Angle Of Scapula Research Articles

Repeatability of two methods for estimating scapular kinematics during dynamic functional tasks

Best practices for scapular motion tracking are still being determined. The repeatability of different scapular kinematic procedures needs to be evaluated. The purpose of this study was to assess the test-retest reliability of two scapular kinematic procedures: double calibration with AMC (D-AMC) and individualized linear modelling (LM). Ten healthy participants had their upper body movement tracked with optical motion capture in two identical sessions. Five scapular calibration poses were performed, and seven dynamic functional tasks were tested. Scapular angles were calculated from both procedures (D-AMC vs LM). The D-AMC approach uses two poses (neutral and maximum elevation) and tracks the scapula with a rigid cluster, while the LM approach predicts scapular positioning from humeral angles based on equations built from the calibration pose data. Angle waveforms and repeatability outcomes were compared. Internal and upward rotation angle waveforms were significantly different (p < 0.05) between kinematic procedures for some tasks, with maximum mean differences up to 17.3° and 23.2°, respectively. Overall, repeatability outcomes were similar between procedures, but the LM approach was slightly better for tilt and the D-AMC approach was notably improved for upward rotation in certain tasks. For example, minimal detectable changes during the Forward Transfer ranged from 6.9° to 11.9° for the D-AMC and 8.9° to 25.3° for the LM. Discrepancies between procedures may be a function of the calibration poses chosen. Additional calibration poses may improve the comparisons between procedures.

Comparing and characterizing scapular muscle activation ratios in males and females during execution of common functional movements.

The shoulder complex relies on scapular movement controlled by periscapular muscles for optimal arm function. However, minimal research has explored scapular muscle activation ratios during functional tasks, nor how they might be influenced by biological sex. This investigation aims to characterize how sex impacts scapular muscle activation ratios during functional tasks. Twenty participants (ten females, ten males) were assessed with surface electromyography (EMG) and motion tracking during seven functional tasks. Activation ratios were calculated from normalized EMG for the three trapezius muscles and serratus anterior. Scapular angles were calculated using a YXZ Euler sequence. Two-way mixed methods ANOVAs (p<.05) were used to assess the effects of sex and humeral elevation level on ratios and angles. Sex-based differences were present in the Tie Apron task, with males exhibiting higher upper trapezius/lower trapezius and upper trapezius/middle trapezius ratios than females. Males also demonstrated decreased internal rotation in this task. Other tasks showcased significant sex-based differences in scapular upward rotation but not in activation ratios. Humeral elevation generally demonstrated an inverse relationship with scapular muscle activation ratios. This study highlights sex-based differences in scapular muscle activation ratios during specific functional tasks, emphasizing the need to consider sex in analyses of shoulder movements. Normative activation ratios for functional tasks were provided, offering a foundation for future comparisons with non-normative groups. Further research is warranted to confirm and explore additional influencing factors, advancing our understanding of shoulder activation and movement in diverse populations.

Technical refinements of the scapular tip-free flap for mandibular reconstruction.

The use of scapular tip chimeric free flaps (STFFs) for reconstructing mandibular defects has recently become popular, but its utility relative to other bone-containing free flaps remains debatable. The aim of the report is to describe how technical modification of STFF impacted in its use for mandibular reconstruction also commenting results obtained in a unicentric series of patients. Patients undergoing mandibular reconstruction using an STFF from January 1, 2014 to June 1, 2022 were retrospectively enrolled in this report. We collected data on chimeric flap type, bone management, vascular pedicles, and the final outcomes. In total, 31 patients (13 men and 18 women) with a mean age of 68 years were enrolled. According to the classification system of Urken, 15 patients had body defects, while 7 had ramus defects, another 7 had symphysis defects, and 2 had both ramus and bodily defects. STFF was always harvested working in two equips simultaneously, in supine position. Dissection included preparation of chimeric components of the flap as latissimus dorsi, serratus and scapular tip. After pedicle dissection scapular bone was cut basing on reconstructive needing with a rectangular (stick) shape including the border of the scapula. In cases of longer bone harvesting, circumflex pedicle was also included to perfuse the upper portion of the scapular border. In five cases, the STFF was harvested with only the scapular angle component, and was thus a composite osteomuscular flap; for the remaining 26 cases, a chimeric STFF was used. Circumflex pedicle was included for eight patients. Six of the seven patients with symphyseal defects underwent a single osteotomy. The average length of the harvested was 69.92 mm (maximum length = 104 mm). The average height of transplanted bone was 26.78 mm (maximum height = 44.2 mm). Mouth-opening was normal in 25 patients, limited in 6 patients, and severely impaired in no patients. The cosmetic results were rated as excellent by 20 patients, good by 8 patients, and poor by 3 patients. The STFF is an excellent option for mandibular reconstruction when other flaps are not available and for patients in poor general condition. Technical innovations here presented made possible to harvest long bone segments with accurate shape thanks to osteotomies if needed and with adequate soft tissues components of the chimeric flap, ensuring satisfactory functional and cosmetic results.

