Subscapularis Research Articles

Ultrasound assessment after a subscapularis-sparing approach to total shoulder arthroplasty.

Although anatomic total shoulder arthroplasty (ATSA) has favorable outcomes, nearly all techniques involve subscapularis tendon release for shoulder joint access. Such takedown of the subscapularis may be associated with decreased function, instability, and pain. Subscapularis-sparing approaches have the theoretical benefits of improved function, decreased failure of the tendon reattachment site, and early range of motion and rehabilitation. The primary purpose of this study was to use ultrasound to assess the postoperative integrity of the subscapularis tendon and surrounding soft tissues after ATSA with a subscapularis-sparing technique through an extensile anterosuperior skin incision. Our hypothesis was that this subscapularis-sparing approach would have low rates of subscapularis disruption. A consecutive cohort of patients who underwent subscapularis-sparing ATSA between 2014 and 2017 were included. Ultrasound was used to evaluate the rotator cuff tendons and deltoid postoperatively, and these were classified as intact, disrupted, or unable to be adequately visualized. Clinical outcome scores, range of motion, and strength measurements were also collected at 1-3 years postoperatively. Thirty-seven subscapularis tendons and 40 supraspinatus and infraspinatus muscles were adequately visualized and included for analysis. Of the subscapularis muscles, 32 (86%) were intact; 38 of the visualized supraspinatus muscles (95%) and 39 of the infraspinatus muscles (98%) were intact. No dehiscence or loss of integrity of the deltoid was noted. Clinical comparison between patients with disrupted subscapularis muscles and patients without such disruption demonstrated no difference in clinical outcome scores and postoperative range of motion but showed less strength in forward flexion, abduction, and external rotation. The rate of subscapularis disruption using a subscapularis-sparing approach for ATSA was low (14%), but the potential for tendon disruption was not eradicated. Favorable clinical outcomes support this surgical approach as a potential technique for ATSA.

The Trillat Procedure for Anterior Glenohumeral Instability.

Anterior glenohumeral instability (AGI) is a challenging condition that requires close attention to osseous and soft-tissue abnormalities. The morphometric variance of the periarticular scapular anatomy may be involved in the pathogenesis of recurrent traumatic anterior instability. The Trillat procedure repositions the coracoid medially and downward by a partial wedge osteotomy, mimicking the sling effect of the Latarjet procedure by moving the conjoint tendon closer to the joint line in throwing position. The Trillat procedure decreases the coracohumeral distance without affecting the integrity of the subscapularis muscle and tendon. Joint preservation methods, such as the Trillat procedure, may be explored in older patients to treat AGI with simultaneous irreparable rotator cuff tears (RCTs) with a static centered head and a functional subscapularis. Shoulder hyperlaxity and instability can be challenging to treat with isolated soft-tissue procedures. In cases without glenoid bone loss, free bone block techniques are ineffective because of the subsequent potential graft resorption, apprehension, or recurrence. The Trillat surgery, in conjunction with an anteroinferior capsuloplasty, seems to be helpful in preventing recurrent instability and in reducing shoulder apprehension. Recently, several variations of the original technique have been described. In the future, anatomical, biomechanical, and clinical studies need to be conducted to further evaluate the morphometric characterization of the procedure, enhance the technical features, improve indications, and avoid coracoid impingement and other potential complications with the Trillat procedure.

Covid-19 associated shoulder girdle calcific myositis: a novel entity.

To investigate the prevalence, describe the radiological features, and consider the clinical sequelae of COVID-19- associated shoulder girdle calcific myositis. All patients who underwent a CT pulmonary angiogram study at our institution (Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom) in April and May 2020, January 2021, and July 2021 were included. A total of 1239 CT pulmonary angiogram studies for 1201 patients were reviewed. Patients with COVID-19 and associated shoulder girdle calcific myositis were identified. Their electronic patient records were reviewed. The patients' demographics, serum inflammatory markers, and proning history were recorded. Of the 364 patients in Wave 1, 71 patients (19.5%) had COVID-19, and of those, 2 patients (2.8%) had shoulder girdle calcific myositis. Of the 521 patients in Wave 2, 354 patients (67.9%) had COVID-19, and of those, 3 patients (0.8%) had shoulder girdle calcific myositis. Of the 316 patients in Wave 3, 37 patients (11.7%) had COVID-19, and of those, 1 patient (2.7%) had shoulder girdle calcific myositis. The overall prevalence was 1.3%. The most common site of calcific myositis was within the subscapularis muscle. COVID-19-associated shoulder girdle calcific myositis is a rare extrapulmonary musculoskeletal manifestation of COVID-19. Early recognition and increased awareness of this disease entity, in our experience, aids in reducing patient morbidity and improving long-term functional outcome. We have reported a novel disease entity associated with COVID-19, in the form of shoulder girdle calcific myositis. We have described the common imaging features and discussed our experience of management and clinical sequelae.

