHBT, then Type II (31.5%), Type III (16.2%) and Type IV (4.6%). No significant difference was observed between the type of attachment of the LHBT and sex, side or age. The LHBT consistently arose from the glenoid labrum and supraglenoid tubercle in all the specimens, with the majority of tendons having a posterior orientation. Involvement of the glenoid labrum can be associated with injury to the LHBT: this may explain the existence of a combined injury in shoulder joint instability. Further study is needed to investigate the association between variations of the LHBT attachment to the glenoid labrum and shoulder joint stability

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Histology, vascularity and innervation of the glenoid labrum.

BACKGROUND: Although the glenoid labrum has an important role in shoulder stability, little is known about its composition, vascularity and innervation. The aims of this study were therefore to evaluate the histology, vascularity and innervation of the glenoid labrum. MATERIALS AND METHODS: Ten glenoid labrum specimens (three male, two female: mean age 81.2 years, range 76-90 years) were detached at the glenoid neck. Following decalcification, sections were cut through the whole thickness of each specimen perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid fossa. Then they were stained using haematoxylin and eosin, a silver nitrate protocol or subjected to immunohistochemistry using anti-protein gene protein 9.5 to demonstrate neuronal processes. RESULTS: The labrum was fibrocartilaginous, being more fibrous in its free margin. There was a variable distribution of blood vessels, being more vascular in its periphery, with many originating from the fibrous capsule and piercing the glenoid labrum. Immunohistochemistry revealed positive staining of nerve fibres within the glenoid labrum. CONCLUSION: The glenoid labrum is fibrocartilaginous, being more fibrous in its periphery, and is vascularized, with the anterosuperior aspect having a rich blood supply. Free sensory nerve fibres were also present; no encapsulated mechanoreceptors were observed. The presence of sensory nerve fibres in the glenoid labrum could explain why tears induce pain. It is postulated that these sensory fibres could play a role in glenohumeral joint proprioception.

Blood supply and vascularity of the glenoid labrum: Its clinical implications.

BACKGROUND: Tears of the glenoid labrum are common after dislocation of the glenohumeral joint. The outcome for healing or surgical reconstruction of the glenoid labrum relies on the extent of its vascularization. This study aims to evaluate the glenoid labrum blood supply and to determine its regional vascularity. MATERIALS AND METHODS: A total of 140 shoulders (30 male and 40 female cadavers) were examined: mean age 81.5 years, range 53-101 years. All blood vessels around the glenohumeral joint were dissected and recorded. Ten specimens with the glenoid labrum and fibrous capsule attached were randomly selected and detached at the glenoid neck and subjected to decalcification. Sections (10-20 µm) were cut through the whole thickness of each specimen from the centre of the glenoid fossa perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid. Sections were stained using haematoxylin and eosin and then examined. RESULTS: The blood supply to the glenoid labrum is by direct branches from the second part of the axillary artery, subscapular, circumflex scapular and anterior circumflex humeral and posterior circumflex humeral arteries, as well as branches of muscular arteries supplying the surrounding muscles. CONCLUSION: This study shows that the glenoid labrum has a rich blood supply suggesting that, regardless of the types of the glenoid labrum lesions or their management, an excellent outcome for glenoid labrum healing and joint stability is possible. The observations also suggest that the blood supply to the glenoid labrum is sufficient, enabling its reattachment.

Variability in attachment of the coracoacromial ligament in relation with its morphology.

PURPOSE: The coracoacromial ligament (CAL) presents with variable morphology and plays a significant role in the development of subacromial impingement syndrome. Sectioning the CAL has been suggested to relieve impingement of the rotator cuff. The aim of the current study was to investigate the CAL attachment in relation with ligament morphology. MATERIALS AND METHODS: The CAL was investigated in 220 cadaveric shoulders from 58 males and 59 females, with a median age of 82 years (range 53-102 years). CALs were classified according to three factors: (1) number of bands present; (2) shape; and (3) attachment to the acromial and coracoid processes. RESULTS: 35 (16%) CALs had a single band, 84 (38%) two bands, and 101 (46%) three or more bands. CAL shape was either broadband (14: 6%), quadrangular (21: 10%), Y-shaped (84: 38%), or multiple-banded (101: 46%). More ligaments were attached to the medial aspect of the acromion (60%) and medial end of the coracoid (75%) than those restricted to the anterior edge of the acromion (40%) and posterior aspect of the coracoid (25%). Multiple-banded ligaments attached significantly more medially at the acromion and coracoid processes, while single band ligament attachments were restricted to the anterior edge of the acromion and posterior aspect of the coracoid process. CONCLUSION: The CAL has variable morphology and attachments with interconnections to different structures around the shoulder. CALs with a medial acromial attachment may narrow the subacromial space leading to further shoulder impingement.