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Shoulder anatomy

Mona Alilet, Julien Behr, Jean-Philippe Nueffer, Benoit Barbier-Brion, Sébastien Aubry
: The subscapularis (SSC) muscle is the most powerful of the rotator cuff muscles, and plays an important role in shoulder motion and stabilization. SSC tendon tear is quite uncommon, compared to the supraspinatus (SSP) tendon, and, most of the time, part of a large rupture of the rotator cuff. Various complementary imaging techniques can be used to obtain an accurate diagnosis of SSC tendon lesions, as well as their extension and muscular impact. Pre-operative diagnosis by imaging is a key issue, since a lesion of the SSC tendon impacts on treatment, surgical approach, and post-operative functional prognosis of rotator cuff injuries...
October 17, 2016: Insights Into Imaging
Jennifer L Pierce, Nicholas C Nacey, Stephen Jones, Davis Rierson, Brian Etier, Stephen Brockmeier, Mark W Anderson
Imaging interpretation of the postoperative shoulder is a challenging and difficult task for both the radiologist and the orthopedic surgeon. The increasing number of shoulder rotator cuff, labrum, and biceps tendon repairs performed in the United States also makes this task a frequent occurrence. Whether treatment is surgical or conservative, imaging plays a crucial role in patient care. Many imaging findings can be used to predict prognosis and functional outcomes, ultimately affecting treatment. In addition, evolving surgical techniques alter the normal anatomy and imaging appearance of the shoulder such that accepted findings proved to be pathologic in the preoperative setting cannot be as readily described as pathologic after surgery...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Matthew H Lee, Scott E Sheehan, John F Orwin, Kenneth S Lee
Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial soft-tissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for real-time high-resolution imaging that enables dynamic assessment and needle guidance...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Tineke De Coninck, Steven S Ngai, Monica Tafur, Christine B Chung
The shoulder joint is the most unstable articulation in the entire human body. While this certainly introduces vulnerability to injury, it also confers the advantage of broad range of motion. There are many elements that work in combination to offset the inherent instability of the glenohumeral joint, but the glenoid labrum is perhaps related most often. Broadly, clinical unidirectional instability can be subdivided into anterior and posterior instability, which usually raise concern for anteroinferior and posteroinferior labral lesions, respectively...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Thomas Suter, Christopher W Kolz, Robert Z Tashjian, Heath B Henninger, Ariane Gerber Popp
BACKGROUND: The best chance that a shoulder arthroplasty will restore motion and muscle balance across the glenohumeral joint is by closely replicating natural articular morphology. Defining the humeral osteotomy plane along clear landmarks at the anatomic neck is critical. We hypothesized that a new osteotomy, based on alternative landmarks on the anatomic neck, would restore 3-dimensional humeral head morphology more reliably than the traditional osteotomy. METHODS: The anatomic neck was digitized in 30 human cadaver shoulders and compared with its 3-dimensional computed tomography reconstruction...
October 6, 2016: Journal of Shoulder and Elbow Surgery
Chad M Fortun, Ivan Wong, Joseph P Burns
Failed arthroscopic soft-tissue stabilization and anterior glenoid bone loss have been shown to have high failure rates after standard arthroscopic stabilization techniques. For patients with recurrent glenohumeral instability, the Bristow-Latarjet procedure is currently the standard of care. It is predominantly performed through an open deltopectoral approach but has recently been described arthroscopically. Although providing excellent clinical outcomes, the Bristow-Latarjet procedure violates the subscapularis muscle, has a steep learning curve with a high complication rate, and permanently changes the anterior shoulder anatomy, making any future revision surgery more challenging...
August 2016: Arthroscopy Techniques
Justin A Ly, Erin M Coleman, Eric J Kropf
The treatment of anterior shoulder instability is well described with various techniques, including arthroscopic double-row repair, an alternative to open stabilization procedures in high-risk groups. The surgical management of posterior instability in high-risk and athletic populations is a less-explored entity. We describe our technique for an all arthroscopic double-row suture anchor repair of a large posterior bony Bankart lesion. We prefer this technique over percutaneous cannulated screw fixation because the double-row suture technique allows for incorporation of capsular plication with bony fixation in an effort to better restore normal anatomy for capsulolabral complex...