Is There a Nerve-free Zone in Which a Subscapularis Split Can Safely be Performed? An Anatomical Study Using Embalmed Specimens.

The subscapularis muscle, which is part of the rotator cuff, is located anterior to the shoulder. In anterior approaches to the shoulder, its supplying nerves are at risk of iatrogenic injury, which may cause postoperative complications. It is unclear whether there is any nerve-free zone in which a subscapularis split can be performed without risking nerve damage. In an anatomical study, we asked: (1) With the arm abducted 60° and externally rotated, what are the median and shortest distances between the entrance point of the subscapular nerves into subscapularis muscle and the myotendinous junction of this muscle? (2) What are those distances in other positions of the shoulder? (3) Did those measurements differ between specimen sexes or sides? In 84 shoulders of 66 embalmed anatomic specimens, the distance from the myotendinous junction of the subscapularis muscle to the entrance points of the subscapular nerves into the subscapularis muscle was measured using an inelastic thread and a millimeter gauge with the arm abducted 60° and rotated externally. In 16 of 84 shoulders, which were selected randomly, after taking the measurements with the arm abducted 60° and rotated externally, arm positions were changed and further measurements were taken with the arm abducted 60° and rotated neutrally, abducted 60° and rotated internally, and abducted 90° and rotated externally. The positions of the entrance points were described with statistical parameters and compared between different sides, sexes, and joint positions. Measurements were verified using eight fresh-frozen shoulders, showing no difference in distances compared with embalmed specimens and confirming reproducibility of measurements. Absolute distances were used to minimize possible distortion when using correlations and for straightforwardness and clinical applicability. The median (range) distance was 43 mm (24 to 64) for the upper subscapular nerve and 38 mm (23 to 59) for the lower subscapular nerve with the arm rotated externally and abducted 60°. In the 16 subsamples, internal rotation decreased the distance to 34 mm (24 to 49) and 31 mm (15 to 43), respectively, and maximal external rotation and 90° of abduction increased it up to 49 mm (30 to 64) and 41 mm (27 to 56). Comparison of left and right sides yielded no difference. Comparison of sexes showed distances for the lower subscapular nerve of 36 mm (23 to 54) in females versus 39 mm (24 to 60) in males. In no specimen did the nerve come closer than 23 mm medial to the myotendinous junction with the arm rotated externally and abducted. Therefore, not exceeding a distance of 20 mm medial to the myotendinous junction with the arm rotated externally seems to provide sufficient protection from nerve injury during surgery. Based on the described zone of 20 mm medial to the myotendinous junction, the risk of nerve injury in a subscapularis split approach can be minimized.

Prevalence of shoulder pain amongst Malaysia men's wheelchair basketball players

Introduction: The shoulder is at high risk of injury, particularly in throwing activities such as basketball. Aims: The objective of this study was to determine the prevalence and patterns of shoulder pain amongst Malaysian men's wheelchair basketball (WCBB) players. Furthermore, factors that are associated with shoulder pain were investigated. Materials and Methods: Eleven national WCBB players participated in this study. All players completed the clinical research forms which collected socio-demographic information, WCBB participation and history of shoulder pain. Assessments of shoulders range of motion, isometric muscle strengths and clinical shoulder tests were performed on all players. Results: The prevalence of shoulder pain amongst Malaysian WCBB players was 36.4%. Players with current shoulder pain had significantly higher Performance Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) scores (13.8 vs. 3.3, P = 0.02) and a greater number of positive shoulder clinical tests (3.5 vs. 1.0, P = 0.04) than players without pain. Players with shoulder pain are frequently diagnosed with rotator cuff injuries, particularly involving the supraspinatus and subscapularis muscles. A significant moderately strong positive correlation between PC-WUSPI score and number of positive clinical shoulder tests was found (r = 0.71; P = 0.01). Conclusions: Prevalence and patterns of shoulder pain amongst Malaysian men's WCBB players are comparable to previous studies. A strong association between PC-WUSPI score and number of positive clinical shoulder tests suggests a potential role of regular PC-WUSPI assessment for early detection of shoulder problems amongst players.

