Glenoid Research Articles

Sex Estimation through Morphometric Analysis of the Temporomandibular Joint

The present study evaluated through a morphometric analysis the temporomandibular joint (TMJ) to estimate sex. Participants in a database with archived tomographic images of patients who sought the Radiology Clinic of the Hospital Universitário Oswaldo Cruz/University of Pernambuco for face or skull tomography were evaluated. Gender was recorded while the participant underwent the tomographic exam and was indexed in the database. The tomographies were recorded in DICOM format and were evaluated using the OSIRIX HD Software. The morphology of the mandibular fossa, the joint eminence and the condyle were evaluated. The measures were analyzed statistically, and results with p 0.05 were considered statistically significant. Both the length of the right and left mandibular condyle (Aco-pco) showed larger dimensions in the male group with a statistically significant result (p = 0.003). The measurements of the glenoid cavity also showed statistical significance with the male gender presenting a higher measurement standard than the female. There was a statistically significant association between Morphology of the left articular eminence and sex. Conclusion: Some linear measures of the JTM indicated the possibility of establishing sexual differentiation and showed that the values referring to the male group tend to be higher than those of the female sex. Further studies with larger sample numbers are needed to achieve scientific evidence.

Coracoid Process of Scapula: Morphometric Analysis in South Indian Population

Introduction: Shoulder pain in subcoracoid impingement syndrome was due to intrusion of rotator cuff tendons in the coracohumeral space. One of the predisposing factors for subcoracoid impingement syndrome was limited subcoracoid space which causes impingement of lesser tubercle of humerus against the coracoid process to produce pain in the anterior region of shoulder. Coracoid process was also used as graft in Latarjet operation done to treat glenohumeral instability. So, understanding the morphometry of coracoid process is very important for orthopaedic surgeons for various surgical procedures. Aim: To analyse the morphometry of coracoid process, coracoglenoid distance and shape of coracoglenoid space among South Indian population. Materials and Methods: This was a cross-sectional study done between March 2018 to September 2018 on 100 dried human scapulae obtained from the bone bank of Department of Anatomy of Private Medical Colleges in South India. Maximum length, breadth, thickness, height of coracoid process, coracoglenoid distance and maximum width of glenoid cavity were measured in millimetres (mm) using digital vernier callipers with the precision of 0.01 mm. Results: Total of 100 dried human scapulae (51 of right side, 49 of left side) were studied and analysed. The average length of coracoid process was 39.47±3.29 mm. The average breadth of coracoid process was 13.91±1.36 mm. The mean thickness of coracoid process was 8.24±1.003 mm. The mean coracoglenoid distance was 27.19±2.42 mm. Breadth of coracoid represents 57.92% of Glenoid width and thickness of coracoid represents 34.27% of Glenoid width. Most common variety of coracoglenoid space found in our study was round bracket shape which was in 51% of scapulae, followed by square bracket shaped in 30% and fish hooked shaped in 19% of scapulae. Conclusion: Morphometry of coracoid process will be taken into account while treating patients with subcoracoid impingement syndrome. Thickness of coracoid process was always smaller than the breadth of coracoid. Hence, the breadth was taken into account when coracoid process was used as a graft to reconstruct glenoid bone loss in recurrent shoulder dislocation.

PHYSIOTHERAPY REHABILITATION OF ROTATOR CUFF INJURY

The shoulder can be considered as one of the largest and most flexible joints in human body. Subscapularis, Supraspinatus, Infraspinatus, Teres Minor are the group of muscles that called as the rotator cuff and Scapular glenoid cavity hold the head of humerus very strongly by the tendons which are surrounded to shoulder joint. Pain which is dull ache in nature may occur at rotator cuff after injury in the shoulder which often aggravates with the use of the arm apart from the body. As the age increases there is an increase in the injuries of Rotator cuff. These may happen earlier in people with occupation that require overhead motions. Many people with this injury can manage their symptoms and return to normal activities with physiotherapy exercises that make the surrounding muscle of the shoulder joint more flexible and improve their strength. A 34-year male was diagnosed in clinical examinations along special tests for the condition on his visit to physiotherapy opd. Patient’s concern was pain at right shoulder and upper arm and difficulty in performing overhead activities. Patient underwent physiotherapy which comprised of reduction in pain, exercises for a period of 13weeks and ongoing which till date resulted in improvements in pain, range of motion, and activities of daily living. The case report suggests the diagnosis and appropriately planned physical rehabilitation management that led to improvement in daily functional goals progressively and remarkably which is major key that leads to a successful recovery till date.

