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The temporomandibular joint (TMJ) is a distinguishing feature of mammals, and in most mammals includes an articular disc that buffers the loads placed on it by mastication. The disc is well developed in mammals with significant lateral masticatory jaw movements but is absent in toothless mammals, including extant monotremes, although histological studies of developing monotremes have shown rudimentary discs that fail to mature. Platypus (Ornithorhynchus anatinus) grind their food between keratinous pads in the maxillae and lower jaws and are the only edentulate mammals that masticate their food. In this study, we characterize the anatomy of the TMJ of the adult platypus to see if we can reconcile the anatomy, including the absence of the articular disc, with the mandibular movements observed in video recordings. We studied the gross anatomy of the maxillofacial region and the microstructure using microcomputed tomography (micro‐CT) and histological examination. Platypuses had well‐developed masticatory muscles but lacked an articular disc between the mandibular condyle and glenoid fossa. The surface of the glenoid fossa was slightly concave than that of the condylar head was correspondingly slightly convex. The pre‐ and postglenoid processes were not well developed. Micro‐CT showed dense trabecular bone in the anterior part of the condyle, where the lateral pterygoid muscle attached. Histological analysis showed that the surfaces of the condyle and glenoid fossa consisted of dense, avascular and thickened fibrous connective tissue. In addition, well‐developed synovial folds were present. These anatomical characteristics are consistent with both anterior and lateral movements of the mandible, while the thick layer of connective tissue substitutes for a disc by absorbing the mechanical stresses associated with mastication. The failure of the disc primordium to develop cannot be attributed to a lack of muscle development, but the distribution of stresses in the toothless platypus jaw is likely to be different from those in a masticating eutherian. [ABSTRACT FROM AUTHOR]

Background: Morphological differences in the temporomandibular joint (TMJ) are crucial for the treatment of patients with cleft lip and palate (CLP). This study aims to evaluate and compare the TMJ parameters in patients with unilateral and bilateral CLP across growing and non-growing age groups using cone-beam computed tomography (CBCT). Methods: CBCT records from 57 patients (23 males and 34 females) aged 6–50 years with a diagnosed unilateral or bilateral CLP were analyzed. Patients were categorized into four groups: growing unilateral (UGCLP), growing bilateral (BGCLP), non-growing unilateral (UNGCLP), and non-growing bilateral (BNGCLP). Measurements of TMJ parameters, including the mandibular fossa, articular eminence inclination, joint spaces, and roof thickness of the glenoid fossa, were conducted using CBCT images. Results: Significant differences were observed in the anterior joint space (AJS) and the roof of the glenoid fossa (RGF) between growing and non-growing unilateral cleft patients. Additionally, significant discrepancies were found in the articular eminence angle when comparing the cleft and non-cleft sides within the unilateral growing group. No significant differences were observed in TMJ parameters between the right and left sides among bilateral cleft patients. Conclusions: The study highlights distinct TMJ morphological differences between growing and non-growing patients with CLP, emphasizing the importance of age-specific considerations in the treatment planning and growth monitoring of these patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the short-term complication rates following open reduction and internal fixation of scapula fractures, factors affecting the development of adverse events, and complication rates based on the anatomic location of the fracture. Methods: Thirty-day complication rates for patients who underwent open reduction and internal fixation of the scapula were compared between glenoid, body, coracoid, and acromion fracture locations, as identified by International Classification of Disease codes. Possible adverse events included postoperative surgical site infection, renal insufficiency, intubation, pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection, wound dehiscence, stroke, and blood transfusion. Results: A total of 251 scapula fractures were identified, with 161 having known fracture locations: 105 glenoid, 20 body, 9 coracoid, and 27 acromial fractures. The rate of any adverse event for all scapular fractures was 2.0%, with no significant difference between anatomic locations (p = 0.79). The overall rates of transfusion, surgical site infection, and return to OR were 0.4%, 0.8%, and 3.98%. Steroid use associated with a significantly increased risk of any adverse event (OR: 55.57, p = 0.038) and outpatient status demonstrated a protective effect on reoperation (OR: 0.11, p = 0.014). There were no significant differences in the rates between groups [transfusion (p = 0.91); surgical site infection (p = 0.17); reoperation (p = 0.85)]. Conclusion: Complication rates within thirty days of ORIF for scapula fracture were low. Reoperation was the most common complication, followed by surgical site infection, wound dehiscence, stroke, transfusion, and pneumonia. Steroid use was a risk factor for developing any adverse event, and outpatient status was protective against reoperation. The 30-day complication profile of glenoid, body, coracoid, and acromial fractures was not significantly different. The low complication rates support the relative short-term safety of operative intervention with internal fixation. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Didelphid marsupials are considered a morphologically unspecialized group with a generalist diet that includes vertebrates, invertebrates, and plant matter. While cranium and scapula variation has already been examined within Didelphidae, variation in mandible shape, usually associated with diet or phylogeny in other mammalian groups, has not yet been properly assessed in the family. We evaluated the variation in mandible shape and size of didelphids (2470 specimens belonging to 94 species) using 2D geometric morphometrics. We classified the diet of the didelphids into four broad categories to assess whether morphospace ordination relates to dietary habits. We also provided the most comprehensive phylogeny for the family (123 out of the 126 living species) using 10 nuclear and mitochondrial genes. We then mapped mandible size and shape onto that phylogeny for 93 selected taxa and ancestral size and shapes were reconstructed by parsimony. We found phylogenetically structured variation in mandible morphology between didelphid groups, and our results indicate that they have a significant phylogenetic signal. The main axis of shape variation is poorly related to size, but the second is strongly allometric, indicating that allometry is not the main factor in shaping morphological diversity on their mandibles. Our results indicate that the shape and size of the ancestral mandible of didelphids would be similar to that of the current species of the genus Marmosa. [ABSTRACT FROM AUTHOR]

Objective: To compare linear distance of glenoid fossa to frontomaxillary nasal suture in skeletal Class-I and II malocclusions. Methods: This cross-sectional study was conducted at the Department of Orthodontics, Altamash Institute of Dental Medicine, Karachi Pakistan. The duration of study was one year from January, 2019 to January, 2020. After taking informed consent from patient and hospital ethical committee a total of 60 patients were included in the study using WHO sample size calculator. Two groups comprising 30 patients each i.e., Skeletal Class-I malocclusion and Skeletal Class-II malocclusion with mandibular retrusion both having normal vertical relationship were included in the study. The cephalometric measurements SNA, SNB, SNMP, FHMP, GF-FMN, CO-GO, CO GN on lateral cephalograms were measured and compared between the two groups. Independent t test was applied and p value ≤ 0.05 was considered as significant. Results: In skeletal Class-I malocclusion the mean linear distance of GF-FMN was 70.2 ± 4.02 mm and in skeletal Class-II malocclusion it was 73.4 ± 4.04 mm (p value .004). Glenoid fossa was 3.2 mm distally placed in patients with Class-II malocclusion. Conclusion: Glenoid fossa position is a diagnostic feature of Class-II malocclusion associated with mandibular retrusion. One of the effective cephalometric measurements to check glenoid fossa position is the distance from the glenoid fossa(GF) to the frontomaxillary nasal suture FMN (GF-FMN). [ABSTRACT FROM AUTHOR]

The study aimed to provide a detailed anatomical description of the forelimb of the capybara using gross anatomy, radiography images, and three-dimensional reconstruction. Four adult animals were used for macroscopic dissections, one for the acquisition of radiographic images and reconstructions, and one specimen for bone descriptions. The results showed the anatomical details of the scapula with a developed hamate process and the absence of a clavicle. Radius and ulna do not fuse. The hand has five metacarpal bones, and the first digit is rudimentary. The proximal row of the carpal comprises the intermedioradial, ulnar, and accessory carpal bones, and the distal row comprises four carpal bones. The muscles present a general pattern similar to other groups of domestic animals; however, the absence of the accessory head of the triceps brachii muscle has been demonstrated. The resulting images provided excellent detail of the main anatomical structures of the capybara's thoracic limb. The illustrations in the present study are a valuable reference for the interpretation of normal and pathological imaging studies in the species in the present study. [ABSTRACT FROM AUTHOR]