Arthroscopic Subscapularis Augmentation Using the Long Head of the Biceps Tendon for Anterior Shoulder Instability

The limitations of transferring the coracoid process along with the conjoined tendon are coracoacromial arch damage, technical difficulty, and nerve injury. The long head of the biceps tendon (LHBT) proximal transposition technique has a weaker sling effect and a risk of nerve injury. The arthroscopic subscapularis augmentation technique may have risks of shoulder external rotation restriction and subscapularis transection. Herein, we introduce an arthroscopic technique for the transfer of the LHBT for subscapularis augmentation to address these risks. Indications of this technique were patients younger than 45 years of age who engage in competitive sports, require forceful external rotation and abduction, have a related capsule-ligament insufficiency, and have a glenoid bone loss <25%. The steps include detaching the LHBT at the upper edge of the pectoralis major, transecting and braiding the LHBT, establishing a scapular tunnel, placing a guide suture through the upper third of the subscapular and scapular tunnel, passing the LHBT through the established tunnels, and fixating the LHBT. This technique achieves stability of the anterior shoulder by transecting and transferring the distal end of the LHBT to press on the upper third of the subscapularis muscle.

Primary Open Latarjet Procedure Results in Functional Differences but No Structural Changes in Subscapularis Muscle Quality vs the Healthy Contralateral Shoulder at Long-term Follow-up

Background: There are concerns that the Latarjet procedure results in loss of glenohumeral rotation and strength and in subscapularis dysfunction. The long-term effects of this procedure on subscapularis quality, glenohumeral rotation, and strength are unknown. Purpose/Hypothesis: To analyze the long-term effect of the primary open Latarjet procedure using a muscle-splitting approach on internal and external rotation and strength, as well as subscapularis muscle quality as compared with the healthy contralateral side. We hypothesized that the primary open Latarjet procedure is associated with a reduction of long-term shoulder strength and function and decreased subscapularis quality. Study Design: Case series; Level of evidence, 4. Methods: A total of 42 patients who underwent a primary open Latarjet procedure for recurrent anterior shoulder instability at a mean age of 26 years (range, 18-36) were reviewed after a mean follow-up of 8.4 years (range, 5-12). The subscapularis muscle volume and fat fraction of both shoulders were assessed. Bilateral active internal rotation (IR) and external rotation (ER), as well as IR and ER strength, were assessed by isokinetic testing (concentric, eccentric, and fatigability). Results: Active IR (0.6-point difference, P < .001) and ER (4° difference, P = .010) were significantly greater in healthy contralateral shoulders. The IR strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric and eccentric testing (range of deficit, 4%-6%; P < .05). Also, the ER strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric testing (11% deficit, P < .05). Subscapularis muscle volume was significantly greater in the operated shoulder (4% difference, P = .022), and there was no significant difference in fat fraction (P = .114). Conclusions: The primary open Latarjet procedure was associated with significantly decreased active IR and ER and strength when compared with the healthy contralateral shoulder. The clinical influence of these findings is yet to be defined. There was no increased subscapularis muscle fatty degeneration but a minimal hypertrophy on the operated side at long-term follow-up.

