Anterior translation of humeral head in glenohumeral joint: Comparison between limb dominance and gender using ultrasonography

Abstract Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.

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An improved quantitative ultrasonographic technique could assess anterior translation of the glenohumeral joint accurately and reliably

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06459-1 ◽

2021 ◽

Author(s):

Satoshi Takeuchi ◽

Calvin K. Chan ◽

Soichi Hattori ◽

Christopher M. Gibbs ◽

Satoshi Yamakawa ◽

...

Keyword(s):

Glenohumeral Joint ◽

Anterior Translation

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Hip shape is symmetric, non-dependent on limb dominance and gender-specific: implications for femoroacetabular impingement. A 3D CT analysis in asymptomatic subjects

European Radiology ◽

10.1007/s00330-017-5072-9 ◽

2017 ◽

Vol 28 (4) ◽

pp. 1609-1624 ◽

Cited By ~ 8

Author(s):

Vasco V. Mascarenhas ◽

Paulo Rego ◽

Pedro Dantas ◽

Miguel Castro ◽

Lennart Jans ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

3D Ct ◽

Ct Analysis ◽

And Gender ◽

Asymptomatic Subjects ◽

Gender Specific ◽

Limb Dominance

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Limb-dominance and gender differences in the ground reaction force during single-leg lateral jump-landings

Journal of Physical Therapy Science ◽

10.1589/jpts.30.387 ◽

2018 ◽

Vol 30 (3) ◽

pp. 387-392 ◽

Cited By ~ 1

Author(s):

Junya Aizawa ◽

Kenji Hirohata ◽

Shunsuke Ohji ◽

Takehiro Ohmi ◽

Kazuyoshi Yagishita

Keyword(s):

Gender Differences ◽

Ground Reaction Force ◽

Reaction Force ◽

And Gender ◽

Limb Dominance ◽

Jump Landings

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Does the innate relative size of the humeral head and glenoid affect the risk of anterior shoulder instability?

Shoulder & Elbow ◽

10.1177/1758573218805099 ◽

2018 ◽

Vol 11 (6) ◽

pp. 424-429

Author(s):

NW Willigenburg ◽

RA Bouma ◽

VAB Scholtes ◽

VPM van der Hulst ◽

DFP van Deurzen ◽

...

Keyword(s):

Shoulder Instability ◽

Humeral Head ◽

Relative Size ◽

Ct Scans ◽

Anterior Shoulder Instability ◽

Multivariate Logistic Regression ◽

Recurrent Instability ◽

Bony Lesions ◽

Joint Contact ◽

And Gender

Background Bony lesions after shoulder dislocation reduce the joint contact area and increase the risk of recurrent instability. It is unknown whether the innate relative sizes of the humeral head and glenoid may predispose patients to shoulder instability. This study evaluated whether anterior shoulder instability is associated with a larger innate humeral head/glenoid ratio (IHGR). Methods We evaluated CT scans of 40 shoulders with anterior shoulder instability and 48 controls. We measured axial humeral head diameter and glenoid diameter following native contours, discarding any bony lesions, and calculated IHGR by dividing both diameters. Multivariate logistic regression determined whether the IHGR, corrected for age and gender as potential confounders, was associated with anterior shoulder instability. Results Mean IHGR was 1.48 ± 0.23 in the group with anterior shoulder instability and 1.42 ± 0.20 in the group without anterior shoulder instability. Measurements for axial humeral head and axial glenoid diameters demonstrated excellent intra-rater reliability (ICC range: 0.94–0.95). IHGR was not significantly associated with anterior shoulder instability (OR = 1.105, 95%CI = 0.118–10.339, p = 0.930). Discussion The innate ratio of humeral head and glenoid diameters was not significantly associated with anterior shoulder instability in this retrospective sample of 88 shoulder CT scans.

