Tumors of the Acromion Process—A Pictorial Review

Introduction Acromion is essential for stabilizing the shoulder complex. Tumors of the acromion are rare. We report the largest series of acromion tumor and tumor-like lesion. Materials and Methods A retrospective review of the oncology and radiology database within our tertiary center for orthopaedic oncology was performed to identify all tumors of the acromion over the past 30 years and imaging was reviewed. Results We identified a total of 31 lesions arising in the acromion and chondrosarcoma was the commonest. Conclusion One needs to be aware of tumor and tumor-like lesions of acromion.

Validity, Agreement and Accuracy of A Hand-Held Dynamometer for Shoulder Muscles Strength Assessment in Healthy Individuals

Background: The shoulder complex has a high prevalence of injuries. It is fundamental to quantify the muscle strength and identify muscular imbalances that predispose to lesions. The aim was to test concurrent validation of the muscle strength assessment with a hand held dynamometer (HHD) for shoulder joint muscles, and measure the accuracy and diagnostic agreement between instruments for assessing the strength of this joint with the hand held dynamometer and isokinetic dynamometer (ID) in a population of healthy individuals Methods: healthy individuals aged between 18 and 40 years were included. The HHD was used to test the isometric contraction of the main shoulder movements. Isometric contraction was performed for 3 seconds. Assessments with HHD and DI were performed on the same day, with a minimum interval of 90 minutes between tests. The study was approved by the Ethics Committee by report No.1537948. Concurrent validation was calculated with Pearson’s correlation, the accuracy obtained by the ROC curve and agreement by Kappa test. Results: The HHD showed concurrent validation between 0.51 – 0.83, with sensitivity between 0.90 and 0.98 and specificity between 0.64 and 0.89 for shoulder movements. The HHD demonstrated moderately-strong to excellent concurrent validity. Conclusion: These results are encouraging for the routine use of this portable and lower cost instrument in quantification of the pique torque of the shoulder muscles. Moreover, this instrument showed good accuracy and moderate to high agreement in comparison with diagnosis of the gold standard instrument.

Ergonomic Consideration in Pillow Height Determinants and Evaluation

(1) Background: Sleep problems have become one of the current serious public health issues. Pillow height affects the alignment of the cervical spine and is closely related to the mechanical environment of the cervical spine. An appropriate pillow height can provide adequate support for the head and neck to reduce the stress in the cervical spine and relax the muscles of the neck and shoulder, thereby relieving pain and improving sleep quality. (2) Methods: We reviewed the current trends, research methodologies, and determinants of pillow height evaluation, summarizing the evidences published since 1997. In particular, we scrutinized articles dealing with the physiological and mechanical characteristics of the head-neck-shoulder complex. (3) Results: Through the investigation and analysis of these articles, we presented several quantitative and objective determinants for pillow height evaluation, including cervical spine alignment, body dimension, contact pressure, and muscle activity. The measurement methods and selection criteria for these parameters are described in detail. However, the suggested range for achieving optimal cervical spine alignment, appropriate pressure distribution, and minimal muscle activity during sleep cannot yet be identified considering the lack of sufficient evidence. Moreover, there remain no firm conclusions about the optimal pillow height for the supine and lateral positions. (4) Conclusions: A comprehensive evaluation combining the above determinants provides a unique solution for ergonomic pillow design and proper pillow height selection, which can effectively promote the public sleep health. Therefore, it is necessary to develop a reasonable algorithm to weigh multiple determinants.

Effects of Internal Fixation for Mid-Shaft Clavicle Fractures on Shoulder Kinematics During Humeral Elevations

BackgroundMid-shaft clavicle fractures account for 35 to 44% of injuries to the shoulder girdle. There is increasing evidence to support surgical repair, but poor functional outcomes have been reported, and associated factors remain unclear.MethodsThe three-dimensional poses of the shoulder bones during arm elevations were measured in 15 patients treated for mid-shaft clavicle fractures by open reduction and internal fixation, and in 15 healthy controls.Results and ConclusionNo significant between-side differences were found in the clavicle length after surgery (p > 0.05). The patients showed increased scapular protraction at lower elevation angles and reduced scapular retraction at higher elevation angles during frontal-plane elevations, with significantly reduced clavicle retraction (p < 0.05), with unaltered scapular rotation and tilt. The ranges of the observed changes were reduced to arm elevations at 60° and 90° in the scapular and sagittal planes. Similar changes were also found on the unaffected side, suggesting symmetrical bilateral compensation. The results suggest that shoulder kinematics in multi-plane arm elevations should be monitored for any signs of compromised bone motions following surgical treatment, and that rehabilitative training may be needed on both sides to improve the bilateral movement control of the shoulder complex.

The Association of a Floating Elbow and a Homolateral Dislocated Floating Shoulder (About a Case)

The floating elbow is a rare lesion, characterized by the presence of a fracture of the humerus and one or both bones of the homolateral forearm. Double disturbances of the upper suspensory shoulder complex, commonly referred to as “floating shoulder” injuries, are ipsilateral fractures of the clavicle and scapula with loss of bone attachment of the glenoid. The combination of a floating elbow and floating shoulder is extremely rare, added an ipsilateral dislocation of the glenohumeral remains exceptional. No case has been reported in the literature of such a lesional association. This observation makes it possible to describe an extremely rare lesion, by proposing the therapeutic attitude and the prognosis.

Flexibility, Position, and Strength of the Shoulder Complex in Pediatric and Adult Amateur Tennis Athletes

Context: Understanding the musculoskeletal adaptations in the shoulder complex of varying ages of tennis athletes may suggest preventive protocols and conditioning and rehabilitation programs to this population. This study aimed to generate a bilateral descriptive profile of shoulder flexibility, scapular and clavicular position, and muscle strength in pediatric and adult amateur tennis athletes. The outcome measures were compared between groups and sides. The number and percentage of athletes “at risk” according to cutoff values for shoulder range of motion (ROM) were also analyzed. Design: Cross-sectional study. Methods: 36 pediatric and 28 adult amateur tennis athletes were tested. Outcome measures were ROM of shoulder flexion, abduction, internal and external rotation, posterior capsule tightness, pectoralis minor index (PMI), scapular upward rotation, clavicular elevation, and strength of the external rotators, serratus anterior, and lower trapezius of the dominant/nondominant sides. Results: Pediatric athletes had greater dominant side external rotation (P = .01) and total ROM (P = .04), increased Low Flexion test (P = .01), and decreased PMI (P = .01) compared with the adults. Bilaterally, the pediatric athletes had greater dominant side external rotation ROM (P < .01) and decreased PMI (P = .002) as compared with their nondominant side, whereas the adults displayed lower values on posterior capsule tightness (P = .01) and decreased PMI (P = .02) on their dominant side compared with their nondominant side. For the remaining outcomes, no interaction effects were observed. The cutoff values for shoulder ROM showed that several athletes were “at risk” of shoulder problems. Conclusion: Upper extremity adaptations at the shoulder are present in both pediatric and adult tennis athletes. These data can assist clinicians in better understanding the biomechanical adaptations in the shoulder of amateur tennis athletes in different age groups.