Co-occurring Acromioclavicular Joint Cyst and Hemarthrosis of the Shoulder Associated With Rotator Cuff Tear Arthropathy

Both acromioclavicular joint (ACJ) cysts and hemarthrosis of the shoulder are rare conditions of massive rotator cuff tear that eventually lead to cuff tear arthropathy. We herein report the first case of a patient with co-occurring ACJ cyst and hemarthrosis of the shoulder. An 80-year-old right-hand-dominant man presented to our outpatient department with a six-month history of repeatable right shoulder pain and swelling. Clinical examination revealed a 5 x 5 x 5 cm elastic hard or hard shoulder lump overlying the ACJ on skin with subcutaneous bleeding and swelling of the shoulder. Shoulder pain at rest and a fully reduced active range of motion (ROM), particularly in flexion and abduction, were also noted. Radiographs demonstrated moderate degeneration of the glenohumeral joint including a bone cyst of the humeral head. Magnetic resonance imaging (MRI) revealed a massive rotator cuff tear with atrophy of the supraspinatus, infraspinatus, and subscapularis muscles. The T2-weighted MRI images showed that the cyst was in direct contact with the markedly degenerated glenohumeral joint. Based on these findings, the patient was diagnosed with massive rotator cuff tear with ACJ cyst and hemarthrosis of the shoulder. The patient underwent distal clavicle resection and reverse total shoulder arthroplasty (RSA). At 12-month follow-up, the patient showed no pain symptoms, no recurrence of the cyst, and excellent ROM. We experienced a very rare case of ACJ cyst and hemarthrosis of the shoulder occurring simultaneously with rotator cuff tear arthropathy. This report is very valuable in that it suggests that RSA is useful for both ACJ cysts and hemarthrosis of the shoulders associated with rotator cuff tear arthropathy.

Comparison of latissimus dorsi tendon transfer with subscapularis release versus sliding of internal rotation contracture in obstetrical brachial plexus paralysis sequela

BackgroundThe purpose of this study was to compare the functional results of latissimus dorsi (LD) tendon transfer with those of subscapularis (SS) muscle release versus sliding.MethodsFifty-six patients with internal rotation contracture and external rotation (ER) weakness as sequelae of Erb’s palsy were included in the study. Of the patients, 24 were included in group 1 (11 boys and 13 girls), with a mean age of 2 years 8 months (range 1.5–5 years) and a follow-up period of 62 months (range 38–68 months). The patients in group 1 underwent LD tendon transfer, with internal rotation contracture and SS release procedures. Thirty-two patients were included in group 2 (18 boys and 14 girls), with a mean age of 2 years 6 months (range 1.5–4.8 years) and a follow-up period of 58 months (range 38–68 months). The patients in group 2 underwent LD tendon transfer with SS sliding.ResultsA significant improvement in preoperative passive ER from − 3.6° to 67.3° after operation was observed in group 1. In group 2, preoperative passive ER in adduction improved from 0° to 72.3°. We found no significant difference (P = 0.1) in postoperative improvement in active ER in both groups (group 1 vs. group 2: 75° vs. 77.3°). Similarly, no significant difference (P = 0.7) in postoperative improvement in passive ER was found between the groups (group 1 vs. group 2: 71° vs. 72.3°).ConclusionsLD tendon transfer with SS release or sliding is an effective procedure to improve shoulder ER in patients with OBPP, with no inferiority of SS muscle release or sliding for internal rotation contractures and increased passive range of shoulder motion.Level of evidenceLevel III; Retrospective Cohort Comparison; Treatment Study.

Open Screw Fixation of Large Anterior Glenoid Rim Fractures Using a Deltopectoral Approach With Subscapularis Splitting.

Anterior glenoid rim fracture is a consequence of the humeral head impacting the glenoid fossa. The management of large glenoid fractures involving more than 20% of the articulating glenoid requires surgical treatment. The 2 main techniques are open reduction internal fixation (ORIF) by screws and arthroscopic treatment using suture anchors or transcutaneous screws. Next to the technical equipment, a surgeon requires extensive experience to achieve good results with the arthroscopic technique. The main disadvantage using the ORIF technique is the detachment of the subscapularis muscle, which is often criticized for causing functional deficits of the subscapularis. Our study demonstrates the feasibility of the ORIF technique through a deltopectoral approach and splitting of the subscapularis. To our knowledge, subscapularis splitting has never been described to treat glenoid fractures.