Towards in-field assessment of humeral and scapular kinematics: a comparison between laboratory and field settings using inertial sensors.

Inertial measurement units allow for quantitative assessment of body motion in many environments. Determining the ability to measure upper limb motion with inertial measurement units, leveraging procedures traditionally used in the lab such as scapular calibration procedures and humeral axial rotation calculation, would expand the opportunities to assess upper limb function in externally valid environments. This study examined if humeral and scapular motion measured in different field settings is consistent with motion measured in a lab setting in similar tasks. Twenty-eight adults participated in the study (14 field setting, 14 lab setting). Three different types of field settings were included: home (n = 5), work (n = 4), and sports (n = 5). Field participants were matched to lab participants based on sex and body height. All participants were equipped with five inertial and magnetic measurement units (Xsens Awinda, Xsens Technlogies, NL, Fs = 100 Hz) on the torso, humeri, and scapulae. Humeral and scapular angles were measured during a functional task protocol consisting of seven tasks. Data from all three field settings were combined. Statistical parametric mapping (α = .05) was used to assess differences in waveforms between the lab and field data. Five out of seven tasks displayed no differences for humeral elevation and humeral axial rotation, while scapular upward rotation and tilt were not statistically different for any tasks. Scapular internal rotation variability was very high for the field setting, but not for the lab setting. Task-based differences in humeral elevation and humeral axial rotation may be related to equipment modifications for the field protocol and between subjects' variability in task performance. Data indicate that humeral elevation, humeral axial rotation, and scapular upward rotation can be measured in externally valid field settings, which is promising for the evaluation of upper limb movement in natural environments.

Investigating scapula positioning in individuals with non-specific lower back pain: A preliminary study

IntroductionLow back pain (LBP) is an economic and physically disabling burden on individuals and society. With 70% of cases classed as non-specific, there is a need for further research into the causes and consequences associated. The involvement of postural balance in musculoskeletal conditions is gaining increasing interest in research and health practice. However, there is a lack of literature surrounding LBP and posture in distal segments of the body. ObjectiveThe current study investigated scapula positioning in those with non-specific LBP. MethodsScapula angle of rotation, scapula protraction, and scapula elevation were assessed in nine participants with chronic non-specific LBP and compared with that of nine asymptomatic controls (aged 18–60 years). The degree of pelvic tilt was assessed across both groups as a secondary outcome measure. ResultsNo difference was identified between the two sample groups for scapula angle of rotation (p = 0.707), protraction (p = 0.755), or elevation (p = 0.691). Anterior pelvic tilt was greater in those with LBP (p = 0.046), supporting previous literature. ConclusionThe findings for the scapula position are novel, given that research in this field is limited. It is concluded that there is no change in scapula positioning in those with non-specific LBP, but there is an increased anterior pelvic tilt.

Does calibration pose improve scapular kinematic repeatability in functional tasks?

Tracking scapular motion can be challenging. More research is needed to determine the best practices for scapular measurement in multi-planar tasks. The purpose of this study was to compare the repeatability of scapular kinematics during a functional task protocol calculated from different calibration procedures. It was hypothesized that select poses would improve repeatability in specific tasks. The torso, humerus, and scapula were tracked with optical motion capture in two sessions for ten pain-free participants. Scapular calibrations were completed in five poses: neutral, maximum elevation, 90° abduction, hand to contralateral shoulder, and hand to back. Each participant completed eight functional tasks (Comb Hair, Wash Axilla, Tie Apron, Overhead Reach, Side Reach, Forward Transfer, Floor Lift, Overhead Lift). Scapular angles were calculated with five different calibration procedures and extracted at 30° increments of humeral elevation in each task. Mean difference, limits of agreement, intraclass correlations, and minimal detectable change (MDC) were calculated for each task and elevation level. The inclusion of different calibration poses did not markedly improve outcomes over the maximum elevation double calibration for most tasks. Using this calibration procedure, median MDCs were 10.0° for upward rotation, 13.7° for internal rotation, and 9.8° for tilt.

