scholarly journals Unknown variant of the accessory subscapularis muscle?

2021 ◽  
Author(s):  
Nicol Zielinska ◽  
R. Shane Tubbs ◽  
Marko Konschake ◽  
Łukasz Olewnik
Keyword(s):  
Rotator Cuff ◽  
Rare Variant ◽  
Shoulder Joint ◽  
Lateral Border ◽  
Morphological Variations ◽  
Subscapularis Muscle ◽  
Medial Rotation

AbstractActing in medial rotation of the arm, the subscapularis (SM) is the most powerful and largest muscle of the rotator cuff. It is morphologically variable, especially in the number of tendons, place of insertion, and number of bellies, and it is sometimes fused with another muscle. An accessory subscapularis muscle (ASM) is among the morphological variations of the SM, but it is a really rare variant. The present case describes a very rare ASM that is divided into proximal tendinous attachment, intermediate fleshy muscular belly and distal tendinous attachment. Its origin is located on the lateral border of the scapula, but some fibers are connected with the muscular part of the SM. Its distal attachment is fused with the capsule of shoulder joint, above the tendinous insertion of the SM. Such an arrangement allows for greater stabilization of the joint. Moreover, there is a possibility that it could be used during treatment of ruptured SM tendons.

Arthroscintigraphy in Suspected Rotator Cuff Rupture

1998 ◽  
Vol 37 (08) ◽  
pp. 272-278 ◽  
Author(s):  
S. Gratz ◽  
G. Köster ◽  
T. Behr ◽  
R. Vosshenrich ◽  
E. Grabbe ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Clinical Signs ◽  
Diagnostic Efficiency ◽  
Rotator Cuff Rupture ◽  
Lower Viscosity ◽  
Rotator Cuff Lesion ◽  
Shoulder Region ◽  
Degenerative Alterations ◽  
Additional Value

Summary Aim: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint. Methods: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBURES 400 μCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard. Results: In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistant. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. Conclusion: Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.

scholarly journals The Relationship between Clinical Tests, Ultrasound Findings and Selected Field-Based Wheelchair Skills Tests in a Cohort of Quadriplegic Wheelchair Rugby Athletes: A Pilot Study

2021 ◽  
Vol 11 (9) ◽  
pp. 4162
Author(s):  
Lucrezia Tognolo ◽  
Alfredo Musumeci ◽  
Andrea Pignataro ◽  
Nicola Petrone ◽  
Michael Benazzato ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Rating Scale ◽  
Clinical Tests ◽  
Wheelchair Rugby ◽  
Manual Wheelchair ◽  
Shoulder Pathology ◽  
Cord Injury ◽  
Pathologic Findings ◽  
The Relationship

Manual wheelchair use may determine shoulder joint overload and rotator cuff injury. Chronic shoulder pathologies can also influence the propulsion ability of wheelchair athletes with spinal cord injury (SCI) during sport activities. However, the relationship between shoulder pathology and wheelchair performances has never been explored. Therefore, the study aimed to investigate the correlation between shoulder pathologic findings with clinical tests and ultrasonography evaluation and the results of wheelchair performance tests. Nineteen quadriplegic wheelchair rugby players were evaluated to investigate the association between clinical and ultrasound shoulder pathologic findings and their correlation with the performance of field-based selected wheelchair skills tests (WSTs). The outcome measures were the International Wheelchair Rugby Classification Score, dominant and non-dominant Physical Examination Shoulder Score, and dominant and non-dominant Ultrasound Shoulder Pathology Rating Scale (USPRS). The WST was measured at the beginning and at one-year follow-up. A statistically significant correlation was found between the time since SCI and dominant USPRS (p < 0.005). The non-dominant USPRS was strongly related to WST at the beginning (p < 0.005) and the end of the study (p < 0.05). Data suggest that the severity of the non-dominant shoulder pathology detected on the ultrasound is related to lower performance on the WST. Chronic manual wheelchair use could be responsible for dominant SCI shoulder joint and rotator cuff muscle damage, while non-dominant USPRS could be related to performance on the WST.

scholarly journals Is it the coracobrachialis superior muscle, or is it an unidentified rare variant of coracobrachialis muscle?

