Differences in soft tissue damage using a percutaneous versus open approach for antegrade straight humeral nailing: a quantitative and qualitative anatomical study

Background: Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. Materials and Methods: We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. Results: The percutaneous technique produced greater latitudinal tearing ( p = 0.002) and less longitudinal tearing ( p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area ( p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. Conclusions: Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.

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The effect of skin entry site, needle angulation and soft tissue compression on simulated antegrade and retrograde femoral arterial punctures: an anatomical study using Cartesian co-ordinates derived from CT angiography

Surgical and Radiologic Anatomy ◽

10.1007/s00276-011-0880-0 ◽

2011 ◽

Vol 34 (8) ◽

pp. 751-755 ◽

Cited By ~ 2

Author(s):

Matthew D. B. S. Tam ◽

Mark Lewis

Keyword(s):

Soft Tissue ◽

Ct Angiography ◽

Anatomical Study ◽

Entry Site ◽

Tissue Compression

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Shoulder Rotation Laxity is Related to Pitching Mechanics

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53307 ◽

2011 ◽

Author(s):

Hongsheng Wang ◽

Koco Eaton ◽

Nigel Zheng

Keyword(s):

Soft Tissue ◽

Shoulder Instability ◽

Humeral Head ◽

Major League Baseball ◽

External Rotation ◽

Rotation Velocity ◽

Ball Speed ◽

The Disabled ◽

Thrower’S Shoulder ◽

Head Translation

According to the 2002 Major League Baseball Disability Analysis, almost 70% of players on the disabled list are pitchers and throwing arm related injuries account for 53% of all disabled list placements. To reach a high ball speed, pitchers cock, or excessively externally rotate their pitching arm to or near an extreme ROM of 180° [1]. The shoulder is then immediately internally rotated to an astonishing 7000°/s after the leading foot contact. The excessive external rotation ROM and astonishing internal rotation velocity are thought to contribute to injury [2]. Repeated exposure to the excessive ROM and large shoulder loads may cause excessive laxity to the anterior shoulder and/or damage the soft tissue [2]. This can lead to shoulder instability and excessive humeral head translation that may cause impingement [3]. Therefore, the mobility and stability of the thrower’s shoulder are extremely relevant to performance and injury prevention.

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Chronic Adaptations of the Posterior Rotator Cuff in Professional Pitchers

The American Journal of Sports Medicine ◽

10.1177/0363546520988688 ◽

2021 ◽

pp. 036354652098868

Author(s):

Stephen J. Thomas ◽

Justin Cobb ◽

Scott Sheridan ◽

Joseph Rauch ◽

Ryan W. Paul

Keyword(s):

Soft Tissue ◽

Rotator Cuff ◽

Internal Rotation ◽

External Rotation ◽

Negative Relationship ◽

Muscle Thickness ◽

Pennation Angle ◽

Muscle Architecture ◽

Infraspinatus Muscle ◽

Teres Minor

Background: Because of the large forces and high frequency of throwing, the upper extremity experiences repetitive stresses that lead to acute and chronic adaptations. While the importance of pennation angle and muscle thickness as predictors of muscle force production has been shown in other populations and other joints, there has been little research done that examines these variables in the shoulders of baseball players. Purpose: (1) To examine the chronic effect pitching has on the rotator cuff muscle architecture (pennation angle and muscle thickness) in healthy professional baseball pitchers, and (2) to examine the correlation between muscle architecture and clinical measures of strength and range of motion (ROM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-eight healthy professional pitchers were recruited during the 2019 spring training. Internal rotation (IR) and external rotation (ER) strength were measured with a handheld dynamometer and IR and ER ROM were measured with an inclinometer. A diagnostic ultrasound machine was utilized to capture images of humeral retroversion, as well as the pennation angle and muscle thickness of the infraspinatus and teres minor muscles. ImageJ software was used to quantify the pennation angle and muscle thickness. Results: There were no significant differences between the dominant and nondominant arms for ER or IR strength. Also, no pennation angle and muscle thickness differences were found between the dominant and nondominant arms. A weak positive relationship between infraspinatus muscle thickness (superficial and total) and ER strength ( P = .016, R = 0.287 and P = .009, R = 0.316) and a moderate negative relationship between soft tissue glenohumeral internal rotation deficit (GIRD) and the bilateral difference of the teres minor deep pennation angle ( R = −0.477, P = .008) were observed. No other significant relationships were noted. Conclusion: Our results are contrary to current literature as we expected to see a stronger dominant arm, with a larger pennation angle and greater muscle thickness. Interestingly, we found that ER strength was positively related to only the thickness of the infraspinatus muscle, and that soft tissue GIRD was positively related to only the side-to-side adaptation of the pennation angle within the deep portion of the teres minor. This suggests that when posterior shoulder tightness occurs, specifically the architecture of the teres minor muscle is involved. However, the organization to which these players belonged has a very extensive training protocol throughout the year that emphasizes bilateral training during a large majority of the exercises. Therefore, the results may not be generalizable to all professional players.