Complete traumatic rotator cuff tears in children and adolescents: a multicenter retrospective study

Objectives:Complete rotator cuff tears in adolescents that require surgery are exceptional. The purpose of this work was to analyze the medium- and long-term results in adolescents who underwent arthroscopic or open repair of a complete rotator cuff tear.Methods:All surgeons who are members of the French Shoulder and Elbow Society (SOFEC) and the French Arthroscopy Society (SFA) were contacted. They were sent an electronic questionnaire asking whether they had had to surgically treat a traumatic complete rotator cuff tear in a child or adolescent. Of 233 surgeons, 90 responded to the questionnaire. Only 15 had actually had the opportunity to address one or more cases. Surgeons who responded positively to the questionnaire were contacted to retrieve complete medical data on their patient(s).Results:Nineteen records were reviewed. The mean age at the time of surgery was 14.7 years (12-17). A frequent injury mechanism was glenohumeral dislocation during contact sports (n = 7/19). The subscapularis muscle was involved in 100% of the cases. In 31% of the cases, the injury also involved the supraspinatus and/or infraspinatus. Open (n = 6/19) or arthroscopic (n = 13/19) surgery was performed. At a mean follow-up of 47 months (24 months - 18 years), 79% had resumed sports at the previous level. Two patients had a neurological complication, one of whom required a nerve graft surgery. In 14% of the cases, pseudarthrosis of the lesser tuberosity occurred, and the surgical revision did not affect the final result. Only one patient had recurrent anterior instability requiring a bone block surgery seven years after the initial surgery.Conclusion:Complete rotator cuff tears are exceptional in adolescents. Injuries are mainly in the subscapularis. Reinsertion, even if it is late, ideally performed by arthroscopy, provides good results with resumption of sports at the previous level in 79% of the cases

Relationship between the Hamada Grade and underlying pathological conditions in the rotator cuff and long head of biceps in symptomatic patients with rotator cuff tears.

BackgroundThis study aimed to investigate the relationship between Hamada Grade and rotator cuff and long head of the biceps (LHB) pathologies in symptomatic patients with rotator cuff tears (RCTs).MethodsWe retrospectively reviewed 376 patients (156 men and 220 women; mean age, 68.4 years) who had undergone surgery for complete RCTs. Preoperative plain radiography, magnetic resonance imaging, and intraoperative findings were assessed. All cases were allocated to the Hamada Grade 1, 2, 3, and 4-5 groups to investigate the correlation between Hamada Grade severity and underlying rotator cuff and LHB pathologies.ResultsThe rate of RCTs involving the infraspinatus was significantly higher in Grade 2 than in Grade 1 (P < .0001). The tear size and fatty muscle degeneration of the subscapularis in Hamada Grade 3 were significantly more severe than those in Grade 2 (P = .01 and P < .0001, respectively). The tear size and fatty muscle degeneration of the rotator cuff in Grade 4-5 were significantly more severe than those in Grade 3 (all P < .05). The complete LHB rupture rate was significantly higher in Hamada Grade 4-5 than in Grades 1, 2, and 3 (all P < .001).ConclusionRotator cuff tears involving the infraspinatus were associated with Hamada Grade 2. The rate of concomitant subscapularis tears with posterosuperior RCTs was significantly higher in Hamada Grade 3 than in Hamada Grade 2. RCT enlargement, progression of fatty muscle degeneration of the subscapularis and posterosuperior rotator cuff muscles, and the increase in complete LHB rupture were associated with Hamada Grade 4-5.

Pectoralis major and pectoralis minor transfer for irreparable subscapularis tendon tears.