Background: Rib fixation for traumatic rib fractures is advocated to decrease morbidity and mortality in select patient populations. We intended to investigate the effect of combination osseous thoracic injuries on mortality with the hypothesis that combination injuries will worsen overall mortality and that SSRF will improve outcomes in combination injuries and in high-risk patients. Methods: Patients with rib fractures were identified from the Trauma Quality Improvement Project registry from 2019. Patients were then divided into rib fracture(s) alone or in combination with sternal, thoracic vertebra, or scapula fracture. Patients were also categorized into those with COPD and smokers. Patients with AIS >3 outside of thorax were excluded. Patients were subcategorized into those who had rib fixation verse nonoperative management for all subgroups. Analysis was performed to evaluate the efficacy of rib fixation. Results: A total of 111,066 patients were included for analysis. The overall mortality was 1.4%. Patients with COPD had over double the mortality risk, with an overall mortality of 3.4%. Combination injuries did not appear to increase mortality. SSRF did not decrease mortality; however, the number of patients in this group was too small to complete statistical analysis. The overall complication rate was 0.43%. There was a trend towards an increase in extrapulmonary complications in the group that underwent surgical fixation. Discussion: Mortality from rib fractures with concomitant osseous thoracic fracture appears to be low. However, mortality is increased in patients with COPD regardless of rib fracture pattern. The number of patients who underwent SSRF was too small to make a statistical comparison. [ABSTRACT FROM AUTHOR]

In unstable shoulders, excessive anteroinferior position of the humeral head relative to the glenoid can lead to a dislocation. Measuring humeral head position could therefore be valuable in quantifying shoulder laxity. The aim of this study was to measure (1) position of the humeral head relative to the glenoid and (2) joint space thickness during passive motion in unstable shoulders caused by traumatic anterior dislocations and in contralateral uninjured shoulders. A prospective cross‐sectional CT‐study was performed in patients with unilateral anterior shoulder instability. Patients underwent CT scanning of both injured and uninjured side in supine position (0° abduction and 0° external rotation) and in 60°, 90°, and 120° of abduction with 90° of external rotation without an external load. Subsequently, 3D virtual models were created of the humerus and the scapula to create a glenoid coordinate system to identify poster‐anterior, inferior‐superior, and lateral‐medial position of the humeral head relative to the glenoid. Joint space thickness was defined as the average distance between the subchondral bone surfaces of the humeral head and glenoid. Fifteen consecutive patients were included. In supine position, the humeral head was positioned more anteriorly (p = 0.004), inferiorly (p = 0.019), and laterally (p = 0.021) in the injured compared to the uninjured shoulder. No differences were observed in any of the other positions. A joint‐space thickness map, showing the bone‐to‐bone distances, identified the Hill−Sachs lesion footprint on the glenoid surface in external rotation and abduction, but no differences on average joint space thickness were observed in any position. [ABSTRACT FROM AUTHOR]

Scapular dyskinesis is a shoulder dysfunction that can be asymptomatic or associated with pain or weakness. Reduced strength and fatigue resistance of the scapular protractor and retractor muscles that stabilize the scapula might contribute to dyskinesis. To determine the strength and fatigue resistance profiles of participants with symptomatic or asymptomatic scapular dyskinesis and compare them with healthy control (HC) individuals using isokinetic assessment. Cross-sectional study. University hospital. Twenty HC individuals and 21 overhead athletes with symptomatic (n = 10) or asymptomatic (n = 11) scapular dyskinesis. Strength (peak torque, maximum work), fatigue resistance (total work), and protraction:retraction ratios measured during a closed chain isokinetic protocol (40 repetitions in concentric mode at 24.4 cm/s). The scapular protractors' strength and fatigue resistance were higher (P <.01) in HC individuals (peak torque = 5.0 ± 0.9 N/kg, maximum work = 2.4 ± 0.5 J/kg, total work = 72.4 ± 0.6 J/kg) than in asymptomatic (peak torque = 3.4 ± 0.7 N/kg, maximum work = 1.7 ± 0.4 J/kg, total work = 50.0 ± 13.7 J/kg) or symptomatic (peak torque = 3.8 ± 0.6 N/kg, maximum work = 1.8 ± 0.3 J/kg, total work = 58.1 ± 12.9 J/kg) dyskinetic participants. The symptomatic dyskinetic group presented the highest retractor strength and fatigue resistance (P <.01) values (peak torque = 5.2 ± 0.6 N/kg, maximum work = 2.9 ± 0.8 J/kg, total work = 87.7 ± 22.7 J/kg), followed by the HC individuals (peak torque = 4.7 ± 1.0 N/kg, maximum work = 2.1 ± 0.5 J/kg, total work = 65.3 ± 17.9 J/kg) and the asymptomatic dyskinetic participants (peak torque = 3.9 ± 1.0 N/kg, maximum work = 1.9 ± 0.6 J/kg, total work = 58.6 ± 18.5 J/kg). The protraction:retraction ratios showed a gradual decrease (P <.001) from the HC individuals (1.1) to the asymptomatic (0.9) and symptomatic (0.7) dyskinetic participants. Scapular dyskinesis is characterized by weaker scapular protractors and reduced agonist:antagonist ratios, especially when patients are symptomatic. Targeting the scapular protractors to achieve a better balance of scapular musculature in rehabilitation and strengthening programs may improve shoulder symptoms and function, but more interventional studies are required. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the morphological parameters of the temporomandibular joint (TMJ) using magnetic resonance imaging in patients without TMJ pathologies. The findings of this investigation are expected to serve as reference values for clinical diagnosis and scientific research on temporomandibular disorders. Methods: Magnetic resonance imaging images of 41 adult patients were examined. The condyle and glenoid fossa measurements were made in the sagittal plane. They were grouped by age, gender, and side, and statistical analysis was performed using the quantific anatomical values measured on magnetic resonance (MR) images. Results: No statistical difference was observed between gender groups regarding all parameters. There was a significant, negative, low-level correlation between age and anterior condylar angle (ACoA) measurements on the left side. Considering the side comparisons, higher Glenoid Fossa Width (GFW) values (P = .030) were measured on the left side than on the right side. A significant, negative, low-level correlation between age and ACoA measurements was observed. Conclusion: The correlation between age and ACoA measurements and GFW difference between different sides of the TMJ were the positive findings to be mentioned for his investigation. The morphological analyses focused on this anatomical region still need to be confirmed by the measurements performed on larger populations, since there are not many articles reporting specific results on this subject. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of congenital unilateral first permanent molar occlusal loss (CUMOL) on the morphology and position of temporomandibular joint (TMJ). Materials and Methods: Cone‐beam computed tomography (CBCT) images of 37 patients with CUMOL (18 males and 19 females, mean age: 13.60 ± 4.38 years) were divided into two subgroups according to the status of second molar (G1: the second molar not erupted, n = 18, G2: second molar erupted, n = 19). The control group consisted of 33 normal occlusion patients (9 males and 24 females, mean age: 16.15 ± 5.44 years) and was divided into 2 subgroups accordingly (G3: the second molar had not erupted, n = 18, G4: the second molar had erupted and made contact with the opposing tooth, n = 15). Linear and angular measurements were used to determine the characteristics of TMJ. Results: In G1, the condyle on the side of the CUMOL shifts posteriorly, with significant side differences observed in Anterior space (AS, P <.05) and Posterior space (PS, P <.05). However, with the eruption of the second permanent molars, in G2, the condyle on the CUMOL side moves posteriorly and inferiorly. This results in significant lateral differences in the AS (P <.05), PS (P <.05), and Superior space (SS, P <.05). Additionally, there is an increase in the thickness of the roof of the glenoid fossa (TRF) on the CUMOL side (P <.05), and a decrease in the inclination of the bilateral articular eminences (P <.05). Conclusions: CUMOL can affect the position and the morphology of the condyle and was associated with the eruption of the second permanent molars. Before the eruption of the second permanent molars, CUMOL primarily affects the position of the condyle. After the emergence of the second permanent molars, CUMOL leads to changes in both the condyle's position and the morphology of the glenoid fossa. [ABSTRACT FROM AUTHOR]

Therocephalia are an important clade of non-mammalian therapsids that evolved a diverse array of morphotypes and body sizes throughout their evolutionary history. The postcranial anatomy of therocephalians has largely been overlooked, but remains important towards understanding aspects of their palaeobiology and phylogenetic relationships. Here, we provide the first postcranial description of the large akidnognathid eutherocephalian Moschorhinus kitchingi by examining multiple specimens from fossil collections in South Africa. We also compare the postcranial anatomy with previously described therocephalian postcranial material and provide an updated literature review to ensure a reliable foundation of comparison for future descriptive work. Moschorhinus shares all the postcranial features of eutherocephalians that differentiate them from early-diverging therocephalians, but is differentiated from other eutherocephalian taxa by aspects concerning the scapula, interclavicle, sternum, manus, and femur. The novel anatomical data from this contribution shows that Moschorhinus possessed a stocky bauplan with a particularly robust scapula, humerus, and femur. These attributes, coupled with the short and robust skull bearing enlarged conical canines imply that Moschorhinus was well equipped to grapple with and subdue prey items. Additionally, the combination of these attributes differ from those of similarly sized coeval gorgonopsians, which would have occupied a similar niche in late Permian ecosystems. Moreover, Moschorhinus was the only large carnivore known to have survived the Permo-Triassic mass extinction. Thus, the subtle but important postcranial differences may suggest a type of niche partitioning in the predator guild during the Permo-Triassic mass extinction interval. [ABSTRACT FROM AUTHOR]

