Acromion Research Articles

Congenital Bilateral Shoulder Dimples in a Newborn Case report and Review of the literature

Congenital Acromial or Shoulder dimples are cutaneous depressions overlying the acromial process of the scapula. They are usually bilateral and symmetrical. Isolated biacromial dimples are usually benign and warrant no further investigations. Family history in an autosomal dominant pattern, as in our case, is frequently obtainable but the majority of isolated bilateral shoulder dimples are sporadic. There are few reports of syndromic associations as well as two cases of associated maternal cocaine abuse. Our case is a term female neonate who was noted on routine new-born check to have bilateral symmetrical shoulder dimples. She was otherwise healthy, had normal range of shoulder movements and was not dysmorphic. On further assessment it transpired the father has the same bilateral shoulder dimples but was not aware of their existence. No further investigations were carried out. This case add to the few reported cases of Biacromial Dimples with autosomal pattern of inheritance in an otherwise normal baby

Tuberculosis, a great masquerader: A case series unveiling rare sites of musculoskeletal involvement through imaging

Skeletal tubercular infections that do not involve the spine or large joints are rarely encountered. This case series aims to highlight the importance of imaging in diagnosing skeletal tuberculosis (TB) at uncommon sites in clinically unsuspected patients by demonstrating specific imaging findings. We present the clinical details and imaging findings of seven pathologically confirmed cases of extraspinal skeletal TB. A multimodality imaging approach including radiography, ultrasonography (USG) and computed tomography (CT) scan was used in most cases. The imaging studies revealed an infective soft tissue collection over different sites including the sternoclavicular joint, acromion process, chest wall and temporo-mandibular joint, along with destruction and erosion of the underlying or adjacent bones. In tubercular endemic countries, strong clinical suspicion should be entertained in cases presenting with a soft tissue collection, even around unusual skeletal sites.

Surgical treatment of scapular fractures: Results and complications

IntroductionThe aim of this study was to describe a surgical technique and report on patient-based functional outcomes and complications following open reduction and internal fixation in patients with scapular fractures. MethodsThe study comprised 14 patients who were treated with open reduction and internal fixation (ORIF) of a scapular fractures between September 2010 and July 2018. Surgical indications were as follows: medial/lateral displacement greater than 20 mm; shortening greater than 25 mm; angular deformity greater than 40°; intra-articular step-off greater than 4 mm; and double shoulder suspensory injuries (including fracture of the clavicle, coracoid or acromion with displacement greater than 10 mm). All patients underwent X-ray examination (true AP, Y scapular view) and computed tomography (CT) scans. Fractures were classified according to the revised (AO/OTA) classification system. Functional outcomes were measured using Constant-Murley scores. ResultsSeven patients had glenoid fossa fractures, six patients had scapular body fractures and one patient had an acromion process fracture. All glenoid fossa and scapular body fractures were exposed via the Judet approach. Eleven of 14 patients were given Constant-Murley scores at the final follow-up examination; three patients were lost to follow-up. The mean follow-up after injury was 44 months (range, 6–92 months). We found infraspinatus muscle hypotrophy in four patients. The mean Constant-Murley score was 93.45 (±8.93) for the injured arm and 98.36 (±2.91) for the uninjured arm. The mean score between the injured and uninjured arm was 4.91(±6.49), which is an excellent functional outcome according to the Constant-Murley score. ConclusionsOpen reduction and internal fixation of displaced scapular fractures is a safe and effective treatment option that results in a reliable union rate and good-to-excellent functional outcome.