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Soft tissue abnormalities in Wassel Type VI radial polydactyly: a detailed anatomical study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193421990212 ◽

2021 ◽

Vol 46 (4) ◽

pp. 352-359

Author(s):

Susumu Saito ◽

Itaru Tsuge ◽

Hiroki Yamanaka ◽

Naoki Morimoto

Keyword(s):

Soft Tissue ◽

Three Dimensional ◽

Anatomical Study ◽

Metacarpophalangeal Joint ◽

Abductor Pollicis Brevis ◽

Level Of Evidence ◽

Thenar Muscle ◽

Pulley System ◽

Radial Deviation ◽

Tissue Abnormalities

Wassel VI radial polydactyly is associated with metacarpal adduction and radial deviation of the metacarpophalangeal joint of the ulnar duplicate. The soft tissue abnormalities responsible for these deformities were characterized using preoperative multi-planar three-dimensional ultrasound and intraoperative observation in four patients. In all patients, the abductor pollicis brevis and superficial head of the flexor pollicis brevis inserted into the radial first metacarpal, whereas the adductor pollicis and deep head of the flexor pollicis brevis inserted into the ulnar thumb. Aberrant location of the flexor pollicis longus and absence of the A1 pulley system was associated with severe radial deviation. An additional superficial thenar muscle along the ulnar metacarpal was associated with minimal metacarpal adduction. Uneven forces on the ulnar duplicate could be associated with these characteristic deformities and joint instability. Knowledge of these abnormalities allows better planning of surgery and further insight into this rare radial polydactyly configuration. Level of evidence: II

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Correlation of Ultrasound Findings With Clinical Stages and Impairment in Adhesive Capsulitis of the Shoulder

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211003675 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110036

Author(s):

Jong Geol Do ◽

Jin Tae Hwang ◽

Kyung Jae Yoon ◽

Yong-Taek Lee

Keyword(s):

Structural Changes ◽

External Rotation ◽

Biceps Tendon ◽

Adhesive Capsulitis ◽

Case Series ◽

Tendon Sheath ◽

Level Of Evidence ◽

Cutoff Values ◽

Diagnostic Values ◽

Ultrasound Parameters

Background: Ultrasound is an essential tool for diagnosing shoulder disorders. However, the role of ultrasound in assessing and diagnosing adhesive capsulitis has not been fully studied. Purpose: To evaluate the ultrasound features of adhesive capsulitis and estimate the correlations between clinical impairment and ultrasound parameters. Study Design: Case series; Level of evidence, 4. Methods: A total of 61 patients with clinically diagnosed unilateral adhesive capsulitis were retrospectively reviewed using high-resolution ultrasound. To compare ultrasound parameters, we performed ultrasound examinations on both affected and unaffected shoulders. Ultrasound parameters, including thickness of the coracohumeral ligament (CHL), rotator interval (RI), axillary recess (AR), hypervascularity of the RI, and effusion of the long head of the biceps tendon sheath, were measured. Passive range of motion (PROM), visual analog scale for pain, and the Shoulder Pain and Disability Index were used for clinical assessment. Results: The CHL, the RI, and the AR in affected shoulders were significantly thicker than in unaffected shoulders ( P < .05). CHL thickness in affected shoulders was significantly correlated with PROM limitation, which included forward elevation, abduction, external rotation (ER), and internal rotation (IR) ( P < .05). AR thickness correlated with passive forward elevation limitation and passive IR limitation ( P < .05). The CHL was significantly thicker in stage 2 compared with stage 1, and the RI was thicker in stage 2 compared with stage 3. The diagnostic cutoff values for adhesive capsulitis were 2.2 mm for CHL thickness (77% sensitivity, 91.8% specificity) and 4 mm for AR thickness (68.9% sensitivity, 90.2% specificity). Conclusion: The ultrasound parameters associated with structural changes were correlated with clinical characteristics of adhesive capsulitis. Thickened CHL, RI, and AR were observed in affected shoulders. The cutoff values of 2.2 mm for CHL thickness and 4 mm for AR thickness can be used as cutoff diagnostic values for adhesive capsulitis.

