scholarly journals «Terrible triad» of the shoulder. Biomechanicalsemi-natural modeling andjustificationto rotator cuff restoration

2021 ◽  
pp. 17-23
Author(s):  
Oleksii Sukhin ◽  
Sergii Strafun ◽  
Andriy Lysak ◽  
Igor Lazarev
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Shoulder Joint ◽  
Tendon Rupture ◽  
Deltoid Muscle ◽  
Axillary Nerve ◽  
Vicious Circle ◽  
Terrible Triad ◽  
Spiral Computed ◽  
Traction Load

The aim of this study: was determine the force of tension and deformation of axillary nerve in rupture rotator cuff and paresis of deltoid muscle of the shoulder joint. Material and methods: Semi-natural modelling based on the axial scans spiral computed tomography of the intact shoulder joint was performed to determine the degree of traction load on the axillary nerve with distal displacement shoulder head and tendon rupture which paresis of the deltoid muscle. Result: The values of deformations for axillary nerve being at the limit of tissue strength at distal displacement of humeral head of the model by 50 %, progressively increased with increasing distal displacement of humeral head to 100 % of its diameter, reaching values 1.7 times higher than the strength nervous tissue. Conclusion: The progressive changes occurring in the axillary nerve under the action of traction loads, and as a consequence of its ischemia, over time can lead not only to demyelination, but also to the defeat of the axons themselves atrophy of its fibers. In turn, deltoid muscle atrophy increases the traction load on the affected axillary nerve, which forms a vicious circle. The only possible option to "break" the vicious circle is restore the stabilizing structures damaged during the injury, among which one of the most important is the tendons of the rotator cuff of the shoulder. Surgical restoration of the integrity rotator cuff of the shoulder reduces the traction load acting on the axillary nerve, which in turn significantly improves the conditions for reinnervation of the deltoid muscle.

scholarly journals Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

2021 ◽  
Vol 6 (5) ◽  
pp. 178-183
Author(s):  
D. V. Menshova ◽  
N. S. Ponomarenko ◽  
I. A. Kuklin
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Shoulder Joint ◽  
Latissimus Dorsi ◽  
Clinical Case ◽  
Deltoid Muscle ◽  
X Rays ◽  
Longus Tendon ◽  
Surgical Methods ◽  
The Right

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and  40  % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In  the  treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures. 

Quantitative analysis of the distal, lateral, and posterior articular branches of the axillary nerve to the shoulder: implications for intervention

2019 ◽  
Vol 44 (9) ◽  
pp. 875-880
Author(s):  
Brittany Bickelhaupt ◽  
Maxim S Eckmann ◽  
Caroline Brennick ◽  
Omid B Rahimi
Keyword(s):  
Methylene Blue ◽  
Shoulder Pain ◽  
Nerve Block ◽  
Humeral Head ◽  
Shoulder Joint ◽  
Deltoid Muscle ◽  
Axillary Nerve ◽  
Blue Staining ◽  
Lateral Aspect ◽  
Minor Muscle

IntroductionThe terminal sensory branches innervating the shoulder joint are potential therapeutic targets for the treatment of shoulder pain. This cadaveric study investigated in detail the anatomic pathway of the posterior terminal sensory branch of the axillary nerve (AN) and its relationship to nearby anatomic structures for applications, such as nerve block or ablation of the shoulder joint.MethodsFor this study, nine shoulders were dissected. Following dissection, methylene blue was used to stain the pathway of the terminal sensory branches of the AN to provide a visual relationship to the nearby bony structures. A transparent grid was overlaid on the humeral head to provide further detailed information regarding the innervation to the shoulder joint.ResultsEight of the nine shoulders displayed terminal sensory branches of the AN. The terminal sensory branches of the AN innervated the posterolateral head of the humerus and shoulder capsule and were deep and distal to the motor branches innervating the deltoid muscle and teres minor muscle. All terminal branches dissected innervated the shoulder capsule at the posteroinferior-lateral aspect of the greater tuberosity of the humerus. All specimens displayed innervation to the shoulder joint in the lateral most 25% and inferior most 37.5% before methylene blue staining.ConclusionThe terminal sensory branches of the AN consistently innervate the inferior and lateral aspects of the posterior humeral head and shoulder capsule. These nerves are easily accessible and would provide a practical target for nerve block or ablation to relieve shoulder pain without compromising motor integrity.

The lever arm ratio of the rotator cuff to deltoid muscle explains and predicts pseudoparalysis of the shoulder

2018 ◽  
Vol 100-B (12) ◽  
pp. 1600-1608 ◽  
Author(s):  
S. Bouaicha ◽  
L. Ernstbrunner ◽  
L. Jud ◽  
D. C. Meyer ◽  
J. G. Snedeker ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Clinical Investigation ◽  
Significant Risk ◽  
Deltoid Muscle ◽  
Shoulder Abduction ◽  
Joint Stability ◽  
Functional Link ◽  
Moment Arms ◽  
Concentric Spheres