Treatment of shoulder joint luxation with glenoid ostectomy in a miniature donkey

A 13-year-old 128-kg miniature donkey gelding was evaluated for right forelimb lameness of 7 weeks' duration. Muscular atrophy of the infraspinatus and supraspinatus muscles over the right scapula with a palpable bony prominence over the point of the shoulder was evident. At the walk, the cranial phase of the stride was reduced with adduction of the distal aspect of the limb, dragging of the toe, and lameness (grade, 4/5). Lateral and craniocaudal radiographs of the right shoulder joint revealed lateral luxation of the humerus in relation to the scapula with bony proliferation and remodeling of the humeral head. Glenoid ostectomy was performed. Immediately after surgery, the donkey was able to intermittently stand squarely on the limb but maintained a reduced cranial phase of the stride at the walk. The donkey had no short-term complications and was discharged from the hospital 11 days after surgery. Following discharge, the donkey was confined to a box stall for 60 days, followed by a gradual increase in movement to full pasture turnout. The lameness continued to improve, and at 15 months after surgery the donkey was turned out in pasture and had mild lameness (grade, 3/5) at the trot. Mild muscular atrophy of the supraspinatus and infraspinatus muscles was present with no signs of pain on palpation or manipulation of the limb. Shoulder joint radiography at 15 months after surgery revealed remodeling of the glenoid cavity of the scapula and humeral head with formation of a pseudoarthrosis. Glenoid ostectomy should be considered as an alternative to shoulder joint arthrodesis in small equids with shoulder joint luxation. Other indications for this procedure could include chronic osteoarthritis or fractures affecting the shoulder joint.

Features of Arthrosis of the Shoulder Joint in the Conditions of Initially Realized Shoulder Instability and in Case of its Combination with Damage to the Rotator Cuff According to Magnetic Resonance Imaging and Arthroscopy

Relevance. Osteoarthritis (OA) leads to functional limitation and reduced quality of life; it is a major cause of pain and disability. Currently, there is a relatively small number of radiological studies concerning the features of OA of the shoulder joint (SJ) provoked by the realized instability and its combination with damage to the tendons of the rotator cuff (RC) of the shoulder.
 Objective: to study the features of the manifestations and course of SJ OA in the conditions of initially realized isolated instability in combination with damage to the tendons of the RC according to magnetic resonance imaging (MRI) and arthroscopy.
 Materials and Methods. The MRI and arthroscopy data of 75 patients with isolated Bankart lesion and combination with RC tendon damage were retrospectively analyzed. The results of the MRI examination were independently assessed by 2 radiologists with 8 and 10 years of experience. Arthroscopic diagnosis was performed at the beginning of the reconstructive stage by a standard examination from 21 points. The degree of articular cartilage damage on MRI was determined according to the adapted classification of R. Outerbridge.
 Results. In Bankart lesion, sites of chondromalacia of the glenoid cavity cartilage can be detected in the form of a linear or curvilinear hyperintensive MR signal on PDfs in the cartilage thickness or as its marginal defect. The thickness of the cartilage in primary dislocations is generally preserved. When instability is combined with RC tendon damage, the degree of cartilage damage is much greater with a decrease in its thickness. The largest area of cartilage damage is observed when 2 or more RC tendons are damaged.
 Conclusions. Primary SJ dislocation is not always accompanied by damage to the articular cartilage. The MR-semiotics of SJ OA in primary dislocation and in a combination with damage to the tendons of RC has the corresponding features. Delaying the restoration of stability in the shoulder joint with the help of surgical treatment is an unfavorable prognostic factor in the development of rheumatoid arthritis and OA SJ. Realized instability in combination with damage to the rotator cuff is an extremely aggravating prognostic factor for OA, as it adds an additional pathophysiological factor in the form of rotational arthropathy.