Irreparable rotator cuff injuries in young patients with moderate to high levels of physical activity remain achallenging pathology for shoulder surgeons. Irreparable anterior rotator cuff injuries require treatment that seeks to restore the dynamic anterior forces of the glenohumeral joint. Among surgical treatment options, transfer of the pectoralis major and minor muscle, have shown good functional outcomes. This technique attempts to reproduce the vector of the subscapular muscle in cases with irreparable tear. Restoration of the dynamic external and internal couple forces to maintain the humeral head in the center of rotation. Pectoralis major transfer (PMa): Irreparable subscapularis tendon (SSC) tear in active patients without osteoarthritis. Pectoralis minor transfer (PMi): Irreparable superior SSC tear with concomitant irreparable supraspinatus tendon (SSP) tear in active patients with no osteoarthritis. Primary osteoarthritis Samilson gradeC, cuff tear arthropathy HamadaIII-V, infection, axillary nerve palsy, older patients with low physical demand, combination with irreparable SSP/infraspinatus tendon (ISP) tear for PMa or combination with irreparable ISP tear for PMi. General anesthesia and beach-chair position with the arm freely mobile in an arm holder. Deltopectoral approach. Exposure of the humeral head and confirmation of the irreparability of the subscapularis tendon. PMa: Detachment of the tendon to be transferred from the humeral insertion, blunt anatomic dissection medially. Exposure of the conjoined tendon and coracoid process. PMi: Detachment of the tendon with an osteotomy at the coracoid process. Passing the PMa or PMi tendon under the conjoined tendon. The PMa tendon is fixed in a2-row configuration, the PMi in asingle row with suture anchors to the lesser tuberosity. Shoulder abduction sling(30°) for 6weeks. Assisted range-of-motion (ROM) exercises with abduction/adduction 60-0-0°, internal/external rotation free-0-0° for 6weeks. Free active ROM exercises after 6weeks, muscle strengthening after 12weeks. The pectoralis major and minor transfer shows an improvement in strength and range of motion in young active patients and an improved Constant score (CS) in long-term follow-up examinations.

Upper body involvement in GNE myopathy assessed by muscle imaging

Upper body muscle involvement has never been systematically investigated in GNE myopathy (GNEM). Aims of our study were to explore upper body involvement in GNEM patients by means of muscle MRI, to compare the degree of pathology with that of lower body and to validate the MRI pattern of the lower limbs in novel patients. MRI scans of 9 GNEM patients were retrospectively evaluated. T1-weighted and short-tau inversion recovery images were scored. As a result, serratus anterior was involved in all patients, followed by subscapularis and trapezius muscles. The majority of scans consistently showed hypotrophy of pectoralis minor. Conversely, cranial muscles including the tongue were always spared while pectoralis major and latissimus dorsi were relatively spared. We confirmed the known pattern of involvement in the pelvic girdle and limbs, that were more significantly affected than the upper girdle in all disease stages. Paraspinal muscles were also frequently affected displaying both a cranio-caudal and latero-medial gradient of severity along the body axis. Upper girdle MRI highlights a selective muscle involvement in GNEM, offering an added value in patients’ diagnostic workup and deep stratification.

Imaging Review of Subscapularis Tendon and Rotator Interval Pathology

As the largest rotator cuff muscle, the subscapularis plays a major role in stabilizing the glenohumeral joint, in conjunction with surrounding rotator cuff structures. Injury to the subscapularis tendon can be isolated, but more commonly is seen in conjunction with supraspinatus tendon pathology. Injury can be associated with biceps pulley instability, superior labral anterior-posterior (SLAP) tears, humeral head subluxation, and anterosuperior and coracoid impingements. The involvement of the rotator interval can lead to what is called “the hidden lesion,” due to its difficulty to diagnose during arthroscopy. Understanding the anatomical relations of the subscapularis tendon with the rest of the rotator cuff and rotator interval, as well as common patterns of injury that involve the subscapularis tendon, can aid in proper diagnosis of these injuries leading to prompt surgical repair. This review describes the anatomy of the subscapularis muscle and tendon, and the magnetic resonance imaging (MRI) patterns of subscapularis tendon injury.

Role of Axillary Arch Muscle in Neurovascular Compression: A Cadaveric Study in the Western Region of Maharashtra, India