Background: This study validated the accuracy of the acromion marker cluster (AMC) and scapula spinal marker cluster (SSMC) methods compared with upright four-dimensional computed tomography (4DCT) analysis. Methods: Sixteen shoulders of eight healthy males underwent AMC and SSMC assessments. Active shoulder elevation was tracked using upright 4DCT and optical motion capture system. The scapulothoracic and glenohumeral rotation angles calculated from AMC and SSMC were compared with 4DCT. Additionally, the motion of these marker clusters on the skin with shoulder elevation was evaluated. Results: The average differences between AMC and 4DCT during 10°−140° of humerothoracic elevation were − 2.2° ± 7.5° in scapulothoracic upward rotation, 14.0° ± 7.4° in internal rotation, 6.5° ± 7.5° in posterior tilting, 3.7° ± 8.1° in glenohumeral elevation, − 8.3° ± 10.7° in external rotation, and − 8.6° ± 8.9° in anterior plane of elevation. The difference between AMC and 4DCT was significant at 120° of humerothoracic elevation in scapulothoracic upward rotation, 50° in internal rotation, 90° in posterior tilting, 120° in glenohumeral elevation, 100° in external rotation, and 100° in anterior plane of elevation. However, the average differences between SSMC and 4DCT were − 7.5 ± 7.7° in scapulothoracic upward rotation, 2.0° ± 7.0° in internal rotation, 2.3° ± 7.2° in posterior tilting, 8.8° ± 7.9° in glenohumeral elevation, 2.0° ± 9.1° in external rotation, and 1.9° ± 10.1° in anterior plane of elevation. The difference between SSMC and 4DCT was significant at 50° of humerothoracic elevation in scapulothoracic upward rotation and 60° in glenohumeral elevation, with no significant differences observed in other rotations. Skin motion was significantly smaller in AMC (28.7 ± 4.0 mm) than SSMC (38.6 ± 5.8 mm). Although there was smaller skin motion in AMC, SSMC exhibited smaller differences in scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation compared to 4DCT. Conclusion: This study demonstrates that AMC is more accurate for assessing scapulothoracic upward rotation and glenohumeral elevation, while SSMC is preferable for evaluating scapulothoracic internal rotation, posterior tilting, glenohumeral external rotation, and anterior plane of elevation, with smaller differences compared to 4DCT. [ABSTRACT FROM AUTHOR]

Pterosaurs, flying reptiles that lived during the Mesozoic era, were the first vertebrates to develop powered flight. Despite being patchy, the pterosaur fossil record extends worldwide, being quite diverse at the Araripe Basin, Brazil. The Romualdo Formation (Aptian-Albian), a Konservat Lagerstätten rich in calcareous concretions, has yielded several of these exceptionally well-preserved, three-dimensional fossils. MN 4727-V, the focus of the present study, consists exclusively of three-dimensionally preserved post-cranial axial and appendicular elements. The anatomy suggests that MN 4727-V is a pteranodontoid since it exhibits an enlarged, warped deltopectoral crest and a subtriangular distal articulation of the humerus. The phylogenetic analysis recovered MN 4727-V as an anhanguerid by the combination of the following characters: scapula substantially shorter than the coracoid (sca/co < 0.80), and posterior expansion of the sternal articulation of the coracoid. The presence of elliptical-shaped, dorsomedially inclined depressions on the dorsal surface of the prezygapophyses of the preserved cervicals has never been reported for any other anhanguerid, although they might not be diagnostic to MN 4727-V. The tail bears unique middle caudals that exhibit ventral projections, a character previously reported only for Anhanguera piscator. The wingspan of MN 4727-V, a juvenile individual, was estimated to be about 3.9 metres. [ABSTRACT FROM AUTHOR]

Background: It is aimed to compare the block onset times and performance features of costoclavicular techniques (medial and lateral approach) versus lateral sagittal technique. Methods: Patients were randomized into three groups. For costoclavicular techniques, ultrasound probe was placed parallel to clavicle obtaining nerve cords, axillary artery and axillary vein visual from lateral-to-medial, respectively. The block needle was advanced from lateral (Group CLB) or medial (Group CMB) to perform costoclavicular block. For lateral sagittal technique (Group LSB), ultrasound probe was placed sagittal and perpendicular below the coracoid process to obtain sagittal artery image with the cords around. Total 20 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine were deposited for all groups. Sensory and motor block onset times, block performance properties, complications, and patient/surgeon satisfactions were investigated. Results: Among 56 patients, the primary outcome, sensory block onset time was shorter in Group CLB than Group CMB and Group LSB (10 [5–15], 10 [10–20], and 15 [10–15] minutes, respectively, p < 0.05). Motor block onset was also fastest in Group CLB (15 [10–20] mins for CLB, 20 [15–20] mins for LSB, and 22.5 [15–25] mins for CMB, p = 0.004). Block performance properties did not differ between the groups. The only complication observed was vascular puncture with an incidence of 28% in Group CMB. Conclusions: Lateral approach costoclavicular technique provides fastest block onset than the other techniques. Considering the success and safety profile, this technique stands as a good alternative in clinical practice. Trial registration: This study is prospectively registered to clinicaltrials.gov on 20/02/2022 (NCT05260736). [ABSTRACT FROM AUTHOR]

Currently, only birds have a pneumatic system, but in the past, this was common among several ornithodirans. Within Titanosauria, it was the saltasaurines that showed a high degree of postcranial pneumaticity. The objective of this work is analysing the extent of postcranial pneumaticity in saltasaurines and compare it with other derived titanosaurs. To carry out this work, presacral vertebrae, dorsal ribs, scapulae, coracoids and ilia of saltasaurines were analysed. The presacral vertebrae present a high degree of pneumatisation with a highly variable distribution of foramina, with some ‘foramina zones’, there is a homoplastic pattern of pneumaticity: presence of foramina connected to camellated tissue. With respect to the ilia, camellated tissue was recorded in all taxa. Instead, scapulae and coracoids, present camellated tissue in Saltasaurus and they cannot be pneumatised in Neuquensaurus. Comparing with other titanosaurs, we observe that there are ‘foramina zones’ for presacral and caudal vertebrae. It is also possible to establish that the pneumatisation of the dorsal ribs has a conservative pattern, not only in saltasaurines but also in the Saurischia clade, and the presence of pneumaticity in the ilia is frequent in the Lithostrotia and even outside, in rebbachisaurs. [ABSTRACT FROM AUTHOR]

An evaluation of scapula position is important to predict spine curvature and shoulder function in patients with adolescent idiopathic scoliosis (AIS). Therefore, a reliable scapula position is required to assess posture in patients with AIS. This study investigated the reliabilities of scapula position tests and differences in scapula position and shoulder function between individuals with and without AIS. The study compared 18 patients with AIS and 18 healthy controls to identify differences in scapula position and shoulder function. The acromion-table distance, lateral displacement of the scapula, acromion depression, winged scapula, upward rotation of the scapula, and anterior tilt of the scapula were measured. Scapula position test reliabilities were assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum clinically important difference (MCID). Shoulder function was measured using the Shoulder Pain and Disability Index. The reliabilities of scapula position tests (ICC 0.85–0.93, SEM 0.1–1.2, and MCID 0.2–2.5) were good. There were significant differences in scapula position and shoulder function between patients with AIS and healthy controls (p< 0.05). Scapula position tests were highly reliable in patients with AIS; they can be used to evaluate scapula position during clinical assessment of posture in patients with AIS. [ABSTRACT FROM AUTHOR]

