Angle Of Scapula Research Articles

Relationship between scapular control during isometric shoulder flexion and scapular motion during baseball pitching: a cross-sectional study

BackgroundA baseball pitcher with decreased scapular control may not be able to achieve suitable scapular motion at maximum shoulder external rotation (MER) of baseball pitching during the pitching action. It is common clinically to compare scapular control of the throwing and non-throwing arms to detect side-to-side differences. However, it remains unclear whether scapular control is different between the throwing and non-throwing arms. Moreover, no data exist on the relationship between scapular control and scapular motion at MER of pitching. Primarily, this study aimed to compare scapular control during isometric shoulder flexion between the throwing and non-throwing arms. Secondly, this study aimed to investigate the relationship between scapular control during isometric shoulder flexion and scapular motion at MER of pitching.MethodsFifteen healthy collegiate baseball pitchers (age, 20.2 ± 1.9 years; height, 1.76 ± 0.05 m; body mass, 73.3 ± 6.7 kg) were recruited. An optical motion tracking system was used to assess scapular motion. Scapular control was defined as the amount of change in the scapular internal rotation angle, downward rotation angle, and anterior tilt angle during isometric shoulder flexion. We assessed scapular position at MER of pitching.ResultsNo significant differences were detected for any of the scapular angles during isometric shoulder flexion between the throwing and non-throwing arms. The amount of change in the scapular internal rotation angle, scapular downward rotation angle, and scapular anterior tilt angle during isometric shoulder flexion had a significant relationship with the scapular downward rotation angle at MER.ConclusionsNo side-to-side difference was noted in scapular control during isometric shoulder flexion in healthy collegiate baseball pitchers at the group level. Further studies are required to understand the side-to-side differences at the individual level. Additionally, there was a relationship between scapular control during isometric shoulder flexion and scapular position at MER. These findings suggest that clinicians may consider using isometric shoulder flexion to assess scapular control in baseball pitchers.

Shoulder Kinesio Taping Does Not Change Biomechanical Deficits Associated With Scapular Dyskinesis.

Observable scapular dyskinesis is associated with biomechanical deficits. Preventative interventions aimed at correcting these deficits may aid in preventing the development and resolution of shoulder pain. Our purpose was to investigate the effects of kinesio taping (KT) on common biomechanical deficits associated with scapular dyskinesis and shoulder pain. Participants (n = 51) with observable scapular dyskinesis, and without shoulder pain were randomized to KT, KT-placebo, or a no-treatment control group. Measurements taken before, immediately after taping, and 3days later included pectoralis minor muscle length, lower trapezius muscle strength, scapular upward rotation angle at 0° to 120° in scapular plane humeral elevation and acromiohumeral distance. There were no changes in scapular upward rotation, lower trapezius strength, and acromiohumeral distance immediately after taping or 3days later compared to baseline (P > .05). The pectoralis minor increased in length in the KT group on day 3 compared to directly after taping (P = .03), but no difference between groups or interaction between time and group were determined (P > .05). Scapular dyskinesis prevalence did not change over time in any group (P > .05). In people with scapular dyskinesis free from shoulder pain, KT applied to the shoulder cannot be recommended to ameliorate the biomechanical deficits associated with shoulder pain.

P115. MAXILLO-MANDIBULAR RECONSTRUCTION WITH VASCULARIZED BONE FLAPS USING INSOURCED VIRTUAL SURGICAL PLANNING AND HOME-MADE CAD-CAM: A 5-YEAR SINGLE-CENTER EVOLUTION IN 75 PATIENTS