ANALYSIS OF THE STRESS-STRAIN STATE THREE-DIMENSIONAL MODEL OF A HEALTHY SHOULDER JOINT

Objective. To work out as close as possible to normal human anatomy three-dimensional finite element model of the shoulder joint with elastic ligaments as well as with muscles and the spatial location of their attachment points, to analyze the stress-strain state of the element proximal humerus and scapula. Methods. A geometric model of the humerus and scapulae are constructed. The three-dimensional modeling of the shoulder join based on the geometric models was used with software SolidWorks with mathematical modeling method finite elements and the stress-strain state analysis in the applicationpackage Ansys software. To approach the real conditions of the model we have added the elastic elements that mimic muscles. Model loaded with forces that reproduce the effort in the muscles, applied to the respective contact planes on the humerus head of the human bone. The stress-strain state of proximal elements is calculated in the humerus and scapula for the angles of the abduction — 0 °, 30°, 60° and 90° in neutral rotation of the humerus.Results. The tensile stresses in the scapula are distributed in such a way that at an angle of 0 ° the limb is not raised +5.67 MPa in the area below the joint depressions. The minimum values of the compressive stress have been reached 18.5 MPa. Maximum stresses are in 1.5–2 times higher area of the articular cartilage of the humerus head compared to the cartilage of the glenoid cavity of the scapula. It is established that the dependence of the valuesof the area of the contact zone in the range of change limb abduction angle (0° ... 90°) can be approximated section of a cubic parabola, with changes in area insignificant and are equal to +2.26% — 7.3 % of the value in neutral position at an angle of 0°. Minor differences with the results of similar studies indicate that the validity of the developed mathematical model. Conclusions. The proposed model would allow performing more correct mathematical modeling and comparative analysis of the stress-strain state for various methods of surgical treatment of pathology shoulder joint, in particular arthroplasty.

Upper arm posture during human embryonic and fetal development.

The upper extremity posture is characteristic of each Carnegie stage (CS), particularly between CS18 and CS23. Morphogenesis of the shoulder joint complex largely contributes to posture, although the exact position of the shoulder joints has not been described. In the present study, the position of the upper arm was first quantitatively measured, and the contribution of the position of the shoulder girdle, including the scapula and glenohumeral (GH) joint, was then evaluated. Twenty-nine human fetal specimens from the Kyoto Collection were used in this study. The morphogenesis and three-dimensional position of the shoulder girdle and humerus were analyzed using phase-contrast X-ray computed tomography and magnetic resonance imaging. Both abduction and flexion of the upper arm displayed a local maximum at CS20. Abduction gradually decreased until the middle fetal period, which was a prominent feature. Flexion was less than 90° at the local maximum, which was discrepant between appearance and measurement value in our study. The scapular body exhibited a unique position, being oriented internally and in the upward direction, with the glenoid cavity oriented cranially and ventrally. However, this unique scapular position had little effect on the upper arm posture because the angle of the scapula on the thorax was canceled as the angle of the GH joint had changed to a mirror image of that angle. Our present study suggested that measuring the angle of the scapula on the thorax and that of the GH joint using sonography leads to improved staging of the human embryo.

Treatment of congenital dislocation of the hip in young children Jaeger (Surg. Gyn. A. Obst. V. 50, No. 4)

Jaeger (Surg. Gyn. A. Obst. V. 50, No. 4) gives 2 cases of successful treatment of congenital hip dislocation in young children. In contrast to the generally accepted late reduction, when the deformation of the glenoid cavity has already gone far, the author proposes to set it early.

Immediate Effect of Muscle Energy Technique and Kalternborn Mobilisation Technique on Pain in Diabetic Patients with Periarthritis of Shoulder

