Scapula Dyskinesis

Scapular dyskinesis is any alteration of its static position or kinematics during movements in the shoulder joint. The correct scapula orientation is associated with the tone of the muscles attached to it. The prevalence of scapular dyskinesis is high among patients with subacromial impingement syndrome, partial rotator cuff tears, shoulder joint instability and SLAP injuries. Scapular dyskinesis can be caused by a whole range of factors, including upper cross syndrome and postural adaptations predisposing to it, neurological disorders. However, instrumental diagnosis of scapular dyskinesis is difficult, which makes the use of clinical tests the main method of its detection. In this lecture, the etiology of scapular dyskinesis, classification, diagnostic tests and treatment methods are analyzed in detail. The detection of scapular dyskinesis and its type determination in patients with shoulder joint pathologies allows us to form an optimal rehabilitation therapy protocol, including techniques of myofascial release, passive and active stretching of spasmodic and training of weak muscle groups aimed at correcting postural disorders, pathology of the scapulohumeral rhythm, restoration of the glenohumeral joint normal biomechanics.

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Could superior capsule findings be used as a predictor for partial bursal-sided rotator cuff tears?

Journal of Orthopaedic Surgery ◽

10.1177/2309499019895153 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949901989515 ◽

Cited By ~ 1

Author(s):

Ulunay Kanatlı ◽

Tacettin Ayanoglu ◽

Erdinc Esen ◽

Baybars Ataoglu ◽

Mustafa Ozer ◽

...

Keyword(s):

Rotator Cuff ◽

Glenohumeral Joint ◽

Arthroscopic Treatment ◽

Rotator Cuff Tears ◽

Subacromial Impingement Syndrome ◽

Control Group ◽

Study Group ◽

Coracoacromial Ligament ◽

Cuff Tear ◽

Significant Difference

Purpose: The purpose of this study was to investigate the relationship between the superior capsule tear patterns and synovitis with subacromial pathologies, such as bursal-sided rotator cuff tear and subacromial impingement syndrome. Methods: Fifty patients who underwent arthroscopic treatment for isolated bursal-sided tear were included in the study. Fifty more patients who underwent arthroscopic treatment for isolated Superior Labrum Anterior Posterior (SLAP) 2 lesion without pathology in the rotator cuff were included in the control group. Firstly, superior capsule tear and common synovitis on the rotator cable were assessed during glenohumeral joint examination. Coracoacromial Ligament (CAL) degeneration grading was performed according to the Royal Berkshire Hospital classification. Bursal-sided partial tear grading was done using Ellman classification. Whether or not there was a relationship between synovitis, classic capsule tear, plus reverse flap capsule tear, and partial bursal-sided tear existence. Results: There were 21 patients with reverse flap capsule tear in the study group and 3 patients in the control group. In addition, there were 13 patients with synovitis in the study group and 4 in the control group. Compared to the control group, there was also a significant positive correlation in the presence of both synovitis and reverse flap capsule tear with the presence of bursal-sided tear in the study group ( p = 0.000). There was, however, no significant difference between the presence of classical capsule tear and the presence of bursal-sided tear ( p = 0.485). Conclusion: This study shows that the presence of reverse flap capsule tear and synovitis was associated with partial bursal-sided tears. Therefore, if the reverse flap capsule tear or synovitis is detected in the superior capsule, the rotator cuff should be evaluated in more detail during subacromial bursoscopy in order not to miss a bursal-sided partial cuff tear.

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Internal Impingement of the Shoulder

The American Journal of Sports Medicine ◽

10.1177/0363546508324966 ◽

2008 ◽

Vol 37 (5) ◽

pp. 1024-1037 ◽

Cited By ~ 89

Author(s):

Benton E. Heyworth ◽

Riley J. Williams

Keyword(s):

Rotator Cuff ◽

Glenohumeral Joint ◽

Capsular Contracture ◽

Rotator Cuff Tears ◽

Scapular Dyskinesis ◽

Glenohumeral Instability ◽

Overhead Athletes ◽

Internal Impingement ◽

Results Of Treatment ◽

Orthopaedic Literature

Internal impingement of the shoulder is a pathologic condition characterized by excessive or repetitive contact of the greater tuberosity of the humeral head with the posterosuperior aspect of the glenoid when the arm is abducted and externally rotated. This arm positioning leads to rotator cuff and glenoid labrum impingement by the bony structures of the glenohumeral joint. Although some degree of contact between these structures occurs under normal conditions, to date most of the orthopaedic literature has focused on internal impingement as a disease state that affects overhead athletes and is characterized by the development of articular-sided rotator cuff tears and posterosuperior labral lesions. The precise cause of these impingement lesions remains unclear. However, it is believed that varying degrees of glenohumeral instability, posterior capsular contracture, and scapular dyskinesis may play a role in the development of symptomatic internal impingement. The purpose of this article is to review the pathomechanics, clinical complaints, physical examination findings, and imaging findings that are associated with internal impingement. The results of treatment will be reviewed, and a diagnostic and therapeutic algorithm for the management of internal impingement is presented.

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Cadaveric evaluation of the feasibility of glenohumeral joint denervation

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00322-x ◽

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.