PURPOSE:Virtual surgical planning (VSP) and computer aided design (CAD) and manufacturing (CAM) of surgical guides and jigs turned craftmanship into precision and enables the surgeon to complement the donor bone osteotomies with the bony resection of the jaw. In recent years, immediate dental rehabilitation became an integral part of VSP. However, outsourced CAD-CAM is expensive and may be no option to many institutions worldwide. We developed an insourced facility for ‘in-house’ VSP and ‘home-made’ 3D printing. METHODS: We present a consecutive series of 150 cases (2010-2020). In 75 cases (2015 -2020) we used insourced VSP and CAD-CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest and scapular angle flaps. Relevant parameters influencing the reconstructive outcome were determined. We compared data with 75 previous reconstructions of the jaw without CAD-CAM (2010-2015). Mann-Whitney U tests and Fisher’s exact tests were used to compare continuous and binary variables between both groups. RESULTS: We went from a fibula-based protocol, towards the selection of optimal vascularized bone for immediate placement of Osseo integrated implants. Bone flap survival was 94,7 % after 4 months. The three-year patient survival is 77,6 %. There were no significant prognostic factors for bone flap failure (such as smoking, radiotherapy or previous interventions). CONCLUSION: In-house VSP and CAD-CAM have evolved into a valuable strategies in maxillo-mandibular reconstruction that promote precision and allow for occlusion-based planning with quality of life, aesthetic outcome and minimizing donorsite morbidity as essential parts of the reconstruction even in high level oral cancers.

Levator scapulae and rhomboid minor are united

Pain over the superior angle of the scapula is a common musculoskeletal symptom. It is often accompanied by radiating pain to the neck, head, and shoulder. The aetiologies can be varied but may also be idiopathic in nature. To explore the fascial connections of this region, we studied 26 unembalmed, -two Thiel and one alcohol body-donors of science, by dissection, histological probes, and plastinations. When removing the descending and transverse fibres of the trapezius, a large prominent triangular area of white connectives is revealed, varying in mass. A subdivision of these connectives can be further dissected to prove that the rhomboid minor and levator scapulae muscles are interconnected and enclosed by connectives. Between these two muscles a bridge of connective tissue, containing fat, is observed. These connectives end cranially at the surface of the splenius capitis, and at the midline, containing vessels and nerves, as supported by histology and plastinations. This unification is separate from the rhomboid major muscle but overlaps with the latter dorsally. It connects to the superior angle of scapula and its upper medial borders, respectively, and cranially to the root of the spine of the scapula. Beneath the united levator scapulae and rhomboid minor, described here, the serratus posterior superior and possibly serratus anterior form a hypomochlion or fulcrum at the superior angle of the scapula. Any tension on this unified entity can unbalance this fulcrum. Investigating the connections between these two unified muscles may help explain the often idiopathic nature of superior scapular pain, and the success or failure of surgery, and other treatments.

Assessment of the head, cervical spine, thoracic spine and shoulder girdle postures in people with and without chronic headache

Background/Aims Cervical dysfunction is one of the common symptoms of chronic headaches. This study was conducted to assess the posture of the head, cervical and thoracic spine and the shoulder girdle in people with and without cervicogenic and migraine headaches. Methods The postural angles of the head, cervical and thoracic spine and the shoulder girdle in frontal and sagittal planes, as well as thoracic spine curvature, were measured on 90 people who were split into three groups: 20 people with cervicogenic headache, 20 people with migraine and 50 people as the control group. Results There were significant differences among the three groups in the craniovertebral angle, coronal head tilt angle and scapular upward rotation angle (P<0.05). There was no relationship between postural angles. Conclusions The results of this study revealed that forward head posture was evident in people with cervicogenic and migraine headache. Decreased scapular upward rotation seen in the migraine headache group highlights the importance of shoulder girdle-related dysfunctions in people with chronic headaches.

Characteristics of the scapula movement during shoulder elevation depend on posture.

[Purpose] This study aimed to clarify the differences in scapular movement during flexion and abduction of the shoulder joint with different postures. [Participants and Methods] This study included 15 male participants. Their shoulder flexion and abduction and angles of the scapular upward rotation, scapular anterior tilt, scapular external rotation, and thoracic spine flexion were measured. Measurements were taken in three positions: the control, thoracic spine flexion, and thoracic spine extension positions using a three-dimensional motion capture system. [Results] In the shoulder flexion, the amount of change in the scapular external rotation was significantly greater in the thoracic flexion than in the thoracic extension. In shoulder abduction, the amount of change in the scapular anterior tilt and external rotation was significantly greater in the thoracic flexion than in the thoracic extension. A comparison of the scapular angles in shoulder flexion and abduction showed that the upward rotation, posterior tilt, and external rotation were significantly greater in abduction than flexion. [Conclusion] To avoid posture-induced incoordination of the scapula and thorax movement during shoulder elevation, postural adjustment of the thoracic spine based on the movements is necessary for the shoulder joint exercises.