Morphometric analysis of acromion process of scapula with special emphasis on its clinical implications

Morphometric analysis of acromion process of scapula with special emphasis on its clinical implications

Unusual presentation of bilateral inferior shoulder dislocation following a trivial fall in an elderly female: a case report

Background. Bilateral inferior dislocation of the shoulder joint is infrequent. This usually results following significant impact from forceful hyperabduction or direct axial loading in the abducted position. We describe the case of bilateral inferior shoulder dislocation following a trivial fall on outstretched arms in an elderly female. A 75-year-old female who was on treatment for type 2 diabetes and hypertension, presented to the emergency department with painful inability to move both shoulders following a trivial fall. Her both shoulders were fixed at the 90 degree abducted position, the acromion processes were prominently palpable and both humeral heads were palpable in the axillae. X-ray confirmed the diagnosis of bilateral inferior dislocation of the shoulder joint. Closed reduction was successfully achieved using a single step levering manoeuvre with one hand applying traction at 90 degree abduction and the other hand levering the humeral head towards the glenoid. Post-procedure was uneventful with satisfactory functional outcomes. We described an unusual presentation of bilateral inferior dislocation of the shoulder joint following a trivial fall in an elderly female. The single step levering manoeuvre was successful in achieving reduction.

Gross anatomical features and osteometric variables of the scapula of the african tree squirrel (Funisciurus anerythrus), house (Rattus Rattus) and wistar rats

This study comparatively investigated gross features and osteometric variables in scapula of three rodents: tree squirrel (Funisciurus anerythrus ), house (Rattus Rattus ) and Wistar rats. A total of thirty three animals (11 per rodent species) were used for the study. The rodents were anaesthetized using ketamine and xylazine combination (80 mg/kg: 10 mg/kg body weight), sacrificed and processed for scapular bone extraction by burying method. Grossly, the scapular bones are flattened in all the rodents and have various shapes; semicircular in squirrel and roughly triangular in both Rattus rattus and Wistar rats. The scapula of the squirrel bears a hook-like acromion process and a distinct subscapular spine. Osteometric variables; scapular width and length of scapular neck are significantly reduced (p<0.05) in the squirrel relative to other rodents. While the length of glenoid and diameter of infra spinatous fossa in Rattus rattus as well as the scapular spine length in squirrel respectively show marked increase when compared to other rodents.
 Keywords: Funisciurus anerythrus, Rattus rattus , Wistar, scapula, morphology, osteometry, comparative

Critical Shoulder Angle and Its Clinical Correlation in Shoulder Pain.

IntroductionThe critical shoulder angle is defined as the angle formed between the plane of the glenoid and the line connecting the most lateral border of the acromion process, as seen on the true anteroposterior radiograph of the shoulder. The purpose of this study was to determine the association between the critical shoulder angle and shoulder pathologies like rotator cuff tears and glenohumeral osteoarthritis. It was also to assess the reproducibility and accuracy of critical shoulder angle values, which were measured with radiographs. ObjectiveThe aim of the study was to find out the association between the critical shoulder angle and shoulder injuries in a rural population cohort. The secondary aims were to assess clinical and radiological correlations between the critical shoulder angle and the symptomology of shoulder pain.Materials and methodsOur study analysis was a prospective design conducted at R L Jalappa Hospital & Research Centre, Karnataka, South India. After meeting the inclusion and exclusion criteria, 100 patients were recruited for the study. Forty-five patients had glenohumeral osteoarthritis and 55 patients had a diagnosis of rotator cuff tears. The majority of the patients were male (70%) in both the glenohumeral osteoarthritis and rotator cuff tear groups. The mean critical shoulder angles in the glenohumeral osteoarthritis and rotator cuff tear groups were 30.31 and 33.62, respectively.ConclusionsOur data aid in demonstrating that glenohumeral osteoarthritis is associated with a significantly narrower critical shoulder angle and wider critical shoulder angles in rotator cuff disease. Further studies, however, should determine whether this association has a cause-and-effect relationship.