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Rare case of angiofibroma presenting as perineal hernia

BMJ Case Reports ◽

10.1136/bcr-2020-236661 ◽

2021 ◽

Vol 14 (1) ◽

pp. e236661

Author(s):

Ruchika Kumari ◽

Cherring Tandup ◽

Ambuj Agarwal ◽

Anish Chowdhury

Keyword(s):

Soft Tissue ◽

Case Reports ◽

En Bloc Resection ◽

Perineal Hernia ◽

Pathological Examination ◽

Soft Tissue Tumour ◽

Open Approach ◽

En Bloc ◽

Rare Tumour ◽

Tissue Tumour

Angiofibroma is a benign soft tissue tumour presenting as a gradually progressive swelling in the vulvovaginal area in women and in the inguinoscrotal region in men. Being a rare tumour, there are only a few case reports in the literature, and among them, presentation as perineal herniation is very rare. En bloc resection of angiofibroma either via laparoscopic or open approach is the choice of treatment to avoid recurrence. Detailed pathological examination and immunohistochemistry workup are imperative to distinguish it from various mesenchymal tumours. Perineal hernia is itself rare and may occur spontaneously or following abdominoperineal resection, sacrectomy or pelvic exenteration. Surgical repair via open transabdominal and transperineal approaches has been described. Here, we report a case of a young woman who presented with spontaneous reducible perineal hernia with a soft tissue tumour as its content, which on histopathological investigation was found to be an angiofibroma.

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Surgical management of ectrodactyly in a dog

Semina Ciências Agrárias ◽

10.5433/1679-0359.2016v37n2p891 ◽

2016 ◽

Vol 37 (2) ◽

pp. 891

Author(s):

Márcio Poletto Ferreira ◽

Marcelo Meller Alievi ◽

Isis Dos Santos Dal-Bó ◽

Fernanda Silveira Nóbrega ◽

Paula Cristina Sieczkowski Gonzalez ◽

...

Keyword(s):

Soft Tissue ◽

Distal Region ◽

Soft Tissue Reconstruction ◽

Tissue Separation ◽

Elbow Luxation ◽

Metacarpal Bones ◽

Intramedullary Canal ◽

Mongrel Dog ◽

Tissue Reconstruction ◽

Steinmann Pin

Ectrodactyly is the term used to designate cases in which soft and bone tissue separation within the distal region of the thoracic limbs is present. It is observed in particular below the metacarpal bones and extending to the radius and ulna. In addition, it can often be associated with ipsilateral elbow luxation. We describe a case of ectrodactyly in a 3-month-old mongrel dog, where bone and soft tissue separation occurred between the third and fourth digits, extending proximally to the carpal region. We identified shortening of the ulna without elbow luxation. The dog was subjected to a surgical procedure comprising bone and soft tissue reconstruction and ulnar diaphyseal osteotomy, which was fixed using a Steinmann pin in the intramedullary canal, maintaining a distance of 1 cm between the two ulnar fragments. Two distal phalanges were removed because it was not possible to reposition them anatomically in the limb. The dog walked with mild lameness nine months after surgery.