The use of a “chimeric” autotissue complex from the subscapularis vascular basin for maxillary reconstruction after malignant tumors resection

The objective of this work – to evaluate the results of reconstructive interventions using free revascularized tissue complexes of the scapular region in patients after maxillary resection for malignant tumors. Materials and methods. Between 2014–2020 the post-resection maxillary defects were replaced with free blood-sup plied flaps of the scapular region in 19 patients. In Group 1 (n = 10), the defect was eliminated after total maxillectomy with preservation of the eyeball using a “chimeric” tissue complex, parts of which were positioned in several planes. In Group 2 (n = 9), total and subtotal defects of the hard palate and alveolar process were replaced using a free flap with the inclusion of the scapula angle, which was placed horizontally. The functional and aesthetic results of the reconstructions, the degree of morphological correspondence of the reconstructed structures, as well as the incidence of postoperative complications were assessed. Results. In Group 1 total necrosis of the flap was noted in 2 cases (20 %), in 1 (10 %) case – necrosis of the skin fragment). In Group 2 graft necrosis was observed in 1 (11 %) patient. Satisfactory and excellent aesthetic and functional results were achieved in 6 (60 %) patients in Group 1 and 8 (89 %) patients in Group 2. Conclusion. The scapular flap has a number of advantages for microsurgical reconstruction, including the presence of a long vascular pedicle with large vessels, inclusion of different tissues, possibility of harvesting a “chimeric” version (with significant mobility of parts), low rate of vascular lesions in the area, and most importantly, morphologically close location of bone tissue of the scapula to the maxilla, which ensures successful application of this flap for maxillary repair in patients with advanced cancer of the upper jaw.

Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression.

To investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre- and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors. Thirty-five patients (mean age, 62.5 ± 8.4years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre-existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < - 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups. Twenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037). The prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing. IV.

The longitudinal relationship between shoulder pain and altered wheelchair propulsion biomechanics of manual wheelchair users

The purpose of this study was to investigate the longitudinal association between within-subject changes in shoulder pain and alterations in wheelchair propulsion biomechanics in manual wheelchair users. Eighteen (age 33 ± 11 years) manual wheelchair users propelled their own daily living wheelchair at 1.11 m.s−1 for three minutes on a dual-roller ergometer during two laboratory visits (T1 and T2) between 4 and 6 months apart. Shoulder pain was assessed using the Performance Corrected Wheelchair User’s Shoulder Pain Index (PC-WUSPI). Between visits mean PC-WUSPI scores increased by 5.4 points and varied from − 13.5 to + 20.9 points. Of the eighteen participants, nine (50%) experienced increased shoulder pain, seven (39%) no change in pain, and two (11%) decreased pain. Increasing shoulder pain severity correlated with increased contact angle (r = 0.59, P = 0.010), thorax range of motion (r = 0.60, P = 0.009) and kinetic and kinematic variability. Additionally, increasing shoulder pain was associated with reductions in peak torque (r = -0.56, P = 0.016), peak glenohumeral abduction (r = -0.69, P = 0.002), peak scapular downward rotation (r = -0.68, P = 0.002), and range of motion in glenohumeral flexion/extension and scapular angles. Group comparisons revealed that these biomechanical alterations were exhibited by individuals who experienced increased shoulder pain, whereas, propulsion biomechanics of those with no change/decreased pain remained unaltered. These findings indicate that wheelchair users exhibit a protective short-term wheelchair propulsion biomechanical response to increases in shoulder pain which may temporarily help maintain functional independence.

The effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity

BackgroundPost-stroke scapular dyskinesia is a predisposing factor for the affection of motor and somatosensory functions of the hemiparetic upper extremity.ObjectiveThe purpose of the study was to investigate the effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity.Subjects and methodsSixty patients with spasticity post-stroke participated in this study. The patients were assigned to one of the two groups as determined by the lateral scapular slide test (LSST) using the palpation meter (PALM); group A with scapular dyskinesia and group B stroke patients without scapular dyskinesia. The scapular position was determined by a measurement of scapular balance angle (SBA), and the upper extremity sensorimotor function was evaluated using Fugl-Meyer Assessment upper extremity (FMAUE) scale. The scapular balance angle and Fugl-Meyer upper extremity scores were compared between groups.ResultsThere was a significant increase in the scapular balance angle of group A compared with that of group B (p < 0.001). Also, there was a significant decrease in sensory and motor functions of group A as measured by Fugl-Meyer upper extremity compared with that of group B (p < 0.001).ConclusionScapular dyskinesia had a significant effect on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity. Management of scapular dyskinesia should be emphasized in the rehabilitation program for stroke patients with spasticity.

An Unusual Case Of Shoulder Pain In A High School Football Player

HISTORY: A 15 year-old right hand dominant male presented to sports medicine clinic due to left shoulder pain. The mechanism of injury was while playing football the day prior where he jumped to catch a pass, and landed directly on grass onto his left shoulder with arm by his side. Heard a “pop” when he landed, and was experiencing intermittent, generalized shoulder pain since the event. Denied prior injury of affected extremity as well as denied numbness or tingling. There was no swelling, discoloration, or bruising per the patient or the mother of the patient. There was no obvious reported deformity of the shoulder as well. The patient denied any neck or elbow pain. Symptoms were improved at rest and with arm at his side. PHYSICAL EXAM: Left Shoulder: Pain with passive abduction, flexion on range of motion (ROM) testing. Active ROM is full in all directions. Tender to palpation (TTP) at the AC joint and scapular angle; no TTP at scapular body. Strength: 2/5 supraspinatus, 3/5 external rotation, 4/5 internal rotation, abduction, and biceps. Positive empty can and drop arm. No erythema, normal sensation throughout left upper extremity, and radial and ulnar pulses 2+ and regular. DIFFERENTIAL DIAGNOSIS: 1. Acromioclavicular sprain 2. Rotator Cuff injury 3. Glenoid labrum injury 4. Distal clavicle contusion 5. Glenohumeral dislocation TEST AND RESULTS: 1. XR Left Shoulder: no acute fracture, dislocation, or soft tissue abnormality2. XR Left Scapula: No acute displaced fracture. 3. MRI (no IV contrast) Left Shoulder: Feathery edema in the rotator cuff musculature centered about the scapula. Low grade muscular strain vs underlying non-displaced scapular body fracture. 4. CT Shoulder Trauma w/ Joint (no IV contrast): Non-displaced hairline fracture in the mid scapular body perpendicular to the long axis. AC and GH joints are intact. FINAL WORKING DIAGNOSIS: Non-displaced extra-articular fracture in the mid scapular body TREATMENT AND OUTCOMES: 1. Immobilization with sling for initial 4 weeks with pendulum swings twice daily 2. At week 4, no pain at rest with asymptomatic full strength. Physical Therapy initiated. 3. Cleared for non-contact and non-collision activities at week 8. 4. Returned to all activities without restriction at week 12.

Stretching Training Can Change Shoulder And Neck Function In Middle-aged Women With Upper Crossed Syndrome

