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.

Clinical and imaging features of tumors in the scapula

Background: Scapula is a small irregular-shaped flat bone, which may suffer from a variety of tumors or tumor-like lesions. Because the imaging manifestations are complex and changeable, correct imaging diagnosis is difficult. Introduction: At present, there are few related radiology literatures, and it is necessary to fully analyze the imaging signs of different types of benign and malignant tumors in scapula to guide clinical treatment. This study was to investigate clinical and imaging presentations of tumors and tumor-like lesions in the scapula so as to increase the diagnostic accuracy of diseases in the scapula. Methods: Patients with scapular tumors confirmed by pathology were enrolled. The imaging and clinical data were analyzed. Result: Among 108 patients, benign tumors were in 53 (49.1%) cases, intermediate in seven (6.5%), and malignant in 48 (44.4%) involving 16 diseases. Osteochondroma was the first benign tumors in 45 cases accounting for 84.9% of all benign scapular tumors followed by chondroma in four cases (7.5%). The intermediate tumors were mainly eosinophilic granuloma in four cases. Metastatic tumors were the commonest malignant tumor (27 cases or 56.2% of all malignant tumors), followed by chondrosarcoma (in 13 cases). Except for the one case of chondroblastoma in which the lesion involved the glenoid cavity, all the other cartilaginous tumors were located in the scapular body and processes. The type of lesions in the bony processes is the same as in the scapular body, the common lesions in the central area of body were malignant tumors, and the commonest lesions in the glenoid area were metastasis. Common imaging features of malignant scapular tumors were ill-defined margins, cortical destruction and soft tissue involvement. The imaging features of chondrosarcoma lack specificity except calcification. Benign lesions usually had clear boundary and marginal sclerosis. Conclusion : A wide variety of benign and malignant tumors may occur in the scapula with mostly cartilaginous and metastatic tumors, and the location and distribution of lesions are similar in the scapula to those in the long bones.

Difference in glenoid retroversion between two-dimensional axial computed tomography and three-dimensional reconstructed images

Background: The glenoid version of the shoulder joint correlates with the stability of the glenohumeral joint and the clinical results of total shoulder arthroplasty. We sought to analyze and compare the glenoid version measured by traditional axial two-dimensional (2D) computed tomography (CT) and three-dimensional (3D) reconstructed images at different levels.Methods: A total of 30 cases, including 15 male and 15 female patients, who underwent 3D shoulder CT imaging was randomly selected and matched by sex consecutively at one hospital. The angular difference between the scapular body axis and 2D CT slice axis was measured. The glenoid version was assessed at three levels (midpoint, upper one-third, and center of the lower circle of the glenoid) using Friedman’s method in the axial plane with 2D CT images and at the same level of three different transverse planes using a 3D reconstructed image. Results: The mean difference between the scapular body axis on the 3D reconstructed image and the 2D CT slice axis was 38.4°. At the level of the midpoint of the glenoid, the measurements were 1.7° ± 4.9° on the 2D CT images and −1.8° ± 4.1° in the 3D reconstructed image. At the level of the center of the lower circle, the measurements were 2.7° ± 5.2° on the 2D CT images and −0.5° ± 4.8° in the 3D reconstructed image. A statistically significant difference was found between the 2D CT and 3D reconstructed images at all three levels. Conclusions: The glenoid version is measured differently between axial 2D CT and 3D reconstructed images at three levels. Use of 3D reconstructed imaging can provide a more accurate glenoid version profile relative to 2D CT. The glenoid version is measured differently at different levels.

Gleno-humeral Joint Functional Outcome in Displaced Scapular Body Fracture Treated with Anatomical Scapula Plate: 2 case series

Introduction: The gleno-humeral (GH) or shoulder joint complexity of its biomechanics had been subjected for a number of study for many years. The ability of the shoulder joint to have multiple degrees of motion is contributed by the interaction between the structures surrounding the joint which maintain its stability. Methods: We report 2 cases of displaced scapular body fracture in our trauma centre fixed using anatomical scapular plate. Both underwent surgery within 3 weeks after their accident, using modified Judet approach and used implant from the same provider. All patients were followed up at 6, 12 , 18 and 72 weeks. At 6 months post operation the motion of the gleno-humeral joint were assessed. The functional status and pain score were joint also assessed using QuickDASH score and Visual Analogue Scale respectively. Results: Active shoulder range of motion, QuickDASH and VAS score are shown in Table 1. Lower QuickDASH score have better functional outcome while lower VAS score indicate lesser pain experience. [Table: see text] Discussions: Scapulo-thoracic joint also important in gleno-humeral joint motion. Scapulothoracic motion allows shoulder movement beyond initial 120o provided by the glenohumeral joint1. This coordinated movement between the scapula-thoracic and glenohumeral joint is termed as scapula-thoracic rhythm2. Displaced scapula fracture will affect the function of the scapula-thoracic rhtym. Scapula bone has uneven bony mass distribution. Anatomical scapular plate is a pre-contoured implant which is specially designed to meet the morphology of the scapula bone. Restoration of the anatomy of the scapula is very important since it will restore the scapula-thoracic rhythm and thus gleno-humeral joint function. Conclusion: In our short follow up, displaced scapular body fracture shows good gleno-humeral joint functional outcome when treated with anatomical scapula plate. Scapula bone plays important role in maintaining the biomechanics of gleno-humeral joint. References: 1. Terry GC, Chopp TM. Functional anatomy of the shoulder. J Athlet Train 2000;35(3):248–55. 2.Halder AM, Itoi E, An K. Anatomy and biomechanics of the shoulder. Orthop Clin NA 2000;31(2).

Case report of an unusual extra-articular scapular malunion: Rare indication for surgery

Introduction Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention. Patient and clinical history A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall. Surgical technique Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization. Results The patient’s symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur. Discussion This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.