Background: Periarthritis Shoulder, also known as adhesive capsulitis, is a condition that results in tissue degeneration, thickening of the joint capsule, and a narrowing of the glenoid cavity. Diabetes mellitus is linked to many debilitating musculoskeletal disorders of the hand and shoulder. Prevalence of adhesive capsulitis or frozen shoulder is estimated to be 11-30 percent in people with diabetes. Various interventions have already been used to prevent pain and improve quality of life. Both Muscle Energy Technique and Kalternborn Mobilization Technique are thought to have a pain-relieving effect.
 Aim & Objective: The study's aim is to compare the effects of both techniques on pain in diabetic patients.
 Methods/Design: In this study experimental study, the participants will be divided into two groups: Kalternborn Mobilization Technique Group (A) and Muscle Energy Technique Group (B) based on inclusion and exclusion criteria. Both interventions include 30-45 min session which will be carried out for duration of four days. Outcome will be Pain and Quality of Life and outcome measures will be evaluated at beginning and at the end of intervention period.
 Result: Successful Completion of trial of Muscle Energy Technique and Kalternborn Mobilisation Technique will provide evidence for best strategy targeting Pain and quality of life in diabetic patients with Periarthritis of Shoulder.
 Conclusion: The study will be concluded with the significant effect of Muscle Energy Technique and Kalternborn Mobilisation Technique on Periarthritis shoulder of diabetic patients.

Analysis of Nerve Endings in the Superior Labrum-Biceps Complex by Fluorescence Immunohistochemistry and Confocal Laser Microscopy.

Objectives The capsuloligamentous structures of the shoulder work as static stabilizers, together with the biceps and rotator cuff muscles, increasing the contact surface of the glenoid cavity. Free nerve endings and mechanoreceptors have been identified in the shoulder; however, there are a few studies that describe the presence of these nerves in the biceps' insertion. The present study aimed to describe the morphology and distribution of nerve endings using immunofluorescence with protein gene product 9.5 (PGP 9.5) and confocal microscopy. Methods Six labrum-biceps complexes from six fresh-frozen cadavers were studied. The specimens were coronally cut and prepared using the immunofluorescence technique. In both hematoxylin and eosin (H&E) and immunofluorescence, the organization of the connective tissue with parallel collagen fibers was described. Results In the H&E study, vascular structures and some nerve structures were visualized, which were identified by the elongated presence of the nerve cell. All specimens analyzed with immunofluorescence and confocal microscopy demonstrated poor occurrence of morphotypes of sensory corpuscles and free nerve endings. We identified free nerve endings located in the labrum and in the bicipital insertion, and sparse nerve endings along the tendon. Corpuscular endings with fusiform, cuneiform, and oval aspect were identified in the tendon. Conclusion These findings support the hypothesis that the generation of pain in the superior labral tear from Anterior to posterior (SLAP) lesions derives from the more proximal part of the long biceps cord and even more from the upper labrum. Future quantitative studies with a larger number of specimens may provide more information on these sensory systems.

Scapular Glenoid Cavity in Central Indian Population: A Morphological Study

Scapular Glenoid Cavity in Central Indian Population: A Morphological Study

The biomechanics of the rotator cuff in health and disease – A narrative review

The rotator cuff has an important role in the stability and function of the glenohumeral joint. It is a complex anatomic structure commonly affected by injury such as tendinopathy and cuff tears. The rotator cuff helps to provide a stabilising effect to the shoulder joint by compressing the humeral head against the glenoid cavity via the concavity compression mechanism. To appreciate the function of the cuff it is imperative to understand the normal biomechanics of the cuff as well as the mechanisms involved in the pathogenesis of cuff disease.The shoulder joint offers a wide range of motion due to the variety of rotational moments the cuff muscles are able to provide. In order for the joint to remain stable, the cuff creates a force couple around the glenohumeral joint with coordinated activation of adjacent muscles, which work together to contain the otherwise intrinsically unstable glenohumeral joint and prevent proximal migration of the humerus. Once this muscular balance is lost, increased translations or subluxation of the humeral head may result, leading to changes in the magnitude and direction of the joint reaction forces at the glenohumeral joint. These mechanical changes may then result in a number of clinical presentations of shoulder dysfunction, disease and pain.This narrative review aims to highlight the importance of functional rotator cuff biomechanics whilst assessing the kinetics and kinematics of the shoulder joint, as well as exploring the various factors involved in cuff disease.