FUNCTIONAL IMPLICATIONS OF A SINGULAR PENGUIN SCAPULA (AVES, SPHENISCIFORMES) FROM THE EOCENE OF ANTARCTICA

Penguins have peculiar modifications in their skeletal anatomy as a consequence of their extremely specialized diving habit. Morphological specialization is particularly evident in the forelimb. However, the kinematics of the pectoral girdle appears to be key to the locomotion of penguins. Penguin scapulae have an unusual morphology among birds. Modern penguins have a very large (especially broad) scapula, whereas this bone is long but narrower in basal fossil species. The recent finding of an incomplete scapula with a singular acromion in the Upper Eocene Submeseta Allomember of the La Meseta Formation in the Antarctic Peninsula reveals a scapula proportionally narrower than those of modern penguins but similar to that of Waimanu and possibly other Eocene species. Osteological comparisons and muscular dissections of modern penguins show that the most striking feature is the curvature of the acromion, and the consequent enlargement of the facies articularis clavicularis. The configuration of the acromion and the corpus scapula reflects a lack of functional optimization in terms of the resistance to forces transverse to the body axis. The scapula´s general morphology suggests it belonged to a medium to large-sized penguin species with no so specialized diving skills.

Extended Curettage and Fibular Grafting in Enchondroma of the Acromion

We report the case of a six-year-old male child with progressive pain and swelling of the right shoulder for six months. On examination, there was a 7x7 cm globular, tender swelling with firm consistency over the posterolateral corner of the right shoulder. Radiographs showed an expansile lytic lesion in the acromion process of the scapula. Biopsy showed lobules of hypocellular cartilage separated by fibroconnective stroma suggestive of an enchondroma. Extended curettage and fibular bone grafting of the lesion was done. At one-year follow-up, the patient was symptom-free and had full, painless shoulder range of motion. To the best of our knowledge, there is no published record of an enchondroma of the acromion.

The comparison of acromiohumeral distance and scapular dyskinesis prevalence in females with and without rounded shoulder posture.

Background: Altered scapular kinematics in individuals with rounded shoulder posture (RSP) may affect acromiohumeral distance (AHD). The purpose of this study was to compare AHD and scapular dyskinesis prevalence in individuals with and without RSP. Methods: A total of 44 women (RSP, n=21; control, n=23) participated in the study. RSP was assessed by measuring acromion to table distance (ATD) in supine position and forward shoulder angle (FSA) using a camera and the AutoCAD software from the lateral side. According to these measurements, ATD more than 2.6 cm and FSA equal or more than 52° were considered as RSP. AHD was measured via ultrasonography with the arm at rest and 90 º of active elevation in scapular plane (scaption). Also, scapular dyskinesis was assessed by Uhl yes/no rating system. Independent and paired t tests were used to compare AHD between and within groups’ comparisons, respectively. Chi-square test was used to compare the scapular dyskinesis prevalence in individuals with or without RSP. The data were analyzed using the SPSS statistical software version 17. Significance level was set at 0.05 Results: There were no statistically significant differences in participants’ AHD in rest position (dominant side, p=0.187, nondominant side, p=0.144) and 90° scaption (dominant side, p=0.144, nondominant side, p=0.182) in each side between the 2 groups. Also, the results of chi-square test showed that there were not any significant differences in the prevalence of scapular dyskinesis during shoulder flexion (dominant side, p=0.653, nondominant side, p=0.541) and shoulder abduction (dominant side, p=0.141, nondominant side, p=0.277) in individuals with and without rounded shoulder postures. Conclusion: According to our results, RSD cannot lead to reduced AHD and higher prevalence of scapular dyskinesis.

Sizing of ballistic arm protection for the VIRTUS body armour and load carriage system

IntroductionSevere haemorrhage from the arm that is unresponsive to direct pressure necessitates the application of a tourniquet. Detachable arm protection, referred to as brassards, are used by the UK Armed...

