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Background: Nonoperative management of posterior shoulder instability is common. However, limited data are available to assess the pathomorphologic factors associated with its failure. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to determine glenohumeral pathomorphologic features predictive of nonoperative management failure of posterior instability; and (2) to determine the relationship between nonoperative management failure and posterior glenoid bone loss (pGBL) progression. It was hypothesized that greater posterior acromial height (PAH) would adversely affect nonoperative survivorship and that shoulders treated nonoperatively would have pGBL progression compared with those undergoing surgical stabilization. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective review of a consecutive series of patients with isolated posterior shoulder instability, defined as isolated posterior labral tear on magnetic resonance imaging (MRI) with corresponding physical examination findings, who underwent nonoperative management for 6 months and had no previous related surgical history. The primary outcome of interest was the failure of nonoperative management, defined as the inability to return to full military duty or requiring surgical intervention. The morphologic features assessed for association with nonoperative management failure included pGBL, glenoid version, acromial morphology, and posterior humeral head subluxation. We secondarily sought to determine the progression of pGBL on serial MRI scans. Cox proportional hazard analysis was used to evaluate risk factors for failure. Results: In this study, 42 of 90 (46.7%) patients had failed nonoperative management and went on to receive an arthroscopic stabilization procedure. The group with failed treatment demonstrated a greater humeral head subluxation ratio than those with successful nonoperative management (0.65 ± 0.2 vs 0.62 ± 0.2; P =.038). Cox proportional hazard analysis identified pGBL, greater PAH, less posterior acromial coverage, and posterior humeral subluxation as significant risk factors for failure. Of those with failed nonoperative management, 17 had repeat MRI scans at a mean of 488.2 ± 87 days after index MRI for comparison, demonstrating a statistically significant progression of pGBL (index MRI, 2.68% ± 1.71%) versus after nonoperative treatment failure (6.54% ± 1.59%; P =.003). Conclusion: Failure occurred 47% of the time in patients who underwent nonoperative management for isolated posterior glenohumeral instability for a minimum of 6 months, and it was associated with a greater posterior humeral head subluxation, less posterior acromial coverage, greater PAH, and greater amounts of glenoid retroversion on index MRI. Additionally, those who had repeat MRI approximately 1 year after the index MRI demonstrated greater pGBL compared with the index MRI. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether the use of concomitant acromioplasty during rotator cuff repair (RCR) improves clinical outcomes and whether the outcomes are affected by acromial type. Purpose: To perform a systematic review of randomized controlled trials comparing clinical outcomes of RCR with and without acromioplasty, with a subanalysis of outcomes based on acromial type. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between RCR with versus without acromioplasty. A subanalysis was performed on the studies that provided outcomes based on acromial type. The search phrase used was rotator cuff repair (acromioplasty OR subacromial decompression) randomized. Patients were evaluated based on retear rate, reoperation rate, and patient-reported outcomes (PROs). Results: Application of inclusion criteria yielded 5 studies (2 studies were level 1, and 3 studies were level 2) including a total of 409 patients, with 211 patients undergoing RCR alone (group A) and 198 patients undergoing RCR with acromioplasty (group B). The mean patient age was 58.5 and 58.3 years in groups A and B, respectively. The mean follow-up time was 52.9 months, and the overall percentage of male patients was 54.1%. The rotator cuff tear size was 20.7 mm and 19.8 mm for groups A and B, respectively. No significant differences were found between groups for any of the PROs at final follow-up. Overall retear rates did not significantly differ between groups based on acromial type. Between 2 studies that measured reoperation rate, a significantly higher reoperation rate was found for the nonacromioplasty group (15%) versus the acromioplasty group (4.1%) (P =.031). One of these studies found that 5 of 9 patients (56%) with a type III acromion in the nonacromioplasty group underwent reoperation compared with 0 of 4 patients with a type III acromion in the acromioplasty group. Conclusion: There is some evidence that acromioplasty during RCR reduces the risk for later reoperation. This may be particularly true for patients with type III acromions, although further studies with larger sample sizes are needed to corroborate these data. [ABSTRACT FROM AUTHOR]

Objective: Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. Materials and methods: This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland–Altman plots, or intraclass coefficients. Results: A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). Conclusion: Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability. [ABSTRACT FROM AUTHOR]