The V angle compliments radiographic assessment of acute acromioclavicular joint dislocations by differentiating between Rockwood types III versus V and by considering dynamic horizontal translation in coronal radiographs.

Acromioclavicular joint (ACJ) dislocations are usually graded radiographically according to Rockwood, but differentiation between Rockwood types III and V may be ambiguous. The potentially clinically relevant horizontal instability is barely addressed in coronal radiographs. It was hypothesized that a new radiologic parameter (V angle) would complement ACJ diagnostics on anteroposterior radiographs by differentiating between cases of Rockwood III and V while also considering the aspect of dynamic horizontal translation (DHT). Ninety-five patients with acute ACJ dislocations (Rockwood types III and V) were included retrospectively between 2017 and 2020. On anteroposterior views (weightbearing: n = 62, non-weight-bearing: n = 33), the coracoclavicular (CC) distance and the newly introduced V angle for assessing scapular orientation were measured bilaterally. This angle is referenced between the spinal column and a line crossing the superior scapular angle and the crossing point between the supraspinatus fossa and the medial base of the coracoid process, reported as the side-comparative difference (non-injured side *minus* injured side). DHT on Alexander views was divided into stable, partially unstable or completely unstable. The V angle on the injured side alone (mean 50.0°; 95% confidence interval (CI), 48.6°-51.3°) showed no correlation with the side-comparative CC distance [%] (r = - 0.040; n.s.). Thus, the V angle on the non-injured side was considered, displaying a normal distribution (n.s.) with a mean of 58.0° (95% CI, 56.6°-59.4°). The side-comparative V angle showed a correlation with the side-comparative CC distance (r = 0.83; p < 0.001) and was able to differentiate between Rockwood types III (4.7°; 95% CI, 3.9°-5.5°; n = 39) and V (10.3°; 95% CI, 9.7°-11.0°; n = 56) (p < 0.001). A cut-off value of 7° had a 94.6% sensitivity and an 82.1% specificity (area under curve, AUC: 0.954; 95% CI, 0.915-0.994). The side-comparative V angle was greater for cases with complete DHT (8.7°; 95% CI, 7.9°-9.5°; n = 78) than for cases with partial DHT (4.8°; 95% CI, 3.3°-6.3°; n = 16) (p < 0.001). A cut-off value of 5° showed a sensitivity of 84.6% and a specificity of 66.7% (AUC 0.824; 95% CI, 0.725-0.924). The scapular-based V angle on anteroposterior radiographs distinguishes between Rockwood types III and V as well as cases with partial or complete DHT. Diagnostic study. Level II.

Scapular kinematics and muscle activity during Yi Jin Bang exercises.

Introduction: Scapular dyskinesis is commonly associated with subacromial pain syndrome (SAPS). Addressing scapular dyskinesis is widely accepted as an important component of shoulder rehabilitation. Our previous randomized controlled trial showed that Yi Jin Bang (YJB) exercises could effectively manage SAPS, but scapular motions and muscle activity during YJB exercises remain unknown. This study examined scapular kinematics synchronously with scapular muscle activation during YJB exercises. Methods: Thirty healthy participants with no shoulder complaints were enrolled in this study. Three-dimensional (3D) scapular kinematics and electromyography (EMG) activation of the upper trapezius, middle trapezius, lower trapezius, serratus anterior, anterior deltoid, middle deltoid, and posterior deltoid were synchronously measured during nine YJB movements. Results: During all YJB movements, the scapula was upwardly rotated and anteriorly tilted, with more upward rotation and a similar or less anterior tilt than the mean resting scapular angle. Column rotation, arm crossover, shoulder support circle, and armpit support high lift generated more internal rotation than the mean resting scapular angle, with the angles of internal rotation significantly greater than the other five movements (p < 0.001). Regarding EMG activity, all YJB movements elicited low activity (1.42%-19.19% maximal voluntary isometric contraction [MVIC]) from the upper trapezius and posterior deltoid and low to moderate activity (0.52%-29.50% MVIC) from the middle trapezius, lower trapezius, serratus anterior, anterior deltoid, and middle deltoid. Conclusion: YJB exercises could be useful in the middle to later phases of shoulder rehabilitation. For patients with insufficient external rotation, some YJB movements should be prescribed with caution.