MORPHOLOGY AND MORPHOMETRY OF SCAPULAR ACROMION PROCESS SARASWATI MEDICAL COLLEGE, UNNAO

Introduction: The shoulder joint is the most important joint in human body and limitation of this joint movements affects the quality of life. The most common problem of joint replacements is the loosening of the shoulder joint. Rotator cuff muscles, static factors of the glenohumeral ligaments, the labrum and the joint capsule play a important role in stability of the glenohumeral joint. Morphometry of the acromion process is of significant importance and is commonly involved in impingement syndrome of the shoulder joint. As during surgery on shoulder joint the variations of the acromion process must be kept in mind and shape and various distances of the acromion process might benefit the orthopaedic operations. Material and Methods: A total of 100 unpaired dry scapula were isolated from the department of Anatomy. Two groups were made according to the side of the scapula and were equally divided into 50 right and 50 left scapula each. Bones were segregated and inspected individually. The shape of the acromion process of scapulae was recorded according to the Bigliani-Morrison-April classification. Dimensions were measured, using a vernier calipers including the size of the scapula and the acromion process.
 Results: Mean length of scapula on right side was 12.98±1.00 and of left side was 13.06± 1.20 cm. Mean Width of right scapulae was 9.56± 0.66 and of left was 9.78±0.59 cm. Mean length of acromion of right and left scapulae was observed as 4.01±0.52 and 4.21±0.67 cm respectively. Mean Acromiocoracoid distance on right was observed as 3.11±0.44 cm and on left side as 3.87±0.45 cm. 48 % of the acromion process of scapulae were quadrangular, 34 % were boot shaped 8% were leaf shaped and rest 10% were other various shapes. Type I scapulae were 33%, type II as 21% and 46% were type III.
 Conclusion: Features and dimensions of acromion process are associated with the pathology of the rotator cuff also role in it plays a significant role in stability of the shoulder joint. These measurements are useful for orthopedicians while performing procedures on shoulder joint.
 Keywords: Scapula, acromion process, shoulder joint, Morphometry

Definition and clinical progress of critical shoulder angle

Rotator cuff disease and degenerative osteoarthritis are caused by many factors. Several studies had shown that rotator cuff disease was related to lateral extension of the acromion and glenoid inclination. A new parameter, critical shoulder angle (CSA), which is defined as the angle between a line connecting the superior to the inferior margins of the glenoid and a line connecting the inferior margin of the glenoid to the inferolateral edge of the acromion measured on anteroposterior (AP) shoulder radiographs, is proposed to comprehensively reflect the relationship between abnormal anatomical structure and rotator cuff injury. There is a close relationship between CSA and the injury of rotator cuff and the osteoarthritis of glenohumeral joint: the injury of rotator cuff is often accompanied by a larger CSA (> 35 °), and a smaller CSA (< 30 °) is closely related to the occurrence of glenohumeral arthritis. Therefore, CSA is helpful for the diagnosis of rotator cuff injury and glenohumeral osteoarthritis. Correction of abnormal CSA by arthroscopic lateral acromial osteotomy also provides a new idea for the treatment of shoulder diseases. In this paper, we reviewed the research progress of the angle from five aspects: definition, measurement, biomechanical significance, treatment and ethnic differences.

Evaluation of the cross-sectional area of acromion process for shoulder impingement syndrome.

BackgroundAnatomic changes in the acromion have been considered a main cause of shoulder impingement syndrome (SIS). To evaluate the relationship between SIS and the acromion process, we devised a new morphological parameter called the acromion process cross-sectional area (APA). We hypothesized that the APA could be an important morphologic diagnostic parameter in SIS.MethodsWe collected APA data from 95 patients with SIS and 126 control subjects who underwent shoulder magnetic resonance imaging (MRI). Then we measured the maximal cross-sectional area of the bone margin of the acromion process on MRI scans.ResultsThe mean of APAs were 136.50 ± 21.75 mm2 in the male control group and 202.91 ± 31.78 mm2 in the male SIS group; SIS patients had significantly greater APAs (P < 0.001). The average of APAs were 105.38 ± 19.07 mm2 in the female control group and 147.62 ± 22.90 mm2 in the female SIS group, and the SIS patients had significantly greater APAs (P < 0.001). The optimal APA cut-off in the male group was 165.14 mm2 with 90.2% sensitivity, 91.4% specificity, and an area under the curve (AUC) of 0.968. In the female group, the optimal cut-off was 122.50 mm2 with 85.2% sensitivity, 84.9% specificity, and an AUC of 0.928.ConclusionsThe newly devised APA is a sensitive parameter for assessing SIS; greater APA is associated with a higher possibility of SIS. We think that this result will be helpful for the diagnosis of SIS.