A STUDY OF MORPHOMETRIC ANALYSIS AND MEASUREMENT OF ANGLE OF TORSION OF THE HEAD OF HUMERUS AND SHOULDER ARTHROPLASTY

Back ground: Humerus is the longest of the long bones of superior extremity.It”s head articulates with scapular glenoid cavity to form the gleno-humeral/Shoulder joint.The rounded head of Humerus is too weakly supported in the scapular glenoid cavity lined by glenoid labrum which makes it the most mobile and most unstable nd joint and so most commonly dislocated joint of the human body.Also the humeral head part is the 2 most important part of shoulder arthroplasty. Aim of the study is to make a clinical evaluation of parameters used in prosthesis design for the humeral component applied in arthroplasty of the proximal upper extremity. Methods: A total of 100 (Rt -58,Lt –42 ) dry human Humerus available in the Department of Anatomy of Calcutta National Medical College,Kolkata,West Bengal and Nilratan Sircar Medical College,Kolkata,West Bengal were taken for the study.The Humeral heads are measured in supero-inferior(SI) diameter, and antero-posterior diameter(AP), The width of Humeral head (Wdth),and angle of Humeral Torsion were measured. At the very beginning the both sided Humerus taken for the study are properly numbered using permanent marker pen.The width of the Humeral head(Wdth) is measured 1stly by pressing the head in modelling dough and when the mould is prepared,semisolid plaster of paris is lled into the mould. After drying the replica of humeral head is smoothened upto the mark of anatomical neck of humerus thus proper width can be measured. The superoinferior(SI) diameter, and antero-posterior diameter(AP) were measured by digital slide callipers by placing it directly onto the surface of consequently numbered humeral heads. The width of Humeral head (Wdth ) were measured from these replica(properly numbered) humeral heads, made of plaster of paris at the middle, the highest thickness was measured. The measurements are taken via spreading slide calipers in milimeters. For measuring the angle of humeral angle of torsion ,we xedly placed the humerus on to a area over the smooth part of the vertical wall which was meeting another horizontal wall at 90 degrees angle thus the line joining the two epicondyles of humerus lies parallel to the vertical wall.Now placing the straight edge of the protractor onto the upper end of humerus the angle of humeral torsion is measured. Results: Both sided Humerae were analysed separately for Morphological measurement, and angle of Humeral torsion.Mean values for SI were 41.31+3.46mm (Right side) and 40.91+3.27mm(Left side). Mean values for AP were 38.27+3.05mm (Right side) and 37.91+2.70mm(Left side). Conclusion: This study will contribute some relevant data and help the orthopaeditians in dealing with cases of shoulder pathology and shoulder arthroplasty cases.

Contribution of automated scannographic measurement in the glenoid component plannification in reverse shoulder prosthesis at CHU de Dijon: According to 34 cases

Introduction: The precision in the placement of a glenoid support in reverse shoulder prosthesis is the most important factor defining the long-term evolution of the prosthesis. We put in place an automatic measure of the version and the glenoidien inclination on various incidences of a 3 dimension scannographic view. This study had as objective to evaluate the plannification realized in 34 patients in whom the protocol was applied in the CHU de Dijon.Methodology: Our study was based on 34 patients who benefitted from a reverse shoulder prosthesis indicated for shoulder arthrosis at university hospital of Dijon. We compared the orientation of the glenoid implant chosen in the course of the plannification with the aid of the software Personalfitet® with the initial position of the glenoid cavity measured on preoperative scans.Results: The average preoperative inclination angle measured on CT scan images was 6,5°, with a maximum of 27° and a minimum of 13°. The version was 11,3°, with a maximum retroversion of 31°. On the planification, the average inclination was at 8,6°, with a minimum inclination of 2° and a maximum inclination of 21,5°.Discussion: The values that we obtained from our method are similar to those described by other studies in literature.Conclusion: Thanks to preoperative plannification with the use of CT scan, the added correction to the orientation of the glenoid support can be perfectly defined.