Background: The Latarjet procedure is increasingly being utilized for the treatment of glenoid bone loss and has a relatively high neurological complication rate. Understanding the position-dependent anatomy of the axillary nerve (AN) is crucial to preventing injuries. Purpose: To quantify the effects of changes in the shoulder position and degree of glenoid bone loss during the Latarjet procedure on the position of the AN. Study Design: Controlled laboratory study. Methods: A total of 10 cadaveric shoulders were dissected, leaving the tendons of the rotator cuff and deltoid for muscle loading. The 3-dimensional position of the AN was quantified relative to the inferior glenoid under 3 conditions: (1) intact shoulder, (2) Latarjet procedure with 15% bone loss, and (3) Latarjet procedure with 30% bone loss. Measurements were obtained at 0°, 30°, and 60° of glenohumeral abduction (equivalent to 0°, 45°, and 90° of shoulder abduction) and at 0°, 45°, and 90° of humeral external rotation (ER). Results: Abduction of the shoulder to 60° resulted in a posterior (9.5 ± 1.1 mm; P <.001), superior (3.0 ± 1.2 mm; P =.013), and lateral (19.1 ± 2.3 mm; P <.001) shift of the AN, and ER to 90° resulted in anterior translation (10.0 ± 1.2 mm; P <.001). Overall, ER increased the minimum AN-glenoid distance at 30° of abduction (14.9 ± 1.3 mm [0° of ER] vs 17.3 ± 1.5 mm [90° of ER]; P =.045). The Latarjet procedure with both 15 and 30% glenoid bone loss resulted in a superior and medial shift of the AN relative to the intact state. A decreased minimum AN-glenoid distance was seen after the Latarjet procedure with 30% bone loss at 60° abduction and 90° ER (17.7 ± 1.6 mm [intact] vs 13.9 ± 1.6 mm [30% bone loss]; P =.007), but no significant differences were seen after the Latarjet procedure with 15% bone loss. Conclusion: Abduction of the shoulder induced a superior, lateral, and posterior shift of the AN, and ER caused anterior translation. Interestingly, the Latarjet procedure, when performed on shoulders with extensive glenoid bone loss, significantly reduced the minimum AN-glenoid distance during shoulder abduction and ER. These novel findings imply that patients with substantial glenoid bone loss may be at a higher risk of AN injuries during critical portions of the procedure. Consequently, it is imperative that surgeons account for alterations in nerve anatomy during revision procedures. Clinical Relevance: This study attempts to improve understanding of the position-dependent effect of shoulder position and glenoid bone loss after the Latarjet procedure on AN anatomy. Improved knowledge of AN anatomy is crucial to preventing potentially devastating AN injuries during the Latarjet procedure. [ABSTRACT FROM AUTHOR]

Background: The minimally invasive approach for the treatment of displaced scapular neck or body fractures has the advantages of less trauma and minimal muscle dissection. In clinical practice, the minimally invasive approach combined with an anatomical locking plate has been used to treat scapular body fractures. In addition, we have made minor modifications to the minimally invasive approach. However, the biomechanical study about the approach combined with an anatomical locking plate in treating scapular body fractures was limited. Methods: Finite element analysis (FEA) was used to conduct the biomechanical comparison between the anatomical locking plate (AP model) and reconstructive plate (RP model) in the treatment of scapular body fractures through the modified minimally invasive approach. A healthy male volunteer with no history of scapula or systemic diseases was recruited. High-resolution computed tomography images of his right scapula were obtained. Two scapula models were constructed and analyzed by the software of Mimics 21.0, Geomagic Wrap 2021, SolidWorks 2021, and ANSYS Workbench 2022, respectively. Results: Through static structural analysis, in terms of equivalent von Mises stress, equivalent elastic strain, and total deformation, the AP model exhibited superior safety characteristics, enhanced flexibility, and anticipated stability compared with the RP model. This was evidenced by lower maximum stress, lower maximum strain and displacement. Conclusion: The minimally invasive approach combined with an anatomical locking plate for scapular body fractures had better biomechanical stability. The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures. [ABSTRACT FROM AUTHOR]

Anthropometric studies of the scapula have been rare in Spanish populations, nevertheless they are of current interest in forensic anthropology for estimation of sex. Although the estimation of sex is usually carried out on the pelvis and skull, other measurements related to the scapula can be helpful when the skeletal remains are incomplete. Glenohumeral osteoarthritis development is influenced, among others, by the morphology of the scapula, which is one of the less studied aspects. We carried out a descriptive study of anthropometric parameters in a series of 157 scapulae (82 individuals) on bone remains dated to the 20th century from a population of Granada (Southern Spain). Seventy seven (49%) were right-side and 80 (51%) left-side; 72 (45.9%) were from males and 85 (54.1%) from females, and the mean age at death was 70.76±11.7 years. The objective was to develop a discrimination function for sex estimation based on anthropometric parameters of the scapula other than those considered to date, and to analyze the prevalence of glenohumeral osteoarthritis in relation to selected anthropometric parameters. A logistic regression model based on parameters of the upper-external segment of the scapula was done. The obtained formula: 1/1+e^ (- (-57.911 + 0.350*B + 0283*C + 0.249*b + 0.166*a +-0.100*β) classifies male sex with 98.3% accuracy and female sex with 92.1%. Glenohumeral osteoarthritis was detected in 16.6% of individuals and was related to age (p<0.05), scapular length (p<0.05), glenoid width (p<0.05), glenopolar angle (p<0.05), and α angle (p<0.05) in bivariate analyses but showed no significant associations in multivariate analyses. This approach can be useful for anthropological-forensic identification when scapula remains are incomplete. Glenohumeral osteoarthritis is significantly associated with a smaller α angle. [ABSTRACT FROM AUTHOR]

This article describes the treatment and evolution of a 76-year-old patient who suffered a fracture of the scapula and the proximal phalanx of the second finger after a bicycle accident. The medical and physiotherapeutic intervention is detailed, especially the second one, focusing on the recovery of the injured shoulder. The physiotherapy treatment shows how a simple intervention based on the combination of several rehabilitative techniques such as magnetic therapy, electrostimulation and manual therapy, are more than enough to provide a full functional recovery. [ABSTRACT FROM AUTHOR]

Introduction: This study quantifies the differences in individual scapular muscle strength in both arms along with obtaining a force couple ratio of scapula stabilizers to gain values in terms of the strength of muscles. Materials and Methods: A quantitative cross-sectional study was done on 30 stroke patients to assess the muscle strength of the serratus anterior, rhomboids, and upper, middle, and lower trapezius (in both shoulders) using a suspension scale. Meanwhile, the muscle force couple ratios were calculated. Results: The results showed significant strength differences between both arms for upper trapezius (P=0.0020), serratus anterior (P=0.018), rhomboids (P=0.001), middle trapezius (P=0.0068), and no difference for lower trapezius (P=0.1746). The mean muscle strength in the non-affected arm is greater than the affected arm. The middle trapezius strength is lowest in the affected arm (0.574 kgf) and the lower trapezius strength is lowest in the non-affected arm (0.767 kgf). The mean force couple ratio for upper trapezius versus lower trapezius was higher in the affected side (10.08) and the non-affected side (7.74). The remaining force couples were similar for both arms. Conclusion: Overall muscle strength of the scapula stabilizers is greater in the non-affected arm than in the affected arm. The strength of the force couple between the upper and lower trapezius is greater in both arms which shows considerable incoordination between the muscles. [ABSTRACT FROM AUTHOR]

Case: We report a unique case of dynamic scapular winging due to compression of the long thoracic nerve by a ventral scapular osteochondroma, representing a combination of mechanical and neural causes. Arthroscopic resection of the lesion was performed, which led to complete resolution of the symptoms. Conclusion: By reporting this case, we aimed to increase awareness of the importance of a correct etiological diagnosis of dynamic scapular winging, so that targeted treatment can be addressed. Arthroscopic resection seems ideal for this indication because it reduces the risk of complications and patient recovery time. [ABSTRACT FROM AUTHOR]

Introduction: The thorax, clavicula, scapula and humerus comprise the finite element musculoskeletal model of the shoulder mechanism, which has been used to analyse its kinematic and dynamic behaviour. The study aims to reflect upon the analysis of the kinematic and dynamic behaviour of the shoulder mechanism. Materials and Methods: A comprehensive literature search was conducted to identify the relevant literature. Databases such as PubMed, Scopus and Google Scholar were used to search for literature published between 2000 and 2023. Results: The scapulothoracic gliding plane’s motion restrictions, which convert the shoulder girdle into a closed-chain mechanism, are represented in the model along with 16 muscles, 3 joints and 3 extracapsular ligaments. The locations of the humerus and shoulder girdle that were recorded in ten subjects during loaded and unloaded humeral abduction and anteflexion are the input variables. Conclusion: The length dependence of electromyography (EMG) amplitude and the unknown force-length relationship makes it difficult to compare muscle force predictions and EMG measurements. The conclusion is that complicated musculoskeletal models cannot be validated using EMG amplitude. The force and moment balance of the three joints are used to examine the function of the muscles. This model allows for an investigation of the function of morphological components and offers useful insight into the mechanics of the shoulder mechanism. [ABSTRACT FROM AUTHOR]