Reconstruction of coracoclavicular ligament combined with hook plate technique for treatment of distal clavicle fractures involving avulsion of coracoclavicular ligament

Objective To explore the operative strategy of distal clavicle fracture involving coracoclavicular ligament. Methods Data of 17 cases of distal clavicle fracture involving coracoclavicular ligament in our hospital from January 2013 to December 2018 were analyzed retrospectively. According to whether the coracoclavicular ligament was reconstructed or not, the patients were divided into two groups: non reconstruction group (10 cases), male (7 cases), female (3 cases), 19-60 years old (37.9±11.9). In the reconstruction group, 7 cases were male 5, female 2, 25-62 years old (44.9±13.0). Three dimensional CT was used to judge the ligament injury and X-ray was used to evaluate the fracture reduction and healing after operation. The time of fracture healing was compared between the two groups. The function of shoulder joint was evaluated by visual analog scale (VAS) and Constant score of shoulder joint. Results The patients in both groups were followed up for (18.7±6.7) months (range, 9-27 months). At the latest follow-up, the time of fracture healing in the reconstruction group was 12.6±0.7 weeks (range, 12-14 weeks); VAS score was 3.0±1.3 and Constant-Murley score was 85±11. While those in the non reconstruction group were 23.7±7.9 (range, 16- 48 weeks), 3.1±1.8 and 77±10 respectively. The time of fracture healing was statistically significant (t=3.361, P=0.004). There was no significant difference in VAS score and Constant score (P> 0.05). In the non reconstruction group, there were 1 case of delayed union of fracture (healed 48 weeks after operation), 1 case of loosening of clavicular hook plate, 5 cases of acromioclavicular joint dislocation (Rockwood type II) after removal of internal fixation, and the overall complication rate was 70% (7/10). Reconstruction group: 1 case of acromial fracture, the overall complication rate was 14.3% (1/7). There was significant difference between the two groups (χ2=5.13, P=0.024). Conclusion Reconstruction of clavicular insertion of coracoclavicular ligament can effectively reduce the postoperative complications of distal clavicular fracture involving the coracoclavicular insertion. Attention should be paid to the repair and reconstruction of coracoclavicular ligament injury during fracture treatment. Key words: Clavicle; Fractures, bone; Ligaments

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty

Objective To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly. Methods Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed. There were 12 males and 31 females with an average age of 72 years (range, 66-78 years). All fractures were fresh and close which caused by trauma. The average time from injury to operation was 8.0 days (range, 6-11 days). According to Neer classification, 21 cases (48.8%, 21/43) were three-part fractures, 22 cases (51.2%, 22/43) four-part fractures. Visual analogue scale (VAS), Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results. Results All operations were successfully completed. The average operation time was 141.3 minutes (range, 120-170 minutes. The mean blood loss was 407 ml (range, 250-700 ml) and intraoperative blood transfusion was 446.5 ml (range, 400-800 ml). All patients were followed up for 10.9 months (range, 6 to 16 months). All patients were discharged within 7 days after operation, and no wounds related complications occurred. The bigger and lesser tuberosities of all patients healed completely within 8 weeks. At the latest follow-up, no loosening or dislocation of prosthesis occurred, and the forward elevation was 133.0° (range, 100°-165°); external rotation was 29.5° (range, 20°-35°); internal rotation was 46.7° (range, 30°-60°). VAS score was 0.8 (range, 0-3). The Neer score was 87 (range, 73-98), with 20 cases (46.5%, 20/43) excellent, 16 cases (37.2%, 16/43) good, and 7 cases (16.3%, 7/43) fair. Constant-Murley score was 88.7 (range, 70-98). A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation, which did not affect the functional rehabilitation exercise or the stability of the prosthesis. During the follow-up, no other complications such as infection, acromial stress fracture and scapular notching were found in all patients. Conclusion The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory. Key words: Aged; Humeral fractures; Arthroplasty, replacement