PURPOSE: Upper Crossed Syndrome (UCS) is a syndrome of abnormal movement patterns of the upper limbs. To judge the improvement of shoulder and neck function, the changes in shoulder joint function and shoulder cervical spine angle after 8 weeks of stretching training was observed in middle-aged women with. METHODS: 12 middle-aged women (Table 1) were selected for a detailed assessment of upper crossover syndrome included in Acromion height test, the distance from the medial margin of the inferior angle of scapula to the spine, measurement of range of motion of shoulder joint, cervical the vertebra and stretching training program. RESULTS: 1. The angles related to the range of motion of the cervical vertebrae were measured and the results were shown in Table 2. It was found that the average range of movement of the cervical spine after training was significantly higher than that before training, and the difference was significant before and after training. 2. The angle related to the range of motion of the shoulder was measured, and the results shown in Table 3. It found that the average amplitudes of shoulder flexion, extension, abduction, adduction, and abduction and horizontal abduction in patients with superior crossover syndrome after training was significantly higher than those before training, and there was a significant difference before and after training (P < 0.05). 3. The height of the acromion and the distance between the inferior angle of the scapula and the spine before and after training was compared (Table 4), and the results were shown in Table 3 CONCLUSION: A long-term sedentary lifestyle may lead to muscle imbalance, weakening the primary motor function of the body, and increasing the risk of soft tissue injury. Stretching training has a significant effect on the shoulder and neck function of patients with UCS. The right joint function sequence can reduce the asymmetry of the body, prevent and reduce bone and joint wear.Table 1: Subject characteristic.Table 2: Comparison of ROM of cervical before and after training.Table 3: Comparison of ROM of shoulder joint before and after training.Table 4: Comparison of acromial height and distance from the inferior angle of the scapula to the spine before and after training.

Results of surgical treatment for Sprengle's deformity with vertical corrective scapular osteotomy.

IntroductionSprengle deformity is the most common congential anomaly of shoulder complex that is the result of scapular placement in cephalad abnormal position. The purpose of this study is the evaluation of clinical and radiological results of vertical corrective scapular osteotomy and comparision of these results with previous studies.MethodsWe retrospectively reviewed the results of the vertical corrective scapular osteotomy (VSO) with or without clavicular osteotomy and wake-up test in 31 consecutive patients at an average duration of follow up of 30 month (6 month-15 years). 22 patients were girls and 9 were boys. The average age of the patients was 7.3 years (3-13) at the time of surgery. We evaluated the clinical and radiological results of this method in last fallow-up. No funding was used for this study and there are no conflicts of interest.Results31 surgical procedures were performed. All osteotomies were healed. No neurovascular complication. Postoperative the mean shoulder flexion and abduction were improved 30 and 36° respectively (p < 0.001). The mean improvement of superior scapular angle (S.S.A) and inferior scapular angle (I.S.A) were 16 and 21° respectively (p < 0.001).ConclusionIt is intuitive that more cosmetic scapular lowering with little chance of neurovascular problems can be achieved after VSO. In addition, scapular rotation can be corrected using this technique, which should be considered as one of the advantages of this technique.We believe that a properly applied VSO procedure in severe deformities is safe with predictable outcomes in the treatment of a complex deformity that provides favorable functional and cosmetic outcomes in the longer term.

Arthroscopic Treatment of Snapping Scapula Syndrome: A Case Report

Introduction: Snapping scapula syndrome is a condition with audible and palpable grating localized to the superomedial angle of the scapula associated with pain. The etiology is likely secondary to anomalous tissue between scapula and chest wall (e.g. bursitis, hooked superomedial angle scapula, Luschka tubercle, malunited rib/scapula fracture and osteochondroma). Case report: We present a case of a 17year-old gentleman, with chronic pain over bilateral upper scapula associated with grating sound upon shoulders movement. Examination revealed significant audible crepitus on bilateral scapula without restriction of shoulders motion. MRI showed no abnormal finding. An attempt for conservative approach including physical therapy and steroid/local anaesthesia injection has been unsuccessful. We subsequently performed an arthroscopic bursectomy and superomedial angle scapula decompression on the right scapula. There were inflammed bursa with fibrotic tissue and prominent superomedial angle of scapula observed during the surgery. Postoperatively, the symptom over right scapula completely resolved with good patient satisfaction. At present, patient is scheduled for the similar surgery on the remaining symptomatic left scapula. In conclusion, arthroscopic scapulothoracic bursectomy with superomedial angle scapula decompression is a reliable treatment for snapping scapula syndrome with predictably high rates of pain relief, patient satisfaction as well as improvement in functional outcomes.