Objective: Forward head posture (FHP) is a common postural disorder that alters shoulder function. This study examined the efficacy of a corrective program involving postural correction exercises (PCEs), scapular stabilization exercises (SSEs), and kinesiotaping (KT) on improving craniovertebral angle (CVA), scapular position, and dominant hand grip strength (HGS) in individuals with FHP. Methods: Sixty subjects (8 males and 52 females, 18–40 years old) were randomly allocated into four equal groups: Group A: received PCEs only, Group B: received PCEs and SSEs, Group C: received PCEs and KT, Group D: received PCEs, SSEs and KT. All subjects received treatment for 4 weeks (4 times/week) and postural advice. Outcome measures included cranio‐vertebral angle (CVA), scapular position using Lateral Scapular Slide Test and dominant HGS using a CAMRY dynamometer that were assessed at baseline and 4 weeks post intervention. Results: Comparing all groups post training revealed that there were statistically significant increases (p < 0.05) in all measured variables (CVA, scapular position and dominant HGS) in favor of group (D). Conclusion: Combination of PCEs, SSEs and KT interventions has achieved the best gains in terms of CVA, dominant HGS and regaining optimal scapular position in FHP subjects. [ABSTRACT FROM AUTHOR]

The scapula in quadrupedal mammals is a flat bone that connects the thoracic limb with the trunk above the shoulder joint. For this purpose, scapulae of 34 dogs and 23 cats were modeled using computer tomography. 9 Landmarks and 50 semilandmarks were used. The cat and dog samples differ in scapula shape, as do male and female cats. Centroid size has no apparent covariance with shape, and we did not find any difference between the two sexes in dogs. The scapula of cats was wider. The scapula of dogs was narrower and longer. Margo cranialis was more oval in cats. Angulus cranialis border was not clear in cats. Angulus caudalis was sharper in dogs. Spina scapulae was closer to caudal in cats. In cats, the fossa supraspinata was wider than the fossa infraspinata. Also, the collum scapulae was narrower in cats. The scapula of male cats was wider than that of female cats. In shape, the fossa supraspinata was wider in male cats. In male cats, the spina scapulae were more caudal. Angulus caudalis was wider in female cats. The most significant gender differences in dogs were in tuberculum supraglenoidale and margo caudalis. Male dogs had larger tuberculum supraglenoidale in shape. Margo caudalis was more caudal in male dogs. Geometric morphometrics was found to be effective in distinguishing the scapula of cats and dogs. In addition, this method can be useful in sex estimation. [ABSTRACT FROM AUTHOR]

Age estimation methods through the metric study of bones in non-adult individuals are a frequently used tool in Biological and Forensic Anthropology; however, few methodological validation studies are available, given the limited number of adequate samples for their study. In this context, the aim of this work is to test the effectiveness of the methods of Fazekas and Kósa (1978), Saunders et al. (1993), Rissech and Black (2007) and Cardoso et al. (2017), for age estimation through the measurements of the scapula, in the non-adult osteological collection of the Anthropology Laboratory of the University of Granada (Spain), one of the most representative identified non-adult collections internationally. For this purpose, nine different measurements of the scapula were taken from a total of 149 non-adult individuals, applying the regression formulae proposed by the different authors and verifying their accuracy. Results have shown the existence of significant differences between the real age and the estimated age in almost all the tested methods, with degrees of error that differ from those obtained in the original study populations. Based on the obtained results, it is recommended to use the method of Cardoso et al. in postnatal individuals, always adjusting the degrees of error with those obtained in this work. [ABSTRACT FROM AUTHOR]

Pexa, BS, Johnston, CD, Elder, EE, Ford, KR, Patterson, MQ, and Myers, JB. Pool-based surfboard elicits activation of posterior shoulder muscles during a surfing stroke. J Strength Cond Res 38(7): 1300–1304, 2024—Surfboard paddling may activate posterior shoulder muscles, which are critical to baseball pitchers’ injury risk and performance. The purpose of this study was to measure posterior shoulder muscle activation during different phases of the surf stroke (propulsion vs. recovery) on a pool-based surfboard. Twenty healthy active adult subjects completed a familiarization and testing session with the pool-based surfboard. During the testing session, electromyography (EMG) sensors were placed on 6 posterior shoulder muscles: latissimus dorsi, infraspinatus, posterior deltoid, upper trapezius, middle trapezius, and lower trapezius. Subjects completed 4 laps in a pool at 3 separate resistances (low, moderate, and heavy) in a randomized order. The peak EMG signal during each phase (propulsion and recovery) was recorded. A 2-way within subject ANOVA (resistance-by-phase) with post hoc Bonferroni’s corrections was used to identify differences in EMG activation. There was a significant main effect of phase for the latissimus dorsi (F 5 91.3, p, 0.001), upper trapezius (F 5 36.5, p, 0.001), middle trapezius (F 5 33.8, p, 0.001), and lower trapezius (F 5 21.6, p, 0.001). The latissimus dorsi demonstrated higher activation during the propulsion phase (p, 0.001), and all trapezius muscles demonstrated higher activation during the recovery phase (p, 0.001). There was a significant main effect of resistance for the posterior deltoid (F 5 3.4, p 5 0.043), with higher muscle activation in the low resistance trials compared with the heavy resistance trials (p 5 0.036). Recreationally active individuals demonstrate activation of the posterior shoulder when using a pool-based surfboard. This poolbased surfboard may be beneficial to activate the posterior musculature and may be more accessible than standard surfing to baseball athletes. [ABSTRACT FROM AUTHOR]

Purpose To determine the pros and cons of an artificial intelligence (AI) model developed to diagnose acute rib fractures in chest CT images of patients with chest trauma. Materials and Methods A total of 1209 chest CT images (acute rib fracture [n = 1159], normal [n = 50]) were selected among patients with chest trauma. Among 1159 acute rib fracture CT images, 9 were randomly selected for AI model training. 150 acute rib fracture CT images and 50 normal ones were tested, and the remaining 1000 acute rib fracture CT images was internally verified. We investigated the diagnostic accuracy and errors of AI model for the presence and location of acute rib fractures. Results Sensitivity, specificity, positive and negative predictive values, and accuracy for diagnosing acute rib fractures in chest CT images were 93.3%, 94%, 97.9%, 82.5%, and 95.6% respectively. However, the accuracy of the location of acute rib fractures was low at 76% (760/1000). The cause of error in the diagnosis of acute rib fracture seemed to be a result of considering the scapula or clavicle that were in the same position (66%) or some ribs that were not recognized (34%). Conclusion The AI model for diagnosing acute rib fractures showed high accuracy in detecting the presence of acute rib fractures, but diagnosis of the exact location of rib fractures was limited. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles. OBJECTIVE: This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment. METHODS: Forty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n = 24) or the control group (CG, n = 25). STEG included progressive strengthening, proprioceptive, and stabilization exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca's Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used. RESULTS: The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p < 0.05), however medio-lateral body sway did not differ between groups (p > 0.05). CONCLUSIONS: Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: The normal value of the scapular muscle activity ratio during arm elevation is not clear. OBJECTIVE: To obtain normal values of the scapular muscle activity ratio during arm elevation in healthy individuals. METHODS: This cross-sectional study enrolled 47 healthy people. The participants performed shoulder flexion and lowered task with 90-degree movements every 2 seconds. Muscle activities of scapular muscles were measured. For normalization, the maximum isometric contraction of the shoulder flexion was measured at 90∘ (reference contraction). The integrated electromyographic value (IEMG) obtained during the task was normalized by IEMG during the reference contraction and the relative IEMG value was calculated. Then, the scapular muscle activity ratio was computed. The relationship between muscle strength and other factors was also investigated. RESULTS: The median values for upper trapezius/serratus anterior and upper trapezius/lower trapezius were often approximately 1, and that for upper trapezius/middle trapezius was often between 1 and 2. The shoulder flexion isometric strength and scapular muscle activity ratio showed significant negative correlations in multiple phases. CONCLUSION: Normal values for upper trapezius/serratus anterior and upper trapezius/lower trapezius during arm elevation and lowering were generally 1. Low muscle strength may contribute to an abnormal scapular muscle activity balance. [ABSTRACT FROM AUTHOR]

Background A widely accepted set of imaging criteria or classification has not yet been adopted to evaluate response to treatment by percutaneous sclerotherapy for aneurysmal bone cyst (ABC). In this article, we described and illustrated the Royal Orthopaedic Hospital (ROH) scoring system which is a new, reproducible, and objective tool to evaluate the radiological response. We also reported our institutional experience in the efficacy of computed tomography (CT)-guided sclerotherapy for treating such lesions. Patients and Methods A retrospective analysis was conducted for 19 patients who underwent CT-guided sclerotherapy with doxycycline and albumin to treat ABC. Follow-up magnetic resonance imaging, at a minimum of 12 months, was assessed according to the four ROH scoring system parameters: cystic component, fluid–fluid level, presence of consolidation, and cortical integrity. The cumulative score was used to grade response as either: excellent, good, equivocal, or poor. Results Out of 19 patients with a mean age of 17.8 years, 11 cases occurred in the long bones, 5 cases in the pelvis, and 1 in each of the C3 vertebral body, scapula, and talus. The mean parameter of response score for cystic component was 2, fluid–fluid level was 1.3, consolidation was 2, and cortical integrity was 2.1. Four cases showed excellent response, 12 cases showed good response, 2 cases showed equivocal response, and 1 case showed poor response. Interrater reliability was excellent (κ = 0.9). Conclusion The ROH scoring system provides the radiologist and surgeon with an objective method to score imaging parameters of response independently and achieve a grade based on the cumulative score. [ABSTRACT FROM AUTHOR]