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The Evolution and Role of the Bursal Acromial Reconstruction

Video Journal of Sports Medicine ◽

10.1177/26350254211001367 ◽

2021 ◽

Vol 1 (2) ◽

pp. 263502542110013

Author(s):

Daniel M. Curtis ◽

W. Michael Pullen ◽

Kevin Helenius ◽

Michael T. Freehill

Keyword(s):

Glenohumeral Joint ◽

Total Shoulder Arthroplasty ◽

Treatment Options ◽

Clinical Problem ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Subacromial Space ◽

Promising Alternative ◽

Diagnostic Arthroscopy ◽

Superior Capsular Reconstruction

Background: Massive, irreparable rotator cuff tears (RCTs) remain a challenging clinical problem with numerous described treatment options. Bursal acromial reconstruction (BAR) represents a promising and evolving technique for a subset of patients with irreparable RCTs. Indications: BAR is indicated for patients with massive, irreparable RCTs with a primary complaint of pain, well-compensated shoulder function, and minimal radiographic degenerative changes of the glenohumeral joint as an alternative to reverse total shoulder arthroplasty or superior capsular reconstruction. Technique Description: Positioning per surgeon preference and diagnostic arthroscopy is performed. Subacromial decompression with a minimal and gentle acromioplasty is performed, followed by assessment of RCT repairability. If the tear is deemed irreparable, acromial measurements in the medial-lateral and anterior-posterior dimensions are obtained. Two pieces of acellular dermal allograft are cut to the acromial dimensions and affixed together using fibrin glue. The reactive side (facing the acromion), medial, and anterior sides of the graft are labeled. Two suture tapes are passed through the corners of the graft and self-locked and run diagonally in a cruciate configuration using an antegrade suture passer. Medial and lateral #2 fiberwire sutures are placed in a luggage-tag configuration. Neviaser (posterior), middle, and anterior acromioclavicular joint portals are created for medial sided suture passage. Medial graft sutures are shuttled through the respective medial portals and the graft is pulled into the subacromial space. The lateral sutures are then removed from percutaneous posterolateral, middle lateral, and anterolateral portals along the acromial edge. Medial sutures are retrieved using a suture grasper subcutaneously on top of the acromion through the percutaneous lateral portals. The sutures are tied through the lateral portals, starting with the medial-lateral sutures, and the knots are buried. Postoperatively, patients are progressed through passive, active-assisted, and active range of motion between weeks 2 and 6 and strengthening is progressed at 6 weeks. Results: Clinical results are lacking in the literature, but anecdotal results in our institution have demonstrated promising early outcomes. Discussion/Conclusion: BAR represents a promising alternative in the array of surgical options for treatment of irreparable RCTs.

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

The American Journal of Sports Medicine ◽

10.1177/0363546518805091 ◽

2018 ◽

Vol 46 (14) ◽

pp. 3486-3494 ◽

Cited By ~ 5

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.

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A study on the position sense of the shoulder joint in the cases of the rotator cuff tears

Journal of Shoulder and Elbow Surgery ◽

10.1016/s1058-2746(95)80285-1 ◽

1995 ◽

Vol 4 ◽

pp. S82 ◽

Cited By ~ 1

Author(s):

Yutaka Morisawa

Keyword(s):

Rotator Cuff ◽

Shoulder Joint ◽

Position Sense ◽

Rotator Cuff Tears

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Біоморфологія м’язів, діючих на плечовий суглоб чорнодзьобої гагари

Scientific Messenger of LNU of Veterinary Medicine and Biotechnology ◽

10.15421/nvlvet8225 ◽

2017 ◽

Vol 19 (82) ◽

pp. 120-124

Author(s):

O.O. Melnyk ◽

M.V. Melnyk

Keyword(s):

Aquatic Environment ◽

Shoulder Joint ◽

Elbow Joint ◽

Shoulder Girdle ◽

Gavia Immer ◽

Environmental Sciences ◽

National University ◽

Development And Differentiation ◽

Muscle Groups ◽

First Time

The article presents the results of studies of the biomorphological features of muscles acting on shoulder joint of some representatives of order Gaviiformes. Shoulder joint is a multifaceted joint, movements of which are provided not only by the muscles of the shoulder joint itself, but also some muscles of the shoulder girdle and elbow joint. It should be noted that the main muscles of the flight of birds are muscles of the shoulder girdle, in particular: thoracic and m. supracoracoideus. Also important are some of the muscles of the elbow, in particularm.coraco-radialis and m. scapula-triceps This is confirmed both by the points of fixation, and the degree of their development.The degree of development and differentiation of muscles acting on the shoulder joint is different, which is due to the peculiarities of the wing operation during the flight, and in waterfowl – peculiarities of underwater swimmingusing wings. The aim of this biomorphological study was understanding of development degree, and the main, mechanisms of differentiation and transformation of muscles acting on the shoulder joint of birds adapted to the aquatic habitat.Material for research was obtained from the funds of the Department of anatomy of Animals named after acad. V.G. Kasyanenko of the National University of Life and Environmental Sciences of Ukraine, where the muscle structures of the shoulder joint were studied on black-tailed gagar Gavia immer in number of 3 individuals. Birds of Gaviiformes order are characterized by a rapid, but little maneuverable flight. They are extremely well adapted to the aquatic environment and spend most of their lives in the water, leaving on land only during breeding. These birds perfectly swim and dive, and during diving use not only the pelvic fins but also the wings. This, in turn, imposes certain imprints on the degree of development and differentiation of the studied muscle groups. It was found that among the studied groups of muscles (shoulder girdle, shoulder and elbow joints) the most developed group of muscles is shoulder girdle – 86%. The muscle groups of the elbow – 8.5% and the shoulder – 5.4% of the joints are significantly less. In addition, for the first time, we have found that the largest in its development among all the muscles examined - the thoracic muscle (the group of muscles of the shoulder girdle) has significant differences in comparison with other species of birds. These differences consist in the fact that this muscle is clearly differentiated into two separate layers, in fact two separate muscles – superficial and deep, most of which are developed superficial. Such a differentiation is due to biomorphological adaptations to the habitat.

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

Clinical Practice ◽

10.17816/clinpract19268 ◽

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.

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