2021 ◽  
Author(s):  
Łukasz Olewnik ◽  
Nicol Zielinska ◽  
Łukasz Gołek ◽  
Paloma Aragonés ◽  
Jose Ramon Sanudo
Keyword(s):  
Case Report ◽  
Rare Variant ◽  
Shoulder Joint ◽  
Biceps Brachii ◽  
Coracoid Process ◽  
Biceps Brachii Muscle ◽  
Shoulder Region

AbstractThe coracobrachialis muscle (CBM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. The CBM demonstrates variability in both the proximal and distal attachment, with some extremely rare varieties, such as the coracobrachialis superior, coracobrachialis longus and coracocapsularis muscle. This case report describes an extremely rare variant of the coracobrachialis superior muscle, or a very rare variant of the CBM. Our findings highlight the importance of muscle variants in the shoulder region, especially the coracoid region, and are significant for radiologists, anatomists, physiotherapists and surgeons specializing in the shoulder joint.

scholarly journals Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model

2018 ◽  
Vol 46 (14) ◽  
pp. 3486-3494 ◽  
Author(s):  
Mengcun Chen ◽  
Snehal S. Shetye ◽  
Julianne Huegel ◽  
Corinne N. Riggin ◽  
Daniel J. Gittings ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Joint Function ◽  
Massive Rotator Cuff Tears ◽  
Sham Surgery ◽  
Biceps Tenotomy

Background: Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear. Hypothesis: Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties. Study Design: Controlled laboratory study. Methods: Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice. Results: Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group. Conclusion: Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model. Clinical Relevance: This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.

scholarly journals The experience with the use of a subacromial balloon in the treatment of patients with large, massive, irreparable rotator cuff tears

2020 ◽  
Vol 11 (4) ◽  
pp. 14-22
Author(s):  
Мaksim F. Lazko ◽  
Alexey P. Prizov ◽  
Fedor L. Lazko ◽  
Evgeny A. Beliak ◽  
Ivan G. Maglaperidze ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Pain Syndrome ◽  
Rotator Cuff Tears ◽  
Average Score ◽  
Subacromial Space ◽  
Rotator Cuff Injuries ◽  
Goutallier Classification ◽  
Upper Extremity Function ◽  
A Prospective Study

Background. Large, massive irreparable rotator cuff tears lead to a significant decrease in the function of the shoulder joint together with the development of a pronounced pain syndrome. Such injuries are difficult to treat, and the number of relapses, when trying to restore them, is quite high. The installation of a subacromial balloon is the method of choice for this group of patients and allows restoring the function of the shoulder joint fairly successfully. Aim: to evaluate the results of the treatment of patients with massive irreparable rotator cuff tears injuries in a prospective study from 2016 to 2018. Methods. The results of the arthroscopic treatment of large, irreparable rotator cuff injuries in 25 patients (with the average age of 67 5 years) with the installation of a subacromial balloon are presented. In all the clinical cases, there was a pronounced (grades 34, according to the Goutallier classification) fatty dystrophy of the rotator cuff muscles (supraspinatus or in combination with subaspinatus). All the patients underwent the subacromial space release with a thorough bursectomy and subsequent installation of a subacromial balloon. Results. The average score on the UCLA scale was 14 3 points (1117) before the operation and 312 points (2933) 12 months after the operation, the results were considered good and excellent. Conclusion. The results obtained allow us to evaluate the described technique as low-traumatic, simple and fast in its accomplishment, aimed at the reduction of the pain syndrome and restoration of the upper extremity function.

scholarly journals Repair of Lafosse I subscapularis injury adds no additional value in anterosuperior rotator cuff injury

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Binghao Zhao ◽  
Qingsong Zhang ◽  
Bo Liu
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Joint ◽  
Statistical Difference ◽  
Supraspinatus Tendon ◽  
Joint Function ◽  
Tendon Tear ◽  
Rotator Cuff Injury ◽  
Additional Value ◽  
Repair Group