Plate fixation using parallelogram prism iliac bone grafts for clavicle oblique nonunion with shortening deformity: a case report

BackgroundPlate fixation using a tricortical iliac bone graft can provide a high ratio of bone union and restore clavicle length in cases of atrophic nonunion. However, the surgical treatment of clavicle oblique nonunions with marked shortening deformity remains challenging and unresolved. Here, we describe a case of clavicle oblique nonunion with shortening that was treated using plate fixation with parallelogram prism iliac bone grafts.Case presentationA 46-year-old man presented to our hospital with severe medial scapular pain. He had been diagnosed with a right clavicle mid-shaft fracture in a motorcycle accident 9 months earlier. He underwent conservative treatment, but radiographs and computed tomography showed clavicle oblique nonunion with marked shortening. Physical examination revealed no pain at the nonunion site; however, tenderness was noted on the medial side of the right scapula and protrusion of the inferior scapular angle was prominent. His symptoms interfered with daily life and required surgery. After release of the nonunion, we harvested the parallelogram prism bone grafts from the iliac crest. We inserted these bone grafts into the fracture ends and fixed them with lag screws, after which we performed plate fixation. Immediately after surgery, right medial scapular pain and scapula winging subsided. Bone union was achieved, and the length of the clavicle was restored at 9 months postoperatively.ConclusionsThis case report provides new information on the surgical treatment of clavicle oblique nonunion with shortening deformity. The presence of medial scapular pain and winging scapula can be clinically problematic in cases of clavicle nonunion with marked shortening. Our case revealed that reliable bone union and clavicle length recovery can be achieved with plate fixation and iliac bone grafts.

Upper body posture in Latin American dancers: a quantitative cross-sectional study comparing different postures

BackgroundIn Latin American dance sport (LD), the shoulder girdle and the torso area are particularly stressed due to the dance style specific requirements. The aim of the study was to define differences in various dance specific upper body postures in Latin American dancers and to show gender-specific differences.MethodsThree dimensional back scans were performed in n = 49 dancers (28 f/21 m). Five typical trunk positions in Latin American dance (habitual standing and 4 dance specific positions, P1–P5) were compared with each other. Statistical differences were calculated using the Man-Whitney U test, Friedmann test, Conover-Iman test and a Bonferroni-Holm correction.ResultsSignificant gender differences were found in P2, P3 and P4 (p ≤ 0.01–0.001). In P5, the frontal trunk decline, the axis deviation, the standard deviation of the rotation, the kyphosis angle and the shoulder as well as the pelvic rotation were also significantly different. The comparison of the postures showed significant differences between postures 1–5 (p ≤ 0.01–0.001) in the males, (scapular height, right and left scapular angles and pelvic torsion). Similar results were observed for the female dancers, with only the parameters of frontal trunk decline with the lordosis angle as well as the right and left scapular angles being non-significant.ConclusionsThis study is an approach to better understand the involved muscular structures in LD. Performing LD changes the static parameters of the upper body statics. Further projects are needed to analyse the field of dance even more thoroughly.

Defining repeatability for scapulothoracic and thoracohumeral motion during the novel work-related activities and functional task (WRAFT) protocol

Upper limb motion can be challenging to measure and analyze during work or daily life tasks. Further, humeral angle calculation method substantially influences angle outcomes. Therefore, the purpose of this study was to assess the repeatability of scapular and humeral kinematics and compare thoracohumeral angle calculation during a work-related and functional task (WRAFT) protocol. Thirty healthy young adults completed the WRAFT protocol (Comb Hair, Wash Axilla, Tie Apron, Overhead Reach, Side Reach, Forward Transfer, Floor Lift, and Overhead Lift) on two separate occasions. Peak humeral angles and select scapular angles were extracted for each task. Intra-class correlation coefficients (ICCs), standard error of measurement, and minimal detectable change (MDC) were examined. Humeral angles were compared using the XZY and ZXY rotation sequences and “true” axial rotation for incidence of gimbal lock and amplitude coherence. Results showed that for scapular kinematics, elevation-based WRAFTs produced overall better ICC scores (0.23–0.90) compared to those tasks primarily driven by lateral humeral motion (0.02–0.84). MDCs ranged from 7°–78°, suggesting some tasks demonstrated good repeatability (Comb Hair, Overhead Reach, Floor Lift), while others had very high variability (Side Reach, Tie Apron). Amplitude coherence for thoracohumeral angles was best for ZXY for all tasks except the Comb Hair and Tie Apron, for which XZY is recommended. “True” axial rotation demonstrated good coherence for all but Tie Apron. The WRAFT protocol may be used for functionally relevant scapular and humeral kinematic assessment for select task and posture combinations.