Background Glenoid version refers to the angle subtended by the glenoid with the scapula. On average, it is 0 ± 10 degrees with a slight propensity toward retroversion. Numerous factors such the dominance(handedness), gender, ethnicity, and pathology are known to affect version. Version has important consequences on the biomechanics of the shoulder joint and is altered in those with arthritis and shoulder joint instability. Aim Our study aimed to determine the normal range of glenoid version in the population. Further, we aim to assess the relationship between gender and version. Settings and Design We conducted a retrospective observational study in a tertiary referral hospital with a target sample size of 200 shoulders. Methods and Materials The computed tomography images were retrospectively reviewed to determine the scapular shape and the glenoid version angle. Statistical Analysis Statistical analysis was done using SPSS v.22 software with p -value less than 0.05 considered as significant. Results The mean age of the individuals in our study was 44 years. In our study, irrespective of gender, most individuals had some degree of anteversion and males had lower degree of anteversion. Previous studies have shown that most normal individuals usually have retroverted shoulder joints. The mean glenoid version was significantly lower in the right than in the left shoulder and males had significantly lower mean glenoid version than females in both shoulders. Most individuals in our study had a flat scapular spine. Conclusion This study shows that the Indian population may have a slight propensity toward anteversion and this has an important bearing on shoulder arthroplasty. Further, this study shows that significantly lower degrees of version are found on the right side and that the degree of version is significantly lower in males. Understanding the role of glenoid version in shoulder biomechanics will go a long way in the early identification of pathology, the preoperative planning of shoulder arthroplasty, and the operative restoration of a functional shoulder joint. [ABSTRACT FROM AUTHOR]

Rotator cuff tears are prevalent shoulder injuries, significantly affecting shoulder stabilization and patient quality of life. Despite rehabilitation efforts post-arthroscopic surgery, the efficacy of scapular-focused exercises remains uncertain with limited supportive evidence. This study aimed to compare the immediate and short-term effects of emphasizing scapulothoracic joint rehabilitation in addition to conventional physiotherapy on pain, range of motion (ROM), function, quality of life, and treatment effectiveness in patients after shoulder arthroscopic rotator cuff tendon repair (ARCR). Two arms, parallel-group, randomized controlled trial, with concealed allocation This parallel-group randomized controlled trial, with concealed allocation, was conducted in a clinic setting on 28 participants aged 30-75 years, exhibiting progressive degenerative full-thickness tears of rotator cuff muscles and undergoing ARCR, provided the tear size was small or medium. Participants were randomly allocated to receive 21 sessions of conventional rehabilitation (n = 14) or comprehensive rehabilitation (with a focus on scapula training; n = 14) in 12 weeks (reporting of intervention complied with Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) Guideline). Pain (as primary outcome), ROM, functional disability, quality of life, and treatment effectiveness were assessed both pre- and post-intervention, along with a 3-month follow-up. Participants, assessors, and statistician were blinded to group assignment. For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used. Trial was completed with 28 participants and no dropouts. The analysis of variance revealed statistically significant group-by-time interaction (p < 0.05) for all outcome measures except for active ROMs (p > 0.05). Multiple comparison analysis showed statistically significant between-group differences (p < 0.05) at 3-month follow-up with large effect size (>0.8 Hedges' g) for all outcomes (mean differences: visual analog scale: 1.3, American Shoulder and Elbow Surgeons: −17.3, Shoulder Pain and Disability Index: 17.6, Western Ontario Rotator Cuff: −19.5, QuickDASH: 17.8), except for extension ROM (passive ROM: confidence interval = −25.4 to 0.56; active ROM: confidence interval = −20.0 to 6.0). The differences in American Shoulder and Elbow Surgeons and Western Ontario Rotator Cuff were also clinically significant based on their minimally clinical important difference cutoff points. For the Global Rating of Change scale, more participants stated "much improved" in the comprehensive group than in the conventional. No adverse effects were reported. Comprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR. • Persistent shoulder pain can lead to long-term rotator cuff tears. • Comprehensive physiotherapy after shoulder surgery improves outcomes. • Scapulothoracic joint rehabilitation in physiotherapy may have added benefits after rotator cuff repair. [ABSTRACT FROM AUTHOR]

To determine if there are differences in condylar volume, glenoid cavity and joint space between patients diagnosed with facial asymmetry (FA), between affected and contralateral sides and with respect to subjects without FA. Cross-sectional, retrospective study comparing CT/CBCT images from patients with FA diagnosis referred to a private clinic, versus a control group, age and sex matched, of patients requiring orthodontic treatment without FA. The 3D Slicer software was used for the analysis. Bivariate analysis was performed to compare qualitative variables using Chi-square or Fisher tests, and for normal distribution quantitative variables, the t-student test was used. The level of significance was p < 0.05. The FA group (n = 138) included: Hemimandibular Elongation (HE) (n = 64), Hemimandibular Hyperplasia (HH) (n = 12), Hybrid Form (HF) (n = 20), Asymmetric Mandibular Prognathism (AMP) (n = 25), Glenoid Cavity Asymmetry (GCA) (n = 9) and Functional Laterognathism (FL) (n = 8). The control group (n = 20) had no FA and no signs or symptoms of temporomandibular dysfunction. The right condylar and glenoid cavity volumes were significantly larger in FA cases. The volumes of the right and left joint space had significant differences only in HE patients. Condylar volumes are higher in almost all FA subgroups compared to matched controls. The glenoid cavity volume is larger in FA patients, except for the GCA right and FL left sides. Regarding articular spaces, HE was the only entity with less volume on the contralateral side. The evaluation of structural volume by 3D-CT images helps to diagnose and differentiate FA subgroups. [ABSTRACT FROM AUTHOR]

After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature. This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles. Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II – control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances. FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side (p < 0.05 for all). Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability. [ABSTRACT FROM AUTHOR]

To examine the effect of induced posterior pelvic tilt (changes in pelvic kinematics) on serratus anterior, lower trapezius, and upper trapezius electromyographic activity, and thoracic posture during arm elevation in individuals with rounded shoulder. Materials and methods Thirty healthy volunteers (26 male and 4 female participants) with rounded shoulder, their mean age 22.80±3.2, BMI 23.51± 3.9 were evaluated for both thoracic and pelvic posture using a 9-camera, 3-dimensional motion capture system (Vicon Nexus version 2, Oxford, UK), serratus anterior, lower trapezius, and upper trapezius electromyographic activity. The measurements were recorded in different six experimental conditions while inducing posterior pelvic tilt during arm elevation. For the six experimental conditions involving arm elevation, repeated measures analysis of variance within-subjects was used to examine the changes in electromyographic activities of lower trapezius, upper trapezius, and serratus anterior due to pelvic kinematics' changes whereas paired t-tests were used to examine the changes in the thoracic posture in response to pelvic kinematics' changes and to compare the pelvic tilt angle between the habitual relaxed position and the induced posterior tilt position. Results Upper trapezius, serratus anterior, and lower trapezius electromyographic activity significantly increased in response (changes in pelvic kinematics) induced posterior pelvic tilt (35:40%) of the maximal posterior pelvic tilt, although there were no apparent alterations in thoracic posture. (p>0.05). Conclusion Induced posterior pelvic tilt, (35:40%) of the maximum, resulted in an increase in the electromyographic activity of serratus anterior, lower trapezius, upper trapezius, which reflects that changes in pelvic kinematic could alter scapular muscles activity, so comprehensive examination of pelvic posture is required in both preventive and treatment programs of shoulder complex injuries. Meanwhile, no significant effect was reported on thoracic posture. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate, using cone-beam computed tomography (CBCT), the relationship of persistent foramen tympanicum (PFT) with degenerative changes in the temporomandibular joint (TMJ) and the presence of pneumatized glenoid fossae and articular eminences. Method: Two experienced oral and maxillofacial radiologists evaluated 510 CBCT scans, from which 94 patients were divided into two groups: G1—patients with PFT and G2—control group. The location of the PFT, presence, or absence of degenerative TMJ changes and morphology were evaluated. Similarly, all images were evaluated for the presence of pneumatized articular eminence and glenoid fossa. The Chi-square test and Fisher's Exact test were used for the categorical variables. A multinomial logistic regression model was performed for subgroup analysis. To assess the estimation-chance occurrence of TMJ alterations the Odds Ratio analysis was used. Results: Statistically significant results were found for erosion, planning, and subchondral cyst. Regarding TMJ morphology, significant results were found for: round, flat, and others. Moreover, it was possible to observe that patients who had the PFT were approximately 48 times more likely to manifest TMJ alterations and approximately 3 times more likely to manifest articular eminence pneumatization. Conclusion: Since individuals who have FTP have a greater chance of having TMJ and PEA changes, it is important for the dental radiologist to be aware of these signs in CBCT scans for a correct diagnosis. Trial registration number: CAAE: 34328214.3.0000.0104 (11/30/2014). [ABSTRACT FROM AUTHOR]