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Biomechanical Evaluation of Glenoid Reconstruction With an Implant-Free J-Bone Graft for Anterior Glenoid Bone Loss

The American Journal of Sports Medicine ◽

10.1177/0363546517716927 ◽

2017 ◽

Vol 45 (12) ◽

pp. 2849-2857 ◽

Cited By ~ 13

Author(s):

Leo Pauzenberger ◽

Felix Dyrna ◽

Elifho Obopilwe ◽

Philipp R. Heuberer ◽

Robert A. Arciero ◽

...

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Humeral Head ◽

External Rotation ◽

Glenoid Defect ◽

Contact Patterns ◽

Grafting Technique ◽

The Mean ◽

The Creation ◽

Glenoid Reconstruction

Background: The anatomic restoration of glenoid morphology with an implant-free J-shaped iliac crest bone graft offers an alternative to currently widely used glenoid reconstruction techniques. No biomechanical data on the J-bone grafting technique are currently available. Purpose: To evaluate (1) glenohumeral contact patterns, (2) graft fixation under cyclic loading, and (3) the initial stabilizing effect of anatomic glenoid reconstruction with the implant-free J-bone grafting technique. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders and J-shaped iliac crest bone grafts were used for this study. J-bone grafts were harvested, prepared, and implanted according to a previously described, clinically used technique. Glenohumeral contact patterns were measured using dynamic pressure-sensitive sensors under a compressive load of 440 N with the humerus in (a) 30° of abduction, (b) 30° of abduction and 60° of external rotation, (c) 60° of abduction, and (d) 60° of abduction and 60° of external rotation. Using a custom shoulder-testing system allowing positioning with 6 degrees of freedom, a compressive load of 50 N was applied, and the peak force needed to translate the humeral head 10 mm anteriorly at a rate of 2.0 mm/s was recorded. All tests were performed (1) for the intact glenoid, (2) after the creation of a 30% anterior osseous glenoid defect parallel to the longitudinal axis of the glenoid, and (3) after anatomic glenoid reconstruction with an implant-free J-bone graft. Furthermore, after glenoid reconstruction, each specimen was translated anteriorly for 5 mm at a rate of 4.0 mm/s for a total of 3000 cycles while logging graft protrusion and mediolateral bending motions. Graft micromovements were recorded using 2 high-resolution, linear differential variable reluctance transducer strain gauges placed in line with the long leg of the graft and the mediolateral direction, respectively. Results: The creation of a 30% glenoid defect significantly decreased glenohumeral contact areas ( P < .05) but significantly increased contact pressures at all abduction and rotation positions ( P < .05). Glenoid reconstruction restored the contact area and contact pressure back to levels of the native glenohumeral joint in all tested positions. The mean (±SD) force to translate the humeral head anteriorly for 10 mm (60° of abduction: 31.7 ± 12.6 N; 60° of abduction and 60° of external rotation: 28.6 ± 7.6 N) was significantly reduced after the creation of a 30% anterior bone glenoid defect (60° of abduction: 12.2 ± 6.8 N; 60° of abduction and 60° of external rotation: 11.4 ± 5.4 N; P < .001). After glenoid reconstruction with a J-bone graft, the mean peak translational force significantly increased (60° of abduction: 85.0 ± 8.2 N; 60° of abduction and 60° of external rotation: 73.6 ± 4.5 N; P < .001) compared with the defect state and baseline. The mean total graft protrusion under cyclical translation of the humeral head over 3000 cycles was 138.3 ± 169.8 µm, whereas the mean maximal mediolateral graft deflection was 320.1 ± 475.7 µm. Conclusion: Implant-free anatomic glenoid reconstruction with the J-bone grafting technique restored near-native glenohumeral contact areas and pressures, provided secure initial graft fixation, and demonstrated excellent osseous glenohumeral stability at time zero. Clinical Relevance: The implant-free J-bone graft is a viable alternative to commonly used glenoid reconstruction techniques, providing excellent graft fixation and glenohumeral stability immediately postoperatively. The normalization of glenohumeral contact patterns after reconstruction could potentially avoid the progression of dislocation arthropathy.

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