Relationship between scapular initial position and scapular movement during dynamic motions.

Optimal scapular position and movement are necessary for normal function of the shoulder joint and it is essential to focus on scapula in the rehabilitation for shoulder disorders. The aim of this study was to discover the relationship between the scapular initial position and scapular movement during dynamic motions in healthy young men. Thirty-four men participated in this study. The scapular angles at initial position and in elevation and lowering during flexion and abduction were measured using an electromagnetic tracking device. The scapular movements from 30° to 120° during flexion and abduction were calculated. Spearman's rank correlation coefficients were used to analyze the relationship between the scapular initial position and scapular movements. For upward rotation and posterior tilt of the scapula, there were significant positive correlations between the scapular initial position and scapular movement during flexion and abduction. For internal rotation, there were significant positive correlations, except 90° in lowering phase and 120° in both phases. While the humeral elevation increased, the correlation coefficients tended to decrease. Except for the internal rotation our results clarified the interactions between the scapular initial position and scapular movement during dynamic motions in healthy young men. The tendency of the decrease in correlation coefficient with elevation angle was shown.

Chest Radiographs for Distinguishing ADA-SCID from Other Forms of SCID.

Early differentiation of adenosine deaminase deficient severe combined immunodeficiency (ADA-SCID) from other forms of SCID may initiate appropriate treatment interventions with the aim of metabolic detoxification and improved outcome. Our hypothesis was that previously described radiological features (inferior scapular angle squaring and spurring and costochondral cupping) can differentiate ADA-SCID from other forms of SCID. Chest radiographs at clinical presentation between 2000 and 2017 of children with ADA-SCID were retrospectively included, provided that the radiological features were assessable. Random chest radiographs of children with other forms of SCID were included for comparison. Three paediatric radiologists (2 senior, 1 junior) assessed the radiographs for the specific radiological features and stated their diagnosis (ADA-SCID or non-ADA-SCID). An optimal threshold for test performance was defined using a ROC curve. Thirty-six patients with ADA-SCID and twenty-five patients with non-ADA-SCID were included (median age 3.8 months). The optimal threshold for test performance was at approximately < 7 months old: sensitivity 91.7%, specificity 80.7%, interreader agreement was k = 0.709, AUC 0.862. The positive likelihood ratio for scapular squaring, scapular spur, and costochondral cupping was 4.0, 54.6 and 7.8, respectively. The test was valid when performed by both senior and junior paediatric radiologists. Radiological features such as scapular spurring, scapular squaring and costochondral cupping can reliably differentiate between ADA-SCID and other forms of SCID. This is true for children aged approximately < 7 months, and this is reliable when assessed by both senior and junior paediatric radiologists.

Angle of approach to the superior rotator cuff of arthroscopic instruments depends on the acromial morphology: an experimental study in 3D printed human shoulders

BackgroundPortal placement is a key factor for the success of arthroscopic procedures, particularly in rotator cuff repair. We hypothesize that the acromial anatomy may strongly determine the position of the shoulder bony landmarks and limit the surgeon’s freedom to position the arthroscopic approaches in direction towards the acromion. The purpose of this study was to analyze the relation between different acromial shapes and the freedom of movement of arthroscopic instruments relative to the rotator cuff from standardized arthroscopic portals in a laboratory study on 3D shoulder models.Methods3D models of shoulders with a broad range of different acromial shapes were printed using CT and MRI scans. Angles from the portals to defined points on the rotator cuff and the supraglenoid tubercle were measured. In conventional radiographs, the critical shoulder angle, the scapular body acromial angle, and the glenoid acromial angle were measured and compared with the measured angles to the rotator cuff.ResultsThere was a large variation of angles of approach of instruments to the rotator cuff between the seven shoulders for each portal. From the joint line portal and the posterior edge portal, the biggest angles were measured to the posterior cuff. From the intermediate portal, the angles were largest to the intermediate rotator cuff and from the anterior portals to the anterior cuff. To the supraglenoid tubercle, best access was from anterior. For all portals, there was a big correlation between the glenoid acromial angle and the scapular body acromial angle with the angles of approach to the tendon and especially to the supraglenoid tubercle.ConclusionThe access to the rotator cuff from almost every portal is influenced by the acromial shape. As hypothesized, a small (small GAA) and flat (big SBAA) acromion provide an easier approach to the rotator cuff from almost every portal. Therefore, it may severely influence the instruments maneuverability.