Background: Scapular dyskinesia (SD) is a common condition that affects racquet athletes, impacting their performance and predisposing them to injuries. Objectives: This study aimed to compare joint position sense (JPS) and force reproduction in racquet athletes with and without SD. Methods: This study was conducted as a cross-sectional study. The statistical population consisted of female student-athletes aged 18 to 30 who were engaged in badminton, tennis, and ping pong in Quchan city, both with and without shoulder dyskinesia. The sample included thirty athletes with shoulder dyskinesia and thirty without it, who were randomly selected. Joint Position Sense was assessed at 45 and 135 degrees of abduction. The tools employed in this research encompassed a consent form, an inclinometer (goniometer), the Kibler test, force-reproduction testing, and the McClure test. Data analysis was performed using the Shapiro-Wilk test and an independent t-test in SPSS version 23, with a significance level set at P < 0.05. Results: The results revealed a statistically significant difference in JPS of the shoulder joint between athletes with and without SD at angles of 45 and 135 degrees (P < 0.05). Similarly, the independent t-test analysis demonstrated a significant difference in force reproduction of the shoulder joint between athletes with and without dyskinesis (P < 0.05). Conclusions: These findings underscore the importance of addressing SD and its associated sensory impairments in racquet athletes to optimize performance and reduce the risk of injuries. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY This study investigated the relationship between the position of the tip of the coracoid process (CP) relative to the glenoid with subscapularis (Ssc) tears. We hypothesized that the coracoid tip is more inferior, lateral and posterior in patients with Ssc tear. MATERIAL AND METHODS This research enrolled 34 isolated Ssc tears and 44 controls. We introduced the axial central glenoid-coracoid angle (acGCA) and sagittal central glenoid-coracoid angle (scGCA) to evaluate the position of the tip of the CP relative to the glenoid center on MRI images. In both groups, acGCA, scGCA on MRI and critical shoulder angle (CSA), glenoid inclination (GI) on true anterior-posterior shoulder radiography were evaluated. RESULTS When both groups were compared in terms of acGCA, the acGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of acGCA for Ssc tears was 28.3°. acGCA values higher than 28.3° showed 93.3% sensitivity and 93.1% specificity for Ssc tears (likelihood ratio:13.53, AUC: 0.979, 95% CI of AUC: 0.950– 0.999). In terms of acGCA, the power analysis between Ssc tears group and control group was 99.9% between Ssc tears and the control group (effect size d=2.63). When both groups were compared in terms of scGCA, the scGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of scGCA for Ssc tears was 41.4°. Scores of scGCA greater than 41.8° showed 80% sensitivity and 89.7% specificity for Ssc tears (likelihood ratio: 7.73, AUC: 0.899 95% CI of AUC: 0.837–0.958). In terms of scGCA, the power analysis between Ssc tear and control group was 99.8% (effect size d=1.23). When both groups were compared in terms of CSA and GI; CSA and GI values in the Ssc tear group were significantly higher (p<0.001 and p<0.012, respectively). CONCLUSIONS AcGCA values higher than 28.3° indicate that the coracoid tip is located more laterally and posteriorly; scGCA values higher than 41.8° indicate that the coracoid tip is located more inferiorly and these two new indexes are showing that more laterally, posteriorly and inferiorly coracoid tip is related to subscapularis tears. [ABSTRACT FROM AUTHOR]

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Round-shoulder posture (RSP) is a common postural condition, characterized by protraction, downward rotation, anterior tilting and internal rotation of the scapula. RSP can lead to shoulder dysfunction. Different methods have been proposed for rehabilitating and correcting the altered posture in RSP including stretching, strengthening exercises, and shoulder brace or taping. However, the findings are controversial and studies are ongoing to develop more effective method. The present study is aimed at investigating the effects of scapular posterior tilting (SPT) exercise in different support positions on scapular muscle activities in men and women with RSP. In a prospective observational clinical study, we assessed demographic, basic clinical parameters and study variables of the subjects with RSP (n = 20) (men/women = 9/11) attending Daegu University in Gyeongsan, South Korea. To do so, we compared electromyographic (EMG) activities of lower trapezius and serratus anterior muscles between men and women with RSP during SPT exercise on four different support surfaces to determine any difference in the EMG activities. The results revealed that women showed significant differences in EMG activities in the lower and left upper trapezius and serratus anterior muscles, while men showed significant differences in EMG activity only in the lower trapezius muscle during SPT exercise on four different surfaces (P < 0.05). The post-hoc analysis revealed significantly greater EMG activity values in the lower trapezius and serratus anterior muscles during SPT exercise on the upper body unstable surface and whole-body unstable surface (p < 0.05). Independent t-tests after the Bonferroni correction showed no significant differences in muscle activities between men and women on the four different surfaces (p > 0.0125). [ABSTRACT FROM AUTHOR]

Simple Summary: This paper presents, to the best of our knowledge, the first documented instance of a specific pathological lesion found in a Late Iron Age (La Tène period) horse. This discovery was made in the CX 143 pit in Alba Iulia, Romania, during archaeological rescue excavations conducted in 2022. In addition to the standard morphological features of the horse, comprehensive investigations revealed an unusual lesion on the left scapular neck. This lesion was evaluated both macroscopically and radiologically and has been interpreted as periarticular and supraarticular hyperostosis. A series of hypotheses were proposed regarding the cause of this specific type of injury, including the possibility of it being traumatic in nature, and potentially influenced by particular conformational aspects of the identified horse. The reconstruction of past life based on archaeozoology is a challenging domain that offers a range of valuable details concerning former human and animal populations. Additionally, the ancient era is a source of information for human and veterinary medicine, as well as for other biological sciences. This report highlights a pathological lesion identified during the investigation of a horse skeleton from a pit dated La Tène in Alba County (Romania). The left scapula with lesions was collected from the skeleton of a buried 7–8-year-old male horse. The aforementioned bone underwent gross, radiological, and computerized tomography evaluation. Macroscopically, a collar of supraarticular cancellous hyperostosis was detected, most likely as a consequence of an invasive chronic phlegmonous periarthritis and/or bursitis of the infraspinate muscle following probably a penetrating cutaneous wound in the shoulder region. A suppurative periarthritis\bursitis of the infraspinate muscle situated nearby caused, apparently, supraglenoidian periosteitis responsible for osteophytes and exostoses formation in the neck region of the scapula. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to compare the surface electromyographic amplitude, activation ratio, and onset latency of the main scapular stabilizing muscles between five typical rehabilitative exercises. Design: Twenty-seven healthy participants performed five scapular exercises (wall slide, wall push-up plus, prone horizontal abduction with external rotation, external rotation in side lying, and lowrow)while simultaneously recording surface electromyographic of serratus anterior, middle trapezius, lower trapezius, and upper trapezius. Surface electromyographic amplitudes, onset latencies, and activation ratios were calculated. Results: Prone horizontal abduction with external rotation showed an excellent upper trapezius/middle trapezius (0.43) and upper trapezius/lower trapezius (0.30) muscle balancewith high (>50% maximum voluntary isometric contraction) middle trapezius and lower trapezius amplitudes, a low (<20% maximum voluntary isometric contraction) upper trapezius amplitude, and an early activation of the scapular stabilizing muscles (-474.7 to 89.9 ms) relative to upper trapezius. External rotation in side lying showed excellent upper trapezius/serratus anterior (0.26), upper trapezius/middle trapezius (0.32), and upper trapezius/lower trapezius (0.21) activation ratios and, along with low row and wall slide, showed early activation of the scapular stabilizing muscles (-378.1 to -26.6 ms). Conclusions: Prone horizontal abduction with external rotation presented optimal scapular neuromuscular control. Although external rotation in side lying, low row, and wall slide did not meet all the criteria associated with optimal scapular neuromuscular control, these exercises could be used in early stages of shoulder rehabilitation because they favor early activation of the scapular stabilizing muscles. [ABSTRACT FROM AUTHOR]