A low teres minor index of trophicity negatively impacts the functional outcomes of reverse shoulder arthroplasty

IntroductionThe teres minor (TM) participates in active external rotation (ER) after reverse shoulder arthroplasty (RSA). The TM index of trophicity (T2/G) measured on CT scan is a predictor of poor results in patients who have irreparable rotator cuff tears. The aim of this study was to evaluate how T2/G impacts the functional outcomes of RSA in the context of massive rotator cuff tears. We hypothesized that a T2/G less than 0.75 is a predictor of worse functional outcomes. Materials and methodsThis study involved 32 shoulders in 26 patients (mean age 71 years) who underwent RSA for cuff tear arthropathy and had a minimum follow-up of 1 year (mean 3 years). T2/G is the ratio between T2 (TM thickness) and G (maximum glenoid cavity thickness) on preoperative axial CT slices. Clinical examination at the final assessment involved determining the Constant score, the shoulder joint's range of motion and the Subjective Shoulder Value (SSV). ResultsEight shoulders had a T2/G of less than 0.75 (group 1) while 24 shoulders had an index above 0.75 (group 2). These two groups were similar preoperatively. The Constant–Murley score in group 1 was significantly lower than in group 2 (50.2 points versus 59.7 points, p<0.05). Group 1 had a postoperative improvement of 1̊ in their ER with elbow at side while group 2 had a 16.5̊ improvement (p=0.002). Group 1 had a postoperative loss of 6.3̊ in their ER in 90̊ abduction while group 2 had a 21.7̊ improvement (p=0.001). The SSV at the final assessment was 69% in group 1 versus 79% in group 2 (p=0.094). ConclusionHaving a TM index of trophicity below 0.75 is a negative predictor of clinical outcomes due to lack of ER after RSA. Level of evidenceIV.

Increased Glenoid Index as a Risk Factor for Pediatric and Adolescent Anterior Glenohumeral Dislocation: An MRI-Based, Case-Control Study.

Background:In adults, anterior glenohumeral instability has been associated with a tall and narrow glenoid morphology, assessed using the glenoid index (GI; glenoid height-to-width ratio) on magnetic resonance imaging (MRI). This morphological association has not been assessed in children and adolescents.Purpose/Hypothesis:To examine the association of GI and other MRI measurements of interest supported in studies on adults with anterior glenohumeral dislocation in patients aged ≤19 years. We hypothesized that these patients would have a significantly greater GI (relatively taller and narrower glenoid morphology) compared with healthy controls.Study Design:Case-control study; Level of evidence, 3.Methods:An institutional radiology database was queried over a 10-year period to identify patients aged ≤19 years who had been diagnosed with radiographically confirmed anterior shoulder dislocation and who underwent glenohumeral magnetic resonance arthrography as well as those without dislocation with normal shoulder arthrogram studies (controls). Patients with bony Bankart lesions were excluded. The following glenohumeral dimensions were measured on shoulder arthrogram: GI, glenoid version, coracohumeral interval, and rotator interval width/depth. Comparative analysis between the 2 groups was performed using the Student t test for each variable, followed by receiver operating characteristic (ROC) analysis to determine discriminative ability when statistically significant.Results:Overall, 55 participants (33 male and 22 female patients; mean age, 15.4 ± 2.1 years) were enrolled; 22 patients were in included in the dislocator group and 33 patients comprised the control group. The mean GI in the dislocator group was significantly greater than the control group (1.55 ± 0.14 vs. 1.38 ± 0.08; P < .001). ROC analysis revealed adequate discrimination of GI in predicting glenohumeral dislocation (area under the curve = 0.88). A GI ≥1.45 was 83% sensitive and 79% specific for predicting dislocation in the study cohort.Conclusion:Patients with anterior glenohumeral dislocation had increased GI (taller and narrower glenoid morphology) than controls. This useful MRI measurement may help identify patients at risk for primary or recurrent anterior glenohumeral instability events and may therefore help with guiding treatment and prevention.

Anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior lesions: A cadaveric study and preliminary report.