August 2016: Arthroscopy Techniques
C D Smith, S J Booker, H S Uppal, J Kitson, T D Bunker
AIMS: Despite the expansion of arthroscopic surgery of the shoulder, the open deltopectoral approach is increasingly used for the fixation of fractures and arthroplasty of the shoulder. The anatomy of the terminal branches of the posterior circumflex humeral artery (PCHA) has not been described before. We undertook an investigation to correct this omission. PATIENTS AND METHODS: The vascular anatomy encountered during 100 consecutive elective deltopectoral approaches was recorded, and the common variants of the terminal branches of the PCHA are described...
October 2016: Bone & Joint Journal
Simon Lee, Asheesh Bedi
Acromioclavicular joint separations are a common cause of shoulder pain in the young athletic population. In high-grade injuries, acromioclavicular joint reconstruction procedures may be indicated for functional improvement. There is currently no gold standard for the surgical management of these injuries. Multiple reconstructive options exist, including coracoclavicular screws, hook plates, endobutton coracoclavicular fixations, and anatomic ligament reconstructions with tendon grafts. This article aims to review pertinent acromioclavicular joint anatomy and biomechanics, radiographic evaluation, classification system, as well as reconstruction options, outcomes, and complications...
September 19, 2016: Current Reviews in Musculoskeletal Medicine
Mateusz Badura, Magdalena Grzonkowska, Mariusz Baumgart, Michał Szpinda
BACKGROUND: The trapezius muscle consists of three parts that are capable of functioning independently. Its superior part together with the levator scapulae and rhomboids elevate the shoulder, the middle part retracts the scapula, while the inferior part lowers the shoulder. OBJECTIVES: The present study aimed to supplement numerical data and to provide growth dynamics of the trapezius in the human fetus. MATERIAL AND METHODS: Using methods of anatomical dissection, digital image analysis (NIS Elements AR 3...
July 2016: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Ron A Meyers, Joshua C McFarland
Slow fibers are typically characterized as functioning in avian postural behaviors such as soaring flight, and are described for a number of elite soarers such as vultures, pelicans and albatrosses. Golden Eagles and Bald Eagles also display soaring behavior and we examined their flight muscles for the presence of slow fibers. Surprisingly, eagles lack a deep layer to the pectoralis found in other soaring species. Additionally, the pectoralis as well as other shoulder muscles had few to no slow muscle fibers...
July 2016: Acta Zoologica
Saad M AlQahtani, Ryan T Bicknell
Lesions of the proximal long head of the biceps tendon (LHB) have been considered as a major cause of shoulder pain and dysfunction. The role of the LHB in causing pain has been a source of controversy for many years, and extensive literature is available discussing anatomy, function, pathology, and most importantly appropriate treatment. Despite this, there is a lack of consensus in the literature regarding the management of biceps-related pathology. Biceps tenotomy and tenodesis are common surgical treatment options when dealing with LHB-related pathology...
September 6, 2016: Current Reviews in Musculoskeletal Medicine
Keyvan Eghbal, Fariborz Ghaffarpasand
BACKGROUND: Several injuries in cervical region as complications of acupuncture have been previously reported in the literature including cord and medulla oblongata injuries, subdural empyema and cervical hematoma. Spinal cord subdural hematoma is a rare condition mainly associated with coagulopathy, trauma and iatrogenic procedures. We herein report an acute cervical subdural hematoma following cervical acupuncture for neck and shoulder pain. CASE DESCRIPTION: A 74-year-old woman presented with progressive quadriparesis and sensory deficit after receiving acupuncture in neck and shoulder...