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Glenohumeral Translations are Only Partially Restored after Repair of a Simulated Type II Superior Labral Lesion

The American Journal of Sports Medicine ◽

10.1177/03635465030310012101 ◽

2003 ◽

Vol 31 (1) ◽

pp. 56-63 ◽

Cited By ~ 49

Author(s):

Andreas Burkart ◽

Richard E. Debski ◽

Volker Musahl ◽

Patrick J. McMahon

Keyword(s):

Clinical Relevance ◽

Glenohumeral Joint ◽

Surgical Techniques ◽

Testing System ◽

Type Ii ◽

Joint Stability ◽

Anterior Translation ◽

Labral Lesion ◽

Force Moment ◽

Biceps Anchor

Background The effect on joint stability of repair of type II superior labrum and biceps anchor lesions is unknown. Hypothesis Increased translations of the glenohumeral joint after a simulated type II lesion will be reduced after the lesion is repaired. Study Design Controlled laboratory study. Methods A robotic/universal force-moment testing system was used to simulate load-and-shift and apprehension tests on eight cadaveric shoulders to determine joint kinematics of the shoulder after venting, creation of a type II lesion, and repair of the lesion. Results At 30° of abduction, anterior translation of the vented joint in response to an anterior load was 18.7 ± 8.5 mm and was significantly increased to 26.2 ± 6.5 mm after simulation of a type II lesion. Repair did not restore anterior translation (23.9 ± 8.6 mm) to that of the vented joint. The inferior translation that also occurred during application of an anterior load was 3.8 ± 4.0 mm in the vented joint and increased significantly to 8.5 ± 5.4 mm with a simulated type II lesion. After repair, the inferior translation decreased significantly to 6.7 ± 5.3 mm. Conclusions Repair of a type II lesion only partially restored glenohumeral translations to that of the vented joint. Clinical Relevance Surgical techniques including improved repair of passive stabilizers injured in the type II lesion should be considered.

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The Veil of Obscuration: Additional Radiographic Sign of Posterior Shoulder Dislocation

Acta Medica Academica ◽

10.5644/ama2006-124.228 ◽

2018 ◽

Vol 47 (2) ◽

pp. 165

Author(s):

Lana Hirai Gimber ◽

Mihra S. Taljanovic ◽

Zachary A. Rockov ◽

Elizabeth A. Krupinski ◽

Tyson S. Chadaz ◽

...

Keyword(s):

Humeral Head ◽

Shoulder Dislocation ◽

Glenohumeral Joint ◽

Posterior Shoulder Dislocation ◽

Chi Square ◽

Lesser Tuberosity ◽

Radiographic Sign ◽

Posterior Shoulder ◽

Significant Difference ◽

The Veil

Objective. To describe a new radiographic sign, “veil of obscuration”, associated with posterior glenohumeral joint (shoulder) dislocations and determine its incidence and validity compared to other known classic radiographic signs.Methods. Four-year retrospective study identified 30 acute posterior shoulder dislocation patients. Radiographs reviewed in consensus by 2 musculoskeletal radiologists for the “veil of obscuration”, seen on AP shoulder radiographs and representing a comminuted fracture of the lesser tuberosity projecting over the humeral head or glenohumeral joint. Incidence of this radiographic sign of posterior glenohumeral joint dislocation in addition to other previously described classic radiographic signs, and association with other fractures, surgery, and mechanism of injury were evaluated. Continuous data was analysed with student t-test and categorical data with Chi-Square test.Results. There were 20 right and 10 left posterior shoulder dislocations. Majority of injuries resulted from vehicle crash (44%). In most cases, reverse Hill-Sachs lesion (83%) and fixed internal rotation of the humeral head (76%) were present, followed by trough line (43%) and “veil of obscuration” (40%). Trough line was seen in significantly more major trauma and vehicle crashes (78% and 46%; P=0.015), while “veil of obscuration” was seen in more seizures (86%; P=0.037) and in all surgical patients. No significant difference in presence of other classic radiographic signs in regards to surgery.Conclusion. The newly described radiographic sign of posterior shoulder dislocations named the “veil of obscuration” has comparable incidence as other classic radiographic signs and may be useful in the recognition and diagnosis of these injuries.

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Hyaluronic acid injections for treatment of pediatric sickle cell avascular necrosis of the humeral head

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102842 ◽

2021 ◽

pp. rapm-2021-102842

Author(s):

Jocelyn Ying-Ah Wong ◽

Sang Le ◽

Carl Lo ◽

Andrew Costandi ◽

Vasili Chernishof ◽

...