Introduction: The Axillary Arch Muscle (AAM), is a rare anomalous finding in the axilla also known as langer’s muscle. In the literature, it is explained as a narrow muscular slip that extends from the latissimus dorsi to the pectoralis major. Variations of this muscular anomaly have been observed. The abduction and external rotation like simulation of the arm in the cadaver suggest the possibility of neurovascular compression by the AAM. The AAM causing compression is considered an etiology of thoracic outlet syndrome by some authors. The symptoms generated by neural or vascular compression can be differentiated clinically. The purpose of this article was to compare the potential role of AAM in causing neural or vascular compression and discussion with the clinical studies which showed varied results. Aim: To find out the possible anatomy of axillary arch muscle and its relation with neurovascular structures. Materials and Methods: The descriptive cadaveric study was conducted in the Department of Anatomy at Seth G.S.M.C. and KEM hospital, Mumbai, India from November 2012 to November 2014. Study included 120 axillae of 60 embalmed cadavers (60 right and 60 left axilla). Axillary arch muscles were identified and their relations with neurovascular structure in an abducted position of the arm were noted and photographed. The simple statistical method of calculating percentages (%) of the collected data was applied to the study. Results: The dissection of the axillary region was carried out in 120 axillae which included 53 male and 7 female cadavers. The axillary arch muscles were identified in the three male axillae unilaterally. Its extent and relations with the neurovascular structure were different in all three cases. Its medial attachment was on the lateral border of latissimus dorsi, fascia over the latissimus dorsi, or the subscapularis muscle, while the lateral attachment was on fascia over coracobrachialis or biceps brachii. All the cases showed close relations with neural as well as vascular structures with the potential of causing compression in varied numbers. Conclusion: Though the existence of this muscle is rare, the findings of the present study will help clinicians, surgeons, and physiotherapists to be vigilant in diagnosing the cases with AAM amongst the individuals frequently adopting hyperabduction maneuvers in their occupations or sports thereby causing neurovascular compression.

A Biomechanical Analysis of Shoulder Muscle Excursions During Abduction, After the Treatment of Massive Irreparable Rotator Cuff Tears Using Superior Capsular Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and SCR with BAR.

IntroductionCurrent understanding of the biomechanical effects of treatment options for irreparable rotator cuff (RC) tears is lacking. This study examines how shoulder muscle lengths and excursions are affected by superior capsular reconstruction (SCR), bursal acromial reconstruction (BAR), and SCR with BAR, following a complete supraspinatus tear.MethodSix fresh-frozen cadaveric shoulders were examined. Deltoid and RC muscle lengths were measured at 0, 30, 45, 60, and 90° of shoulder abduction under six conditions: (1) intact, (2) partially torn supraspinatus, (3) completely torn supraspinatus, (4) SCR, (5) SCR with BAR, and (6) BAR. Muscle excursions from 0–90° of abduction were then calculated.ResultsSubscapularis muscle lengths after SCR, BAR, and SCR with BAR were significantly greater (post-hoc Tukey HSD test; p < .01) compared to the other conditions. Supraspinatus, infraspinatus, teres minor, and deltoid lengths were not significantly different (ANOVA test; p > .01) between the conditions. All muscle excursions remained statistically similar between the conditions (ANOVA test; p > .01).ConclusionThese findings demonstrate that the use of SCR, BAR, or SCR with BAR for a complete supraspinatus tear, may increase subscapularis muscle length while maintaining other shoulder muscle lengths. An increase in subscapularis length can allow for more effective subscapularis muscle strengthening and increased compensatory function in the long term. Additionally, all shoulder muscle excursions are preserved after partial or complete supraspinatus tears and after SCR, BAR, or SCR with BAR. Therefore, these surgical treatments can initially normalize shoulder muscle function during 0–90° of abduction, after an irreparable supraspinatus tear.

A comparative study of ultrasonography and magnetic resonance imaging for the evaluation of rotator cuff injuries

Introduction: The Rotator cuff is a group of muscles and tendons which provide strength and stability during shoulder motion and includes Subscapularis, Supraspinatus, Infraspinatus & Teres minor muscles and their tendons. There are numerous causes of shoulder disability, although Rotator cuff pathologies are most common cause of shoulder disability, Impingement syndrome, Bicipital tendinopathy, Dislocation, Adhesive capsulitis and Glenoid labral tears are other causes that can lead to shoulder pain and restriction of mobility of the shoulder Objectives 1. To study the spectrum of rotator cuff pathologies encountered on Ultrasound & Magnetic resonance imaging. 2. To correlate Ultrasound and Magnetic resonance imaging findings. Material and Methods: Present study was a single centric, cross sectional prospective, observational, hospital-based study in which 40 patients underwent ultrasound and MRI of the shoulder and findings of both were compared.Results: Average age group of the study population was 49.77 years. The gender distribution in our study showed a male preponderance, of 16 males [53.3%] and 14 female [46.7%]. Study showed out of 40 patients, 21 patients (70%) had disease of the shoulder on right side while 9 patients (30%) had disease on left side. All of the patients in our study were right-handed. For partial thickness tears USG had a sensitivity of 92.86%, specificity of 100%. In cases with full thickness tears, 100% sensitivity and 96.3% specificity was achieved. Conclusion: Based on our findings, USG can be used as a first line modality while investigating a case of shoulder joint pain to rule out rotator cuff tears and MRI should be used as second line non- invasive test to confirm the diagnosis & to rule out associated injuries. Ultrasound is nearly as efficient as MRI and is practical, well accepted, and accurate non-invasive imaging technique in patients presenting with shoulder pain.