Comparison of scapular kinematics from optical motion capture and inertial measurement units during a work-related and functional task protocol.

Understanding scapular motion during everyday tasks is essential for adequate return-to-work and intervention programming, yet most scapular assessments involve restricted motion analysis within a laboratory setting. Inertial measurement units (IMUs) have been used to track scapular motion, but their validity compared to "gold standard" optical motion capture is not well defined. Further, it is unclear how different IMU sensor placements could affect scapular kinematic outcomes during a functional task protocol. To assess the reliability of scapular motion measurements with the use of the "gold standard" optical motion capture and IMUs, and to compare scapular IMU placement to assess which location (acromion or spine) was best for reliability of scapular motion, participants completed two testing sessions. During each lab visit, participant torso, humeri, and scapulae motion was tracked during 3 trials of 8 dynamic tasks and two elevation movements. Scapular angles were extracted during each task. To assess intra-session reliability, intra-class correlation coefficients (ICCs), and root mean square errors (RMSEs) were calculated. Results showed ICCs and RMSEs were acceptable. Although there appeared offsets between the two motion capture system scapular kinematics outcomes based on the plotted waveforms, the movement patterns appeared consistent between both motion capture methods. Data also showed that acromion IMU placement produced slightly more reliable outcomes than placement on the spine. Two placements of scapular tracking IMUs were tested with identical procedures.

Maxillomandibular Reconstruction Using Insourced Virtual Surgical Planning and Homemade CAD/CAM: A Single-Center Evolution in 75 Patients.

Virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) of surgical guides and jigs have dramatically changed the predictability of bony reconstruction of the jaw. VSP craftsmanship can lead to precision and enables the surgeon to complement the donor bone osteotomies with bony resection of the jaw. In recent years, immediate dental rehabilitation has become an integral part of VSP. However, outsourced CAD/CAM technology is expensive and may not be an option for many institutions worldwide. The authors present here a consecutive series of 75 maxillofacial reconstructions from 2015 to 2020. We established an insourced "in-house" protocol for VSP and "home-made" CAD/CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest, and scapular angle flaps. All patient files were analyzed retrospectively, and relevant parameters influencing the reconstructive outcome were determined. The authors went from a fibula-based protocol toward the selection of optimal vascularized bone for immediate placement of osteointegrated implants. Bone flap survival was 94.7% after 4 months. The 3-year patient survival is 77.6%. The authors show the multiple steps required for the routine use of in-house CAD/CAM and report the related financial balance. Insourced VSP and CAD/CAM has evolved into a valuable strategy in maxillomandibular reconstruction that promotes accuracy and precision and allows for occlusion-based planning with quality-of-life and aesthetic outcomes as essential parts of the reconstruction even in high-level oral cancers. Further reductions in the hardware and software acquisition costs may lead to widespread implementation of this innovative technology. Therapeutic, IV.

Validating scapular motion measurements using an optical motion analyzer and gravity magnetic resonance imaging.

[Purpose] This study aimed to validate whether scapular motion measured using a pad with retroreflective markers and optical motion analyzer (VICON MX) can reflect the motion calculated by images using multi-posture (gravity) magnetic resonance imaging. [Participants and Methods] The participants were 12 healthy males (12 dominant-side shoulders). The measurement items were the scapular angle at shoulder flexion 140° and 160° and abduction 100°, 120°, 140°, and 160°. The scapular angle changes were extracted from the upward/downward and internal/external rotations. Angular changes were calculated by subtracting the scapular angle in static position (drooped upper limb and external shoulder rotation) during resting chair sitting from the scapular angle in each of the six limb positions and subtracting it at shoulder abduction 100° from the scapular angle at shoulder abduction 120°, 140°, and 160°. [Results] The results showed no agreement in most cases and no consistent bias. [Conclusion] The result questions the validity of scapular motion analysis using pads with optical markers. However, the facility environment imposes many study limitations, and this method requires further validation eventually.