Abstract Background The study aimed to explore the additional value of repair of Lafosse I subscapularis injury compared with debridement in anterosuperior rotator cuff injury. Methods The prospective study was conducted on a total of 41 patients with supraspinatus tendon tear combined with Lafosse I subscapularis injury. Eighteen patients were divided into the repair group and 23 patients were divided into the non-repair group. The two groups were compared for intraoperative parameters, pain score, range of motion of the shoulder joint, shoulder joint function and quality of life (QoL) at pre-operation, 3 and 6 months postoperatively and the final follow-up visit. Results The width of supraspinatus tendon tear did not exceed 3 cm and did not retract beyond the glenoid in among patients. There was no statistical difference of preoperative data between two groups, including age, course of disease, positive Jobe test, positive Bear-hug test, positive Lift-off test, Patte stage, longitudinal tear and pain severity (P > 0.05). Compared to preoperative levels, the severity of pain, ASES scores and EQ-5D-3L scores were significantly lower at 3 and 6 months postoperatively and the final position (P < 0.05). However, there was no statistical difference in pain severity, ASES scores and EQ-5D-3L scores between repair group and non-repair group (P > 0.05). Similarly, compared to preoperative levels, the range of motion of shoulder joint was significantly improved after operation, including internal rotation, external rotation, forward flexion and elevation (P < 0.05). However, there was no statistical difference in range of motion of shoulder joint between repair group and non-repair group (P > 0.05). Conclusion Operative treatment can effectively lessen severity of pain in the patients, improve shoulder joint function, increase the range of motion of the shoulder joint and enhance the QoL in treating anterosuperior rotator cuff injury. However, repair of subscapularis brings no benefit compared to debridement in treating supraspinatus tendon tear combined with Lafosse I subscapularis injury.

Ultrasonography and MR Arthrogram in detection of shoulder joint disorders

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Souad Elsayed Mohammed Mansour ◽  
Mohammed Sobhi Hassan ◽  
Mohammed Gamal Eldin Abdel Motelib
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Shoulder Dislocation ◽  
Mr Arthrography ◽  
Golden Rule ◽  
Supraspinatus Tendon ◽  
Tendon Tear ◽  
Diagnosis Classification

Abstract Purpose To know the role of Ultrasonography and MR Arthrogram in detection of shoulder joint disorders Methods and material Thirty patients with suspected shoulder joint disorders underwent US,MRI ,MR arthrography shoulder. Results All cases with ALAPSA, Bankert, reverse bankert, hillsachs, perthes and SLAP are diagnosed accurately by MR arthrography with sensitivity of (100%) in GLAD ,Supraspinatus tendenopathy ,Supraspinatus tendon tear and IGHL injury sensitivity was decreased to 75%,in cases of paraglenid cysts arthrography did not diagnose any of them as there are no communication between the cyst and the joint Conclusion MR arthrography shoulder has a golden rule in diagnosis ,classification of cases of shoulder dislocation ,SLAP injuries and rotator cuff impingement

Surgical Exposures

2018 ◽  
pp. 57-70
Author(s):  
Joaquin Sanchez-Sotelo
Keyword(s):  
At Risk ◽  
Rotator Cuff ◽  
Surgical Procedures ◽  
Shoulder Joint ◽  
Shoulder Function ◽  
Front Side ◽  
Shoulder Region ◽  
Neurovascular Structures ◽  
Large Muscle

Adequate exposure is critical for any of the open surgical procedures described in this book. Although exposures may need to be modified, most of the time the same approaches are used for various procedures. Small variations on exposures also exist that are based on surgeons’ preferences. All shoulder exposures are somewhat complicated by three particular issues related to the anatomy of the shoulder region. First, the deltoid is a large muscle that wraps around the front, side, and back of the shoulder. Second, the rotator cuff, so important for shoulder function, oftentimes needs to be divided and repaired. Finally, a number of neurovascular structures are very close to the shoulder joint and at risk for injury.

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