Unilateral Double Subscapular Artery: A Case Report

Variations in the Subscapular Artery (SA) are among the most common variations in the Axillary Artery (AA) and its branches. However, the occurrence of a common trunk from the third division is unusual. Hereby, authors report an atypical variation in the distal division of the axillary artery found during routine dissection of an elderly female cadaver. In this donor, the third portion of the AA gave rise to an SA, a common trunk, and the anterior circumflex humeral artery. In addition, the common trunk gave rise to a second SA, the posterior circumflex humeral artery, the scapular circumflex artery, and the thoracodorsal artery. Both SA branches appeared to irrigate the subscapularis muscles. Comprehension of the diverse anatomical variations of the subscapular artery is critically important in surgical procedures and therapeutic interventions for the upper limb.

Structural and Functional Results of Subscapularis and Conjoint Tendon After Latarjet Procedure at 8-Year Average Follow-up

Background: The Latarjet procedure involves initial dissection through a longitudinal split of the subscapularis tendon with only a final partial closure to accommodate the transferred coracoid bone. Furthermore, by transferring the coracoid bone block to the anterior glenoid, the surgeon completely alters the resting and dynamic route of the attached conjoint tendon. The eventual structural and functional integrity of the subscapularis and conjoint tendons is currently unknown. Purpose: To examine the structural and functional integrity of the subscapularis and the conjoint tendon after the Latarjet procedure at an 8-year average follow-up. Study design: Case series; Level of evidence, 4. Methods: Twenty patients with anterior shoulder instability at a mean age of 30 years (range, 19-50 years) underwent the open Latarjet procedure. Clinical examination at the final follow-up included quantitative isometric measurement of abduction and internal rotation strength compared with the nonoperative side. Patients were assessed via radiograph examination and preoperative computed tomography. Final position and healing of the transferred coracoid bone block were evaluated using standard radiographs. At follow-up, the subscapularis and conjoint tendon were evaluated via magnetic resonance imaging (MRI) with metal artifact reduction techniques and via ultrasound. Results: Nineteen of the 20 shoulders remained stable at the final follow-up; there was 1 redislocation (5%) after 14 months. The mean Rowe score was 83 points (SD, 17.9 points), the mean Constant score was 85 points (SD, 8.1 points), and the Subjective Shoulder Value was 80% (SD, 18%). The mean abduction strength of the operative shoulder was 7.41 ± 2.06 kg compared with 8.33 ± 2.53 kg for the nonoperative side (P = .02). The mean internal rotation strength at 0° for the operative shoulder was 8.82 ± 3.47 kg compared with 9.06 ± 3.01 kg for the nonoperative side (P = .36). The mean internal rotation strength in the belly-press position for the operative shoulder was 8.12 ± 2.89 kg compared with 8.50 ± 3.03 kg (P = .13). Four of 20 shoulders showed mild tendinopathic changes of the subscapularis tendon but no partial or complete tear. One patient exhibited fatty degeneration Goutallier stage 1. Conjoint tendon was in continuity in all 20 shoulders on MRI scans. Conclusion: Abduction, but not internal rotation strength, was slightly reduced after the Latarjet procedure at a mean of 8 years of follow-up. The subscapularis tendon was intact based on ultrasound examination, and the conjoint tendon was intact based on MRI scans. Subscapularis muscle girth relative to the supraspinatus muscle remained intact from preoperative measurements based on MRI scans.