Background: The soft tissue in the shoulder plays a significant role in anterior shoulder instability, leading to humeral head displacement from the glenoid fossa. Arthroscopic Bankart repair is a widely accepted method to restore the labrum to the joint rim. This study aims to evaluate the clinical outcomes of Bankart repair by knotless suture anchors at medium-term follow-up, assess the functional outcomes of the knotless suture anchor method for recurrent anterior glenohumeral instability, and conduct clinical assessment using the Rowe score at 6-week, 3-month, 6-month, and 12-month intervals in patients. Methods: In this retrospective study, patients who underwent arthroscopic Bankart repair using a 2.8 mm knotless suture anchor (MINI-VIM PK®) were enrolled. They were assessed for shoulder stability, range of motion (ROM), and functional outcomes using the Rowe scale at the baseline, 6-week, 3-month, 6-month, and 12-month follow-up intervals as part of the planned early efficacy measures. All the statistical analyses were performed using SPSS software. Results: The mean age of the subjects was 28.10 ± 6.14. In this trial, 51 patients (69.86%) were diagnosed with recurrent shoulder dislocation on the left side, and 22 patients (30.14%) on the right side. The Rowe score demonstrated a significant improvement (P < 0.0001), increasing from 44.73 ± 1.64 to 95.62 ± 18.33 at the 12-month follow-up period. This indicated better clinical outcomes and reduced recurrence of instability with the use of knotless suture anchors. Conclusion: The use of knotless suture anchors demonstrated reduced recurrence rates, improved post-operative shoulder motion, and increased stability without adding complexity to the procedure. [ABSTRACT FROM AUTHOR]

Purpose: This study examines the influence of preoperative fatty infiltration (FI) of the subscapularis tendon (SBS) on outcomes following reverse total shoulder arthroplasty (rTSA) with SBS repair. Methods: A cohort of 161 rTSA patients with SBS repair, followed for a mean of 45.3 months, was divided into three groups based on FI: Group A (intact upper and lower portions, n = 85), Group B (intact lower portions, n = 44), and Group C (fatty infiltrated in both portions, n = 32). The mean age was 74.5 years (range: 65–95). Results: Preoperative FI displayed significant disparity among the groups: Group A (1.18 ± 0.60), Group B (2.95 ± 0.56), and Group C (4.0 ± 0.00) (p <.001). Group A exhibited a more positive trend in activities of daily living, particularly in toileting ability (81% in Group A, 68% in Group B, and 72% in Group C), although without statistical significance (p = 0.220). Complication rates varied: Group A had seven acromial fractures (8%), three cases of instability (3%), and six instances of scapular notching (7%). Group B experienced four acromial fractures (9%) and four cases of scapular notching (9%), while Group C had only one case of scapular notching (3%) (p = 0.733). Conclusion: In cases characterized by favorable preoperative SBS quality, there was an elevation in functional internal rotation (IR) post-surgery, accompanied by an increased incidence of postoperative complications. Hence, careful consideration is advised when determining the necessity for SBS repair. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Purpose: In the present study, we want to systematize the previous studies on the scapular foramina (SF) and nutrient foramina (NF) with emphasis on the clinical relevance of this topic. Although seemingly not important, radiologists, clinicians and surgeons should be aware of the presence and characteristics of the SF and NF and look out for possible mistakes that may cause harm to the patients during either the diagnostic process or surgery. Methods: A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Web of Science, Embase, Cochrane Library and Google Scholar. The whole process was divided into three stages. In the first stage, the following search terms were used: ((scapular foramina) or (scapular foramen) or (scapular nutrient foramina) or (scapular nutrient foramen) or (scapula foramen) or (scapula foramina) or (scapula nutrient foramina)). Results: The results of the present meta-analysis were based on a total of 3316 studied scapulae. A pooled prevalence of scapulae in which at least one SF was found was set to be 11.29%. The most common localization of the SF was found to be the infraspinous fossa, in which the SF occurred with the prevalence of 52.31%. Subsequently, a pooled prevalence of scapulae in which at least one NF occurs was established at 74.23%. Conclusion: The presented data contribute to a comprehensive understanding of the prevalence, distribution, and characteristics of suprascapular and nutrient foramina in scapulae, considering different topographical areas, genders, and sides. [ABSTRACT FROM AUTHOR]

The dolphin (Tursiops truncatus) is the most studied and most common species of cetacean in captivity. In this study, the size results obtained were the ribs and scapula. The first measure is a difference from the proximal to the distal end between the literature and this study. the second and third sizes have long, short, and longer proximal to distal differences. The fourth, fifth and sixth sizes show that the bones of T.truncatus are smaller than those of the Numataphocoena yamashitai species and the seventh size shows that the differences between T.truncatus and the Numataphocoena yamashitai species are several short and long costae. For the scapula, the dimensions of the first and second bones are larger than the present study species T.truncatus and Numataphocoena yamashitai. The sizes of the three results from this study are almost the same as the species Numataphocoena yamashitai except for the species Prosqualodon marplesi, which is larger than this study and research in California. The fourth size, which is 49.0 mm from head to tuberculum, is larger than the species T.truncatus and Numataphocoena yamashitai studied. The fifth size, the diameter of the rib head of this research species is smaller than the species Numataphocoena yamashitai and Prosqualodon marplesi, both of which are smaller than T.truncatus, and some of these differences are caused by food, habitat and environmental conditions. [ABSTRACT FROM AUTHOR]

Background: We noted that patients with thoracic outlet syndrome (TOS) have elevation of the ipsilateral scapula and named this the scapular elevation sign (SES). The aim was to determine the prevalence of SES in a normal cohort, compare SES with other provocative tests and to determine the treatment effect on SES. Methods: First, normal asymptomatic subjects were prospectively assessed to determine the prevalence of SES in a normal cohort. Second, patients with TOS were retrospectively examined for the presence of SES and four provocative tests: supraclavicular pressure, scalene test, elevated arm stress test (EAST) and the military brace manoeuvre. All patients were initially treated non-surgically. Surgery was offered to patients with persistent symptoms at 6 months. Patients were re-examined for the presence of the SES after treatment. Results: The prevalence of SES in our normal cohort was 4% (2/53). Our study cohort included 20 patients with TOS. The SES was positive in 18 patients (90%). Supraclavicular pressure was positive in 11 (55%), scalene test in 13 (65%), EAST in 9 (45%) and military brace manoeuvre in 11 patients (55%). Following non-surgical treatment, six patients had symptom resolution, three had improvement, nine persistent symptoms and two were lost to follow-up. The SES was positive in one out of six patients with symptom resolution, two out of three patients with improvement and in all nine patients with persistent symptoms. Patients with persistent symptoms underwent surgery with symptom resolution in eight and improvement in one patient. The SES remained positive in two patients after surgical treatment. Conclusions: The SES is simple and sensitive, does not rely on variations in performance of the test and suitable for diagnosis and assessment of outcomes of TOS. Level of Evidence: Level III (Diagnostic) [ABSTRACT FROM AUTHOR]

Individuals with shoulder impingement syndrome (SIS) exhibit changes in corticospinal excitability, scapular kinematics, and scapular muscle-activation patterns. To restore the scapular kinematics and muscle-activation patterns in individuals with SIS, treatment protocols usually include scapula-focused exercises, such as scapular-orientation and strength training. To investigate whether scapular-orientation and strength training can reverse the altered corticospinal excitability of recreational overhead athletes with SIS. Randomized controlled clinical trial. University laboratory. Forty-one recreational overhead athletes with SIS: 20 in the scapular-orientation group (age = 26.45 ± 4.13 years, height = 171.85 ± 7.88 cm, mass = 66.70 ± 10.68 kg) and 21 in the strengthening group (age = 26.43 ± 5.55 years, height = 171.62 ± 5.87 cm, mass = 68.67 ± 10.18 kg). Both groups performed a 30-minute training protocol consisting of 3 exercises to strengthen the lower trapezius (LT) and serratus anterior muscles without overactivating the upper trapezius muscles. Participants in the scapular-orientation group were instructed to consciously activate their scapular muscles with electromyographic biofeedback and cues, whereas the strengthening group did not receive biofeedback or cues for scapular motion. Corticospinal excitability was assessed using transcranial magnetic stimulation. Scapular kinematics and muscle activation during arm elevation were also measured. After training, both groups demonstrated an increase in motor-evoked potentials in the LT (P =.004) and increases in scapular upward rotation (P =.03), LT activation (P <.001), and serratus anterior activation (P <.001) during arm elevation. Moreover, the scapular-orientation group showed higher LT activation levels during arm elevation after training than the strengthening group (P =.03). With or without biofeedback and cues, scapula-focused exercises improved scapular control and increased corticospinal excitability. Adding biofeedback and cues for scapular control during exercise helped facilitate greater LT activation, so feedback and cues are recommended during scapula-focused training. [ABSTRACT FROM AUTHOR]