Keyword(s):

Hyaluronic Acid ◽

Pain Management ◽

Avascular Necrosis ◽

Sickle Cell ◽

Physical Functioning ◽

Humeral Head ◽

Glenohumeral Joint ◽

Skeletal Maturity ◽

Management Plan ◽

Multidisciplinary Pain Management

BackgroundAvascular necrosis (AVN) can impact up to 50% of patients with sickle cell disease (SCD) and can result in significant pain, decline in physical function and decreased quality of life. While hyaluronic acid (HA) has been used in the adult population for shoulder osteoarthritic pain, we present the first published pediatric case of HA injections in the glenohumeral joint, used to improve function and pain control.Case presentationThe patient is a 12-year-old woman with SCD, who suffered from chronic pain due to AVN of the humeral and femoral head. Despite engaging in a multidisciplinary pain management plan, she continued to have severe decline in physical functioning and became a wheelchair user. As a result, she was scheduled for a right total hip arthroplasty, which necessitated aggressive postoperative therapies using the glenohumeral joint. To improve this pain and to facilitate postoperative recovery, the patient underwent 4 weekly HA injections into the glenohumeral joint. Over a 2-month period, the patient was able to improve physical functioning, decrease opiate use and participate in all postoperative therapies.ConclusionConservative options to improve functioning and pain are especially important in pediatric patients where it may be desirable to delay surgical interventions until skeletal maturity. Our case report demonstrates the benefits of intra-articular HA as part of a multidisciplinary pain management plan to improve function and decrease pain related to AVN of the humeral head. Future studies should assess the long-term benefits of HA injections for AVN in the setting of SCD.

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Anatomy and Biomechanic of the Shoulder

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00466 ◽

2019 ◽

Vol 7 (11_suppl6) ◽

pp. 2325967119S0046

Author(s):

Troydimas Panjaitan

Keyword(s):

Rotator Cuff ◽

Humeral Head ◽

Glenohumeral Joint ◽

External Rotation ◽

Central Component ◽

Subscapularis Tendon ◽

Glenoid Fossa ◽

Greater Tuberosity ◽

Glenohumeral Ligaments ◽

Shoulder Complex

The shoulder is one of the most complex joints of the human body. Consequently, they are susceptible to injury and degeneration. Mechanical shoulder pathology typically results when overuse, extremes of motion, or excessive forces overwhelm intrinsic material properties of the shoulder complex resulting in tears of the rotator cuff, capsule, and labrum. The fundamental central component of the shoulder complex is the glenohumeral joint. It has a ball-and-socket configuration with a surface area ratio of the humeral head to glenoid fossa of about 3:1 with an appearance similar to a golf ball on a tee. Overall, there is minimal bony covering and limited contact areas that allow extensive translational and rotational ability in all three planes. The glenohumeral joint has 2 groups of stabilizers, which are static (passive) and dynamic (active) restrains. Static stabilizers include the concavity of the glenoid fossa, glenoid fossa retroversion and superior angulation, glenoid labrum, the joint capsule, and glenohumeral ligaments, and a vacuum effect from negative intra-articular pressure. Dynamic stabilization is merely the coordinated contraction of the rotator cuff muscles that create forces that compress the articular surfaces of the humeral head into the concave surface of the glenoid fossa. During upper extremity movement, the effects of static stabilizers are minimized and dynamic or active stabilizers become the dominant forces responsible for glenohumeral stability The simple act of arm elevation is a complex task that occurs via the combination of glenohumeral and scapulothoracic motion, together known as scapulohumeral rhythm. In the first 1200, glenohumeral arm abduction, the supraspinatus and deltoid work together and create a force couple that promotes stability, while raising the arm (deltoid contraction). In addition, the humerus must undergo 450 external rotation to not only clear the greater tuberosity posteriorly but also loosen the inferior glenohumeral ligament (IGHL) to allow maximum elevation. There are several anatomical updates regarding the rotator cuff and capsular footprint. The footprint of the supraspinatus on the greater tuberosity is much smaller than previously believed, and this area of the greater tuberosity is actually occupied by a substantial amount of the infraspinatus. The superior-most insertion of the subscapularis tendon extends a thin tendinous slip, which attaches to the fovea capitis of the humerus. The teres minor muscle inserts to the lowest impression of the greater tuberosity of the humerus and additionally inserts to the posterior side of the surgical neck of the humerus.

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