The utility of the acromion marker cluster (AMC) in a clinical population

IntroductionThe acromion marker cluster (AMC) is a non-invasive scapular motion tracking method. However, it lacks testing in clinical populations, where unique challenges may present. This investigation resolved the utility of the AMC approach in a compromised clinical population. MethodsThe upper body of breast cancer survivors (BCS) and controls were tracked via motion capture and scapular landmarks palpated and recorded using a digitizer at static neutral to maximum elevation postures. The AMC tracked the scapula during dynamic maximum arm abduction. Both single (SC) and double calibration (DC) methods were applied to calculate scapular angles. The influences of calibration method, elevation, and group on mean and absolute error with two-way fixed ANOVAs with interactions (p < 0.05). Root mean square errors (RMSE) were calculated and compared. ResultsDC improved AMC estimation of palpated scapular orientation over SC, especially at higher arm elevations; RMSE averaged 11° higher for SC than DC at maximum elevation, but the methods were only 2.2° different at 90° elevation. DC of the AMC yielded mean error values of ∼5–10°. These approximate errors reported for AMC with young, lean adults. ConclusionsThe AMC with DC is a non-invasive method with acceptable error for measuring scapular motion of BCS and age-matched controls.

Comparison between the musician-specific seating position of high string bow players and their habitual seating position \u2013 a video raster stereographic study of the dorsal upper body posture

BackgroundEffects of playing high stringed bow instruments on the upper body posture have not been analysed so far. The instrument-specific seating position when playing in an orchestra is compared to the habitual seating position.MethodsThree dimensional back scans were performed in 13 professional violinists and viola players of a radio orchestra (8 f / 5 m). Trunk position in their habitual seating position and in the instrument- specific seating position imitating playing was compared. Statistical differences were calculated using Wilcoxon Matched Pairs Test with Bonferroni Holm correction.ResultsSignificant differences were found between the seated position with instrument and without (p < 0.001, 0.03, 0.02 or 0.01) in the spine (trunk length, sagittal trunk decline, lumbar bending angle, maximal rotation, standard deviation rotation, lumbar lordosis), the shoulder (scapula distance, scapula rotation, scapula angle right) and pelvis distance.ConclusionsPlaying an instrument changes the static seating position by increased rotation of the spine and specific shoulder adaptations holding the instrument (left arm) and the bow (right arm), with minor effects on the pelvis. This forced position may result in chronic health effects. The method used in this study is an approach to better understand the involved muscular structures and possible resulting health damages.

Scapula pre-augmentation in sheep with polycaprolactone tricalcium phosphate scaffolds

A scapula free flap is a commonly used method to reconstruct intraoral defects of the mandible and maxilla. Despite its clear advantages, it shows some deficiencies concerning the amount and shape of the available bone, especially with respect to later implant placement. To overcome these limitations, we pre-augmented the scapula prior to a potential flap-raising procedure with polycaprolactone (PCL) tricalcium phosphate (TCP) scaffolds in a sheep model. In our study, the scapula angle was augmented with a block of PCL-TCP in three adult sheep. After 6 months, the amount of newly formed bone and scaffold degradation were evaluated using cone-beam computed tomography scans and histomorphometric analysis. All animals survived the study and showed no problems in the augmented regions. The scaffolds were attached firmly to the scapula and showed a bonelike consistency. A fair amount of the scaffold material was degraded and replaced by vital bone. Our method seems to be a valid approach to pre-augment the scapula in sheep. In further experiments, it will be interesting to determine whether it is possible to transplant a modified scapula flap to an intraoral defect site.