Effect of forearm positions on scapular movements and trunk rotation angles.

[Purpose] The study investigated the impact of distinct forearm positions on scapular movement and trunk rotation angles. [Participants and Methods] We enrolled 23 healthy young males. Measurements of trunk rotation and relative scapular segment angles were acquired under three conditions employing three-dimensional motion analysis, each executed in a seated posture: (1) both forearms in a neutral position, (2) the forearm on the rotational side adopted supination while the opposite forearm utilized pronation, and (3) the forearm on the rotational side employed pronation while the opposite forearm assumed supination. [Results] The scapular angles in all three scenarios reflected downward rotation, posterior tilt, and external rotation of the rotational-side scapula. Conversely, the contralateral scapula exhibited upward rotation, anterior tilt, and internal rotation. Although the scapular and trunk rotation angles corresponded with the three forearm positions, all three were significantly different and were significantly increased when the rotational-side forearm was in supination (opposite side pronation) and decreased when the rotational-side forearm was in pronation (opposite side supination). [Conclusion] During trunk rotation, regular scapular movements were observed, which varied depending on forearm position and influenced the range of trunk rotation.

Pectoralis Major Transfer for Medial Scapular Winging

Background: Scapular winging is a rare and often misdiagnosed disorder, which can be painful and functionally limited. Medial scapular winging is often due to serratus anterior dysfunction in the setting of a long thoracic nerve palsy. While nonoperative management can be successful, transfer of the pectoralis major with autograft hamstring augmentation to the inferior scapula is an effective operative means of relieving pain and restoring shoulder function in those who fail conservative management. Indications: The patient is a 16-year-old woman with symptomatic medial scapular winging who had a complete workup and 6-month course of conservative treatment, including physical therapy. Thus, we elected to proceed with a 2-incision transfer of the sternal head of pectoralis major transfer with autograft hamstring augmentation to the inferior scapular angle. Technique Description: A 2-incision transfer of the sternal head of pectoralis major with autograft hamstring to the inferior scapular angle is a strong and reliable method of operatively treating medial scapular winging. In addition, performing this operation in the lateral position allows for ease of access to both the anterior and posterior incisions. Results: At 1-year follow-up, the patient had full, painless range of motion of the shoulder with 5/5 strength in all tested planes. She also had returned to all activities, including softball, without restrictions. Discussion/Conclusions: A 2-incision transfer of the sternal head of the pectoralis major with autograft hamstring augmentation to the inferior scapular angle is an effective means of operatively treating medial scapular winging. Multiple studies have shown that this operation improves motion, pain, and function for those who have failed an appropriate course of conservative treatment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Quantitative anatomy of the growing supraspinatus muscle in the human fetus.

The supraspinatus muscle, one of the four rotator cuff muscles, initiates abduction of the arm, simultaneously stretching the articular capsule at the glenohumeral joint, and also contributes to exorotation of the arm. In the present study we aimed to evaluate the age-specific normative values for morphometric parameters of the supraspinatus muscle in human fetuses at varying ages and to elaborate their growth models. Using anatomical dissection, digital image analysis (NIS Elements AR 3.0) and statistics (Student's t-test, regression analysis), the length, width, circumference and projection surface area of the supraspinatus muscle were measured in 34 human fetuses of both sexes (16 males, 18 females) aged 18-30 weeks of gestation. Neither sex nor laterality differences were found in numerical data of the supraspinatus muscle. In the supraspinatus muscle its length and projection surface area increased logarithmically, while its width and circumference grew proportionately to gestational age. The following growth models of the supraspinatus muscle were established: y = -71.382 + 30.972 × ln(Age) ± 0.565 for length, y = -2.988 + 0.386 × Age ± 0.168 for greatest width (perpendicular to superior angle of scapula), y = -1.899 + 0.240 × Age ± 0.078 for width perpendicular to the scapular notch, y = -19.7016 + 3.381 × Age ± 2.036 for circumference, and y = -721.769 + 266.141 × ln(Age) ± 6.170 for projection surface area. The supraspinatus muscle reveals neither sex nor laterality differences in its size. The supraspinatus muscle grows logarithmically with reference to its length and projection surface area, and proportionately with respect to its width and circumference.