Morphometry of Acromion Process of Scapula with Respect to Gender

Background: Of the wide spectrum of musculoskeletal disorders affecting the shoulder, subacromial impingement syndrome is considered to be quite common. The main objective of the present study is to evaluate the morphometry of acromion and to measure other parameters like acromiocoracoid distance (ACD) and acromioglenoid distance (AGD). Materials And Method: Study was conducted on 100 male and 100 female adult scapulae. Length and breadth of the acromion, ACD, and AGD were measured using vernier callipers. Measured parameters were tabulated and analysed for statistical significance. Results: Acromial length, acromial breadth, ACD and AGD varied significantly with sex. Positive correlation was observed between above parameters in male scapulae, whereas positive correlation was seen only between ACD & AGD among female scapulae. Conclusion: The studied parameters could be help during diagnoses and treatment of shoulder pathologies. They can also be used for forensic and anthropological purposes for determining gender, ethnicity

Morphometric analysis of the acromion process of the scapula

Context: This study was done to analyze the morphometric parameters of the acromion process of human scapulae. The knowledge of morphometry of acromion process is vital for orthopedic surgeons while performing surgeries like acromioplasty for the treatment of subacromial impingement syndrome and repair of rotator cuff tears. Aims: The aim was to study the morphometry of the acromion process of the scapula. Settings and Design: The study was conducted on 105 adult dry human scapulae of unknown age and sex. All damaged human scapulae were excluded from the present study. Subjects and Methods: Length, breadth, thickness of acromion process, coraco-acromial distance, and acromioglenoid distance were measured in millimeter using digital Vernier caliper. Statistical Analysis Used: Data were tabulated. Mean and standard deviation for each parameter were calculated using SPSS version 16.0. Results: The mean acromial length was 41.65 ± 7.57 mm, acromial width was 24.50 ± 2.91 mm, acromial thickness was 7.62 ± 1.34 mm, coracoacromial distance was 33.35 ± 6.12 mm, and acromioglenoid distance was 29.41 ± 4.65 mm. Conclusions: The data obtained in the current study can add to the knowledge that can aid in surgical procedures around the shoulder joint.

04 Verification of Balance Function on Exercise using a New Wearable Device with Pneumatic Gel Muscles

Abstract Brief Introduction Decrease in the ability to control posture correlates with the risk of falls in the elderly. Exercises for reactive postural control and dynamic stability can improve postural control ability. However, balance exercises for reactive postural control are difficult because they require expensive therapeutic instruments or an expert skill level to generate the proper disturbance. The purpose of this study is to design a new wearable device using pneumatic artificial muscles for balance exercises. Furthermore, we investigated the effect of using this device on balance function. Methods Used We used a pneumatic gel muscle (PGM) for the wearable balance exercise device. The balance exercise device consists of two PGMs, a soft supporter, a small air tank, and a hand switch. The PGMs were attached to both sides of the acromion processes and pointed vertically down to the height of the iliac crest. Therefore, these PGMs generated a force in the direction of lateral trunk bending. Eight healthy adult males participated in this study. The participants received balance exercise using this device. We compared center of pressure (COP) data between the pre-test and post-test of exercise. Key Results Using this device, the rectangle area, boundary length, and medio-lateral length of COP significantly decreased in the post-test, compared to the pre-test (p = 0.031, p = 0.031, and p = 0.049, respectively). Brief Discussion and Conclusion The balance exercises with disturbances have the effect of improving balance function. This device was able to add unexpected medio-lateral disturbances during balance exercises. Therefore, participants were able to learn reactive postural control and stability more effectively. Our results suggest that this device could immediately improve postural control by creating small disturbances. Funding This research was based on results obtained from a project commissioned by the New Energy and Industrial Technology Development Organization (NEDO).

Scelidosaurus harrisonii from the Early Jurassic of Dorset, England: postcranial skeleton

PRISM FUND TRINITY COLLEGE CAMBRIDGE ST JOHN'S COLLEGE OXFORD SMITHSONIAN INSTITUTION (WASHINGTON DC)