This study aims to investigate the anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior (SLAP) lesions in a human cadaveric model. In this anatomic study, bilateral shoulder girdles of 12 adult formalin embalmed cadavers were used. All cadavers were male, and the mean age was 63.4±7.3 years. The portal entry point was determined as midway between the anterior and posterior borders of the acromion, approximately 1 cm lateral from the edge of the acromion. After a guidewire was placed in the glenoid cavity at the 12 o'clock position where the SLAP lesion typically occurs, a switching stick was inserted there. Each glenoid was then drilled with a 2.4 mm drill through an arthroscopic cannula. Subsequently, anatomical dissection was executed to assess the relationship of the transmuscular portal with the suprascapular nerve, axillary nerve, supraspinatus tendon, acromion, and biceps tendon. Lastly, the shortest distance between the aforementioned structures with the drill was measured by a sensitive caliper to determine whether there was a penetration of the structures. Differences between the right and left sides were analyzed. The mean distance between the portal and the axillary nerve was 55.5 mm±6.0 mm, and the mean length of the suprascapular nerve was 61.2 mm±7.0 mm. The mean distance between the portal and the supraspinatus tendon was 2.8 mm±1.5 mm. No penetration of the axillary nerve, suprascapular nerve, and supraspinatus tendon was observed in any cadaver. No differences were detected for measured anatomical parameters between the right and left sides (p>0.05). Findings from this cadaveric study revealed that the transmuscular portal may allow for a reliable anchor placement without any nerve or tendon penetration during arthroscopic SLAP repair. Level V.

The infraspinatus muscle activity during pitching motion in baseball players with shoulder instability.

BackgroundShoulder microinstability is often overlooked, which can be problematic, especially in overhead athletes. The slipping phenomenon is defined as posterior or lateral sliding of the humeral head in an elevated arm. When the shoulder is close to the end range of stability, the infraspinatus is highly activated and keeps the shoulder in the glenoid cavity. This study aimed to examine the characteristic physical function and infraspinatus activity during the pitching motion in baseball pitchers with shoulder instability.MethodsTwenty-one male baseball pitchers participated and were divided into 2 groups based on radiograph findings at zero position: slipped (group S) and nonslipped (group N) groups. Physical function using Hara test and infraspinatus muscle activity during pitching were evaluated.ResultsThe infraspinatus muscle activity during the acceleration phase was significantly greater in group S (59.5 ± 33.0%MVC) than in group N (33.0 ± 16.9%MVC) (P < .05). Positive rate of the Hara test in group S was significantly high in the loose test and elbow push test.ConclusionsThis study shows that baseball pitchers with slipping phenomenon have capsular laxity and scapular instability that indicate high infraspinatus muscle activity during the acceleration phase. Therefore, repetitive pitching with hyperactivity of the infraspinatus on the slipping shoulder may cause fatigue and dysfunction.

A Novel Technique for Labral Reconstruction Using Long Head of Biceps Tendon: Duru Technique.

Arthroscopic capsulolabral repair is a well-established surgical treatment for traumatic anterior shoulder instability. When there is insufficient labral tissue during arthroscopic primary or revision Bankart repairs, various soft tissue procedures have been recommended. All these procedures aim to reattach glenohumeral ligaments to the glenoid rim and regain the tight anterior structures to prevent re-dislocation or subluxation. Some authors recommend the Latarjet procedure, even in the absence of critical bone loss in this patient group. The labrum increases the depth of the glenoid cavity, thereby, increasing the glenoid track. It behaves like a block for the humeral head. Reconstruction of the labral tissue may strongly contribute to shoulder joint stability when it is totally absent. In this article, we describe a novel labral reconstruction technique (Duru technique) using the long head of the biceps tendon in two patients without an existing labral tissue.

Sex estimation using scapular measurements: discriminant function analysis in a modern Italian population

ABSTRACT Accurate sex estimation of skeletal remains is of critical importance in medico-legal investigations. Despite a significant number of metric sex estimation techniques being developed over recent years, minimal research has been conducted on the suitability of the scapulae. The aim of this study was therefore to establish population-specific discriminant functions from six scapular measurements from the left and right scapulae of 180 contemporary individuals (94 males and 86 females) from the modern and documented CAL Milano Cemetery Skeletal Collection. The measurements comprise the maximum morphological length and breadth of the scapula, the maximum length and breadth of the glenoid cavity and the maximum width of the acromion process and coracoid process. All measurements were sexually dimorphic, as a significant mean difference (p < 0.001) in size was found. All direct and stepwise functions, apart from one outperformed (~83- 96%) univariate ones (~65 – 86%). The maximum width of the coracoid process measurement performed the worst, and therefore should be used with caution. Bilateral asymmetry was observed in three male and three female measurements. High accuracy rates combined with high levels of inter- and intra-observer agreements (R > 0.995) indicate that this technique is suitable for estimating the sex of skeletal remains.