August 30, 2016: World Neurosurgery
Pablo Villaseñor-Ovies, José Eduardo Navarro-Zarza, Miguel Ángel Saavedra, Cristina Hernández-Díaz, Juan J Canoso, Joseph J Biundo, Robert A Kalish, Francisco Javier de Toro Santos, Dennis McGonagle, Simon Carette, José Alvarez-Nemegyei
This study aimed to identify the anatomical items of the upper extremity and spine that are potentially relevant to the practice of rheumatology. Ten rheumatologists interested in clinical anatomy who published, taught, and/or participated as active members of Clinical Anatomy Interest groups (six seniors, four juniors), participated in a one-round relevance Delphi exercise. An initial, 560-item list that included 45 (8.0 %) general concepts items; 138 (24.8 %) hand items; 100 (17.8 %) forearm and elbow items; 147 (26...
August 18, 2016: Clinical Rheumatology
Giovanni J Passanante, Matthew R Skalski, Dakshesh B Patel, Eric A White, Aaron J Schein, Christopher J Gottsegen, George R Matcuk
The inferior glenohumeral ligament (IGHL) complex is comprised of three components supporting the inferior aspect of the shoulder. It consists of an anterior band, a posterior band, and an interposed axillary pouch. Injuries to the IGHL complex have a unifying clinical history of traumatic shoulder injury, which are often sports or fall-related, with the biomechanical mechanism, positioning of the arm, and individual patient factors determining the specific component of the ligamentous complex that is injured, the location of the injury of those components, and the degree of bone involvement...
August 16, 2016: Emergency Radiology
Christopher C Schmidt, Felix H Savoie, Scott P Steinmann, Michael Hausman, Ilya Voloshin, Bernard F Morrey, Dean G Sotereanos, Emily H Bero, Brandon T Brown
Understanding of the distal biceps anatomy, mechanics, and biology during the last 75 years has greatly improved the physician's ability to advise and to treat patients with ruptured distal tendons. The goal of this paper is to review the past and current advances on complete distal biceps ruptures as well as controversies and future directions that were discussed and debated during the closed American Shoulder and Elbow Surgeons meeting in 2015.
October 2016: Journal of Shoulder and Elbow Surgery
Shadpour Demehri, Nima Hafezi-Nejad, Elliot K Fishman
The inherently unstable anatomy of glenohumeral (GH) joint predisposes it to shoulder dislocation. Shoulder dislocation can occur either due to acute trauma or due to chronic microtraumas in the setting of underlying morphological abnormality. A plain radiograph is the initial imaging modality for diagnosis and management of shoulder dislocation and its associated osseous abnormalities such as Hill-Sachs deformity or osseous Bankart lesion. However, advanced imaging techniques such as multidetector CT (MDCT) with three-dimensional (3D) volume rendering and MRI can be helpful in further characterization of osseous abnormalities and detection of associated soft tissue injuries, respectively...
August 13, 2016: Emergency Radiology
David Pope, Christopher Wottowa
BACKGROUND: Anterior interosseous nerve (AIN) palsies can arise spontaneously or be attributed to one of many causes. We present 4 cases, the largest series to date, in which a mixed peripheral neuropathy presented primarily as an AIN palsy following ipsilateral shoulder arthroscopy. In this report, we detail the patient's presenting symptoms, describe our management of the complication, and provide hypotheses for the mechanism behind the complication. METHODS: Four different surgeons performed the initial arthroscopic surgeries, but the senior author in all cases managed follow-up and treatment of the neuropathy...
October 2016: Journal of Shoulder and Elbow Surgery
Rajeev Mannem, Melissa DuBois, Matthew Koeberl, Damian Kosempa, Scott Erickson
Shoulder dislocations are frequently seen in the general population and can be a cause of instability. Instability can lead to debilitating symptoms and morbidity as a result of progressive damage to the shoulder. Anterior shoulder dislocations are the most frequent type of dislocations and have been studied extensively with MRI. The soft tissue Bankart lesion is the most well-known entity associated with anterior instability; however, additional structural lesions arising from traumatic events have been described in recent literature which also predispose to anterior shoulder instability...
October 2016: Skeletal Radiology
Hussan Mohammed, Matthew R Skalski, Dakshesh B Patel, Anderanik Tomasian, Aaron J Schein, Eric A White, George F Rick Hatch, George R Matcuk
The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments...
July 29, 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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