Aims In patients with a rotator cuff tear, tear pattern and tendon involvement are known risk factors for the development of pseudoparalysis of the shoulder. It remains unclear, however, why similar tears often have very different functional consequences. The present study hypothesizes that individual shoulder anatomy, specifically the moment arms (MAs) of the rotator cuff (RC) and the deltoid muscle, as well as their relative recruitment during shoulder abduction, plays a central role in pseudoparalysis. Materials and Methods Biomechanical and clinical analyses of the pseudoparalytic shoulder were conducted based on the ratio of the RC/deltoid MAs, which were used to define a novel anatomical descriptor called the Shoulder Abduction Moment (SAM) index. The SAM index is the ratio of the radii of two concentric spheres based on the centre of rotation of the joint. One sphere captures the humeral head (numerator) and the other the deltoid origin of the acromion (denominator). A computational rigid body simulation was used to establish the functional link between the SAM index and a potential predisposition for pseudoparalysis. A retrospective radiological validation study based on these measures was also undertaken using two cohorts with and without pseudoparalysis and massive RC tears. Results Decreased RC activity and improved glenohumeral stability was predicted by simulations of SAM indices with larger diameters of the humeral head, being consequently beneficial for joint stability. Clinical investigation of the SAM index showed significant risk of pseudoparalysis in patients with massive tears and a SAM < 0.77 (odds ratio (OR) 11). Conclusion The SAM index, which represents individual biomechanical characteristics of shoulder morphology, plays a determinant role in the presence or absence of pseudoparalysis in shoulders with massive RC tears.

scholarly journals What is the Optimal Reconstruction Option after the Resection of Proximal Humeral Tumors? A Systematic Review

2017 ◽  
Vol 11 (1) ◽  
pp. 203-211 ◽  
Author(s):  
Andrew Dubina ◽  
Brian Shiu ◽  
Mohit Gilotra ◽  
S. Ashfaq Hasan ◽  
Daniel Lerman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Proximal Humerus ◽  
Deltoid Muscle ◽  
Axillary Nerve ◽  
Functional Requirements ◽  
Postoperative Function ◽  
Osteoarticular Allograft ◽  
Common Location ◽  
Vascularized Fibula

Purpose: The proximal humerus is a common location for both primary and metastatic bone tumors. There are numerous reconstruction options after surgical resection. There is no consensus on the ideal method of reconstruction. Methods: A systematic review was performed with a focus on the surgical reconstructive options for lesions involving the proximal humerus. Results: A total of 50 articles and 1227 patients were included for analysis. Reoperation rates were autograft arthrodesis (11%), megaprosthesis (10%), RSA (17%), hemiarthroplasty (26%), and osteoarticular allograft (34%). Mechanical failure rates, including prosthetic loosening, fracture, and dislocation, were highest in allograft-containing constructs (APC, osteoarticular allograft, arthrodesis) followed by arthroplasty (hemiarthroplasty, RSA, megaprosthesis) and lowest for autografts (vascularized fibula, autograft arthrodesis). Infections involving RSA (9%) were higher than hemiarthroplasty (0%) and megaprosthesis (4%). Postoperative function as measured by MSTS score were similar amongst all prosthetic options, ranging from 66% to 74%, and claviculo pro humeri (CPH) was slightly better (83%). Patients were generally limited to active abduction of approximately 45° and no greater than 90°. With resection of the rotator cuff, deltoid muscle or axillary nerve, function and stability were compromised even further. If the rotator cuff was sacrificed but the deltoid and axillary nerve preserved, active forward flexion and abduction were superior with RSA. Discussion: Various reconstruction techniques for the proximal humerus lead to relatively similar functional results. Surgical choice should be tailored to anatomic defect and functional requirements.

scholarly journals Operative Trearment Unoperative Chronic and Massive Rotator Cuff Tendon Rupture of the Shoulder

2017 ◽  
Vol 2 (1) ◽  
pp. 398
Author(s):  
Lanshakov V.A.
Keyword(s):  
Surgical Treatment ◽  
Rotator Cuff ◽  
Shoulder Joint ◽  
Tendon Rupture ◽  
Positive Outcomes ◽  
Rotator Cuff Tendon

In clinic of traumatology and orthopedics GBOU DPO NGIUV was treated 125 patients with tendon rupture rotators of the shoulder joint, in which treatment was used as the classic methods of surgical treatment, and we have developed approaches and methods of surgical treatment with the use of sutures and staples of nickelid titanium allowing to bring the number of positive outcomes to 84.8%.

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 Cadaveric evaluation of the feasibility of glenohumeral joint denervation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Amr M. Aly
Keyword(s):  
Muscle Weakness ◽  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Axillary Nerve ◽  
Low Risk ◽  
Dorsal Approach ◽  
Articular Branch ◽  
Pectoral Nerve ◽  
Teres Minor

Abstract Purpose To assess the feasibility of total shoulder denervation through two proposed incisions. Methods Total shoulder denervation was performed through an extended delta-pectoral approach and a transverse dorsal approach at the spine of the scapula. The study involved six cadavers. Course and number of articular branches from the lateral pectoral, axillary and supra-scapular nerve were documented. Results All shoulder joint articular branches were accessible through the proposed anterior and posterior approaches. The articular branch of the lateral pectoral nerve and supra scapular nerve were present in all the specimen. Axillary nerve articular branches were variable in number but when present anteriorly were proximal to the deltoid muscular branches and posteriorly proximal to the muscular branches to the teres minor. Conclusion Total glenohumeral denervation was feasible through our proposed anterior and posterior approaches. Enhanced knowledge of articular nerve branches could provide interventional targets for joint and ligament pain, with low risk of muscle weakness.

Sign in / Sign up

Export Citation Format

Share Document