Scapular Malalignment in Patients with Stroke: A Narrative Review

Background: Scapular Malalignment leads to functional incapacity in stroke patients. This malalignment hampers the functional mobility and stability of shoulder joint in stroke patients due to which there is reduced range of motion and hampers activities of daily living in stroke patients. So, to investigate the extent of scapular malalignment in patients with acute, chronic and sub-acute stroke. Methods: Four databases (PubMed, Google Scholar, Cochrane, Science Direct) were searched to identify eligible studies using the keywords Scapular Malalignment and Stroke. Only observational studies published in last 10 years (2010-2020) were included in this review. Results: Eight Studies, included in the review were conducted on patients with acute, sub-acute and chronic stage. The results showed that there is more of inferior angle tilting seen in patients with stroke and it increases with spasticity and alters functional mobility in patients with stroke. Discussion: All studies were consistent in using the appropriate tools for measurement of scapular malalignment. Literature showed scapular malalignment affects scapular balance angle, functional mobility of hand and range of motion in patients with acute, sub-acute and chronic stroke. Most of the literature includes patients with sub-acute and chronic stroke. There was no conflict of evidence observed among all articles. Conclusion: There is influence of Scapular malalignment on spasticity, duration of stroke, upper limb mobility, and range of motion in stroke patients. Scapular Malalignment is observed in acute, sub-acute and chronic rotation and there is more of inferior angle tilting and rotation of scapula observed. KEY WORDS: Scapular Malalignment, stroke.

Relationship Between Rotator Cuff Tears and Scapular Morphology

Background The purpose of this study was to identify differences in the morphology of the scapula according to the presence or absence of a rotator cuff tear (RCT). Methods One hundred and three shoulders with and 87 shoulders without RCTs were included in this study. The critical shoulder angle (CSA) and lateral acromion angle in the frontal view and the acromial coverage angle (ACA) and coracoid and scapular spine angle (CSSA) in the lateral view were evaluated using three-dimensional computed tomography. The glenoid anterior tilt, anterior acromial projection angle (AAPA), coracoid process angle, scapular spine angle (SSA) and inferior angle angle (IAA) with respect to the scapular plane were measured in the lateral view. The morphological parameters of the scapula associated with RCT were statistically analysed using a multivariate logistic regression analysis. Results In univariate logistic regression analysis, CSA, ACA, CSSA, AAPA, SSA and IAA were significantly different between shoulders with and without RCTs. In multivariate logistic regression analysis, CSA and IAA were greater in shoulders with RCT and were significantly associated with this condition. Conclusion To the best of our knowledge, this is the first study to focus on the relationship between RCT and the scapular body. RCT cases were characterised by a greater curvature of the scapular body in addition to CSA.

Thoracic spine teardrop fracture – A case report

This is a case report of a young man who suffered from an anterior inferior angle fracture (teardrop) of the thoracic spine at the dorsal spine third vertebra (D3). It was due to a road traffic accident and led to paraplegia and hypoesthesia below D7 dermatome. The patient was treated with decompression and posterior stabilization using pedicle screw fixation followed by physiotherapy. Teardrop fracture is a type of cervical fracture that is associated with high morbidity and mortality due to its instability, with no reported similar fracture pattern at the thoracic spine level. This is a unique case of a thoracic teardrop fracture that was treated surgically with a posterior approach, a good clinical outcome, and 18 months follow-up.

Evaluation of Late Postural Complications in Breast Cancer Patients Undergoing Breast-Conserving Therapy in Relation to the Type of Axillary Intervention-Cross-Sectional Study

Purpose: The aim of the study was to evaluate posture in patients undergoing breast-conserving therapy (BCT) in relation to the type of surgical intervention to the axilla. Methods: The study was conducted on patients who had undergone breast-conserving surgical treatment for breast cancer 5–6 years earlier. In 54 patients, BCT+ALND (axillary lymph node dissection) was performed, while 63 patients were subjected to BCT+SLND (sentinel lymph node dissection). The control group consisted of 54 females. The study was conducted using digital postural assessment. Results: No statistically significant differences were observed with respect to the parameters between the BCT+SLNB and BCT+ALND groups (p > 0.05). However, the differences were highly significant between the CG (control group) and the studied groups (BCT+ALND, BCT+SLNB) for the following parameters: BETA angle of thoracolumbar spine inclination (p = 0.002), GAMMA angle of thoracic spine inclination (p = 0.0044), TKA (thoracic kyphosis angle) (p < 0.0001) and shoulder level inclination (p = 0.0004). The BCT+ALND patients were characterized by higher dependency of raised shoulder (p = 0.0028) and inferior angle of the scapula (p = 0.00018) on the operated side compared to BCT+SLNB patients. Conclusions: Postural imbalance occurs independent of the type of axillary intervention. Disturbances within the upper torso (abnormal position of shoulders and inferior angles of scapulae) are more pronounced in patients after ALND.

Scapulothoracic Alignment Alterations in Patients with Walch Type B Osteoarthritis: An In Vivo Dynamic Analysis and Prospective Comparative Study

Background: Kinematic changes of the scapulothoracic joint may influence the relative position of the glenoid fossa and, consequently, the glenohumeral joint. As the alignment of the scapula relative to the thorax differs between individuals, such variability may be another factor in the development of posterior head subluxation. The purpose of this study was to compare scapulothoracic alignment in pathologic type B shoulders with contralateral healthy shoulders. Methods: Seven adult volunteers with unilateral type B glenohumeral osteoarthritis (OA) underwent bilateral computed tomography (CT) scans of the shoulders and arms. A patient-specific, three-dimensional measurement technique that coupled medical imaging (i.e., CT) and optical motion capture was used. Results: The scapulothoracic distance at the trigonum was 75 ± 15 mm for pathologic shoulders and 78 ± 11 mm for healthy shoulders (p = 0.583), while at the inferior angle, it was 102 ± 18 mm for pathologic shoulders and 108 ± 12 mm for healthy shoulders (p = 0.466). Conclusion: Scapula positioning at a resting position did not differ between pathologic and healthy shoulders. However, pathologic shoulders tended to be limited in maximal glenohumeral motion and exhibited greater anterior tilt of the scapula in internal rotation at 90 degrees, which may be adaptive to the restricted glenohumeral motion.