Effect of Interferential Therapy and Elastic Band Exercises on Subjects with Round Shoulder and Forward Head Posture: A Randomized Trial

Objective: To investigate the effect of the Interferential therapy (IFT) with elastic band exercises to improve round shoulder posture (RSP) and forward head posture (FHP) in university female students.Methods: A randomized trial was conducted at a state university in Haryana, India from July-October 2021. Females having FHP and RSP were included in the study. Subjects were divided into two groups. Group A performed elastic band exercises for 10 repetitions each twice weekly for four weeks along with IFT application for 10 minutes. While group B performed only elastic band exercises. Various Round Shoulder measurements, Craniovertebral angle (CVA) and Neck Disability Index (NDI) were assessed. Results: Of 30 females, the mean age, weight, and BMI was 19.56±3.14 years, 50.83±9.13 Kg and 19.6±3.23 Kg/m2 respectively. The distance between 3rd thoracic vertebra (T3) and acromion was significantly improved in group A as compared to group B, i.e., 2.80 ±0.86 vs. -1.47 ±1.98 (p-value 0.020), respectively. However, an insignificant association of group A and B was found with distance from couch to acromion (p-value 0.590), distance from thoracic 3rd level to inferior angle of scapula (p-value 0.630), CVA (p-value 0.130), and NDI (p-value 0.550).Conclusion: Four weeks of intervention have significantly improved the distance between the T3 and the acromion process parameters for both round shoulder and FHP in both groups. However, other parameters were not statistically improved but clinical improved in patients who received elastic band exercises combined with IFT.

Characteristics, Management, and Outcomes of Inferior Scapula Angle Fractures: A Systematic Review of the Literature.

Fractures of the inferior angle of the scapula represent a rare entity, with few cases published in the literature to date. Their optimal management is still unclear. A systematic literature search was conducted in PubMed and Google Scholar of reports published between 1977 and 2022. Inclusion criteria were cases presenting inferior scapula angle fractures (ISAF) and reporting management and outcomes. Extracted data included patient demographics (age, sex), mechanism of injury, associated injuries, management, procedures performed, and outcomes. Seventeen studies (22 cases; 19 males and three females) were included. The mean age was 33 years (15 adult and seven pediatric cases). High energy injuries were the most common mechanism of injury (77%). Displacement of the fragment was reported in 64%. The most common initial treatment was conservative (77%); of these cases, more than half failed initial treatment (53%). Of the displaced ISAF cases, 89% failed conservative treatment, contrary to 83% of the nondisplaced cases that were successfully treated conservatively. Surgery yielded 100% success both as initial treatment and after failed conservative management. Displaced fractures should be approached surgically, while conservative management should be reserved for nondisplaced fractures.

Anatomical Study of Variations in the Branching Patterns of Neurovascular Pedicle of Latissimus Dorsi

Introduction Variations in the branching and position of the dominant pedicle of the Latissimus Dorsi (LD) muscle has been noted during dissection of the posterior aspect of the cadaver. Knowledge about the point of branching of the pedicle is highly valuable for the surgeon while performing various reconstructive surgeries. Aims and Objectives To analyze and study the insertion and branching of the dominant neurovascular pedicle of LD. Material and Methods A total 40 LD muscles were excised from the point of origin and retracted superior-laterally towards its insertion. The pedicle was then cleared of any unwanted fascia by strip dissection and the point of branching was identified with respect to the level of the inferior scapular angle (ISA). Results An anatomical variation was observed in the study of the branching of the neurovascular pedicle. Upon consideration via statistical calculations, the following levels of branching locations were noted. ~12.5% - 2.0-inch superior to level of ISA ~37.5% - 1.0-inch superior to level of ISA ~25.0% - 1.5-inch superior to level of ISA ~25.0% - 0.4-inch inferior to level of ISA The first three types were considered as early branching whereas the last type was considered as late branching of LD. Conclusion This study shows the variations in the branching in the pedicle of the LD at various points that were considered. This is hence of surgical importance that must be noted to prevent surgical vascular damage that may occur during procedures and increase the methodology of pre-operative planning