Clinical Factors Related to Improved Scapular Control After a Scapular Conscious Control Program in Symptomatic Overhead Athletes: Secondary Analysis of a Randomized Controlled Trial

Background: Predictive variables associated with the effects of a scapular conscious control program should be identified and used to guide rehabilitation programs. Purpose: To determine whether potential factors are associated with the success of scapular muscle balance with an early control program in patients with subacromial pain and scapular dyskinesis. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 38 amateur overhead athletes with subacromial pain and medial border prominence were recruited. They performed progressive conscious control of scapular orientation during 45° and 90° of arm elevation. Stepwise logistic regression and receiver operating characteristic curve were used to determine the optimal cutoff point of related factors for success or failure of the program. Potential factors including pain level during activity, pain duration, anterior/posterior shoulder flexibility, forward shoulder posture, posterior displacement of root of spine and inferior angle, scapular kinematics, and muscle activation before conscious control program were recorded as independent variables. Successful control defined as decreases of the upper trapezius/serratus anterior ratio in 2 consecutive trials of the 90° program or failure in the program was used as a dependent variable. Results: Having a posterior displacement of the inferior angle of the scapula of ≤16.4 mm and scapular posterior tipping during arm elevation of ≤3.3° (collected before the control program) were associated with the success of the program ( R 2 = 0.286; P < .05). Additionally, participants with each or both variables present at baseline had probabilities of success of 78% and 95%, respectively. Conclusion: The value of scapular posterior displacement and posterior tilt should be considered before early scapular control program. Other factors related to the success of the program should be found due to the limited variance explained in the regression model.

Endoscopy-assisted removal of angle foreign body presenting as persistent localised corneal oedema

A 20-year-old man presented to us with injury to the left eye by a glass bulb 3 weeks ago. The acute injury resolved with a peculiar residual localised corneal oedema in the inferior one-third of the cornea . This localised oedema in absence of any evidence of a localised visible injury to the cornea indicated towards a possible retained foreign body. The foreign body visibility was equivocal on gonioscopy. Subsequently via a limbal incision, an endoscope was introduced into the anterior chamber. The endoscopic view revealed the glass foreign body lodged into the inferior angle of the eye which was removed with the help of an intraocular forceps. Over the next week, the corneal oedema resolved completely.

Ventral scapular osteochondroma excision through ‘triangle of auscultation’: A case series

Introduction: Surgical intervention through the ‘triangle of auscultation’ is less morbid to patients, as it is devoid of muscles and provides an easy access to tumours arising on the ventral aspect of scapula especially near inferior angle. Method: Three patients presented to us with pseudo-winging of scapula and an audible thud on abduction of the arm. A bony mass, painful in two and painless in one patient, was palpable along the anterior aspect of the inferior angle of scapula. A clinical diagnosis of osteochondroma was made which was corroborated by X-rays and computed tomography (CT) imaging. Ventral scapular osteochondroma excision is challenging due to multiple muscle attachments, requiring extensive soft tissue dissection and muscular release. Numerous blood vessels and nerves in the vicinity may also add to the degree of difficulty. This necessitates the need of a minimally invasive and muscle-sparing procedure. We hereby describe a novel surgical approach to the ventral aspect of scapula through the triangle of auscultation for excision of scapular osteochondroma. Results: Pseudo-winging disappeared following surgery. Snapping of the scapula resolved with early, full shoulder range of motion. Quick disabilities of arm, shoulder and hand (DASH) score improved from mean 20.2 preoperatively to 0 postoperatively at 3 months in all the patients. Conclusion: The approach is simple with minimal blood loss as it does not involve splitting or cutting of trapezius, rhomboid major or subscapularis muscles.

The Effects of Force That Pushes Forward Lumbar Region on Sagittal Spinal Alignment When Wearing Backpack

The purpose of this study is to design a backpack to push the lumbar region forward and confirm the change in the sagittal plane of the spine using radiography when wearing the backpack to present an effective backpack wearing method that can help spinal alignment. Place the question addressed in a broad context and highlight the purpose of the study. A total of 14 adult volunteers participated in the study. The study was carried out on the subjects without carrying a backpack, with a general backpack, and with a backpack designed to push the lumbar region forward. We investigated cervical, thoracic, lumbar, and sacral alignment under these three conditions. Lumbar lordosis showed a significant decrease in the state of wearing a general backpack compared to the case without a backpack, and a significant increase in the state of wearing a backpack designed to push the lumbar region forward rather than a general backpack. In addition, the sacral slope was significantly increased when carrying the backpack designed to push the lumbar region forward, compared to carrying the general backpack. There was a significant correlation between the sacral and lumbar alignment change when wearing the backpack compared to the state without a backpack. The results of this study indicate that wearing a backpack designed to push the lumbar region forward may contribute to the recovery of lumbar lordosis that is reduced when wearing a general backpack. This may be due to an increase in the sacral slope corresponding to the inferior angle of lumbar spine.