Purpose: Scapular glenoid fractures, categorized based on the Ideberg classification, are commonly addressed surgically through approaches like the anterior deltoid-pectoral approach, posterior Judet approach, modified Judet approach, or posterior axillary approach. However, these methods present limitations in exposing the superior part of the glenoid. Therefore, we propose an approach for patients with concomitant acromion fractures, involving the anterior lateral flipping of the fractured acromion, allowing direct superior visualization of the superior and posterior superior parts of the glenoid. Method: Retrospective analysis was conducted on the data of five patients with shoulder fractures combined with scapular Ideberg III fractures between June 2018 and May 2023. All patients were treated using the shoulder approach above the scapular spine. There were four males and one female, aged 23–54 years with an average age of 36.6 years. One case involved the left shoulder, and four cases involved the right shoulder. X-rays and CT were taken before and after surgery to assess the location of the fractures and the healing status. Clinical evaluation included the assessment of efficacy using the Constant-Murley scoring criteria and analysis of surgical complications. Results: All five patients were followed up for a duration of 14–36 months. All fractures healed completely, with an average healing time of 4.3 months (range: 3–6 months). There were no complications such as suprascapular nerve injury, nonunion, wound infection, or shoulder joint instability observed postoperatively. At the final follow-up, the Constant-Murley shoulder joint function score ranged from 84 to 98 points, with an average of 91.4 points. Three patients achieved an excellent rating in shoulder joint function score, while two patients achieved a good rating. Conclusion: The shoulder approach above the scapular spine exhibits advantages such as easy exposure and reduction, minimal intraoperative trauma, and clear visualization. [ABSTRACT FROM AUTHOR]

Background and Purpose: Kinesiology tape (KT) has been used clinically to improve posture, mobility, and muscle strength. Limited research has investigated the effect of KT on respiratory function. The purpose of this study was to explore the effects of KT on posture and breathing in healthy individuals. Methods: Ninety-two adult participants were randomly assigned to a KT, sham tape (ST), or control group. Data collection occurred over 2 sessions. Baseline measurements included chest wall expansion (CWE) at the sternal angle (SA) and xiphoid process (Xi), maximal inspiratory pressure (MIP), and tragus (TWD) and acromion (AWD) to wall distances. Next, KT or ST was applied to the upper back and neck, or no tape was applied based on group assignment. Measurements were then repeated. Participants returned for a final round of measurements 48 hours later. Mixed-measures ANOVAs were used to determine the influence of tape at baseline (T0), immediately post-taping (T1), and 48 hours post-taping (T2). Post hoc analyses used the Tukey method. Results: Analysis showed significant differences between T0 and T1 (P = .004) and between T1 and T2 (P 5 .004) for AWD on the left. CWE-Xi data showed within group differences T0-T2 (P = .004) and T1-T2 (P = .004). MIP data showed within group differences between T0 and T1 (P = .001), T0 and T2 (P < .001), and T1 and T2 (P < .001). Discussion: KT had a limited and inconsistent impact on posture where there was a decrease inAWDon the left from T0 to T1 and then an increase from T1 to T2. No other changes in posture were found. Taping did not affect CWE at the SA. There was an evident training effect for CWE-Xi and MIP, where all groups saw increases over time. Conclusion: This method of KT application is not supported as an intervention for influencing posture and enhancing inspiratory breathing mechanics in healthy adults. Further investigation of KT in other populations is needed. [ABSTRACT FROM AUTHOR]

Background: The accurate and effective evaluation of parameters such as critical shoulder angle, lateral acromion angle, and acromion index from shoulder X-ray images is crucial for identifying pathological changes and assessing disease risk in the shoulder joint. Methods: In this study, a YOLOv8-based model was developed to automatically measure these three parameters together, contributing to the existing literature. Initially, YOLOv8 was used to segment the acromion, glenoid, and humerus regions, after which the CSA, LAA angles, and AI between these regions were calculated. The MURA dataset was employed in this study. Results: Segmentation performance was evaluated with the Dice and Jaccard similarity indices, both exceeding 0.9. Statistical analyses of the measurement performance, including Pearson correlation coefficient, RMSE, and ICC values demonstrated that the proposed model exhibits high consistency and similarity with manual measurements. Conclusions: The results indicate that automatic measurement methods align with manual measurements with high accuracy and offer an effective alternative for clinical applications. This study provides valuable insights for the early diagnosis and management of shoulder diseases and makes a significant contribution to existing measurement methods. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to investigate the potential relationship between shoulder anatomical parameters and the shape of rotator cuff tears (L-shaped, U-shaped, and crescent-shaped). Materials and methods: The study included 160 (n:160) patients. Patients were divided into four groups: crescent type, u type and L type tears and control group. There were 40 cases in each group. The operated patients were divided into three groups based on the shape of the tears in arthroscopic images. Measurements of Critical Shoulder Angle (CSA), Greater Tuberosity Angle (GTA), Acromion Index (AI), Lateral Acromion Angle (LAA), and Humerus Footprint width (coronal width and sagittal width) were taken in each group and compared. Results: Patients were divided into four different groups: Crescent type group (n:40), L type group (n:40), U type group (n:40) and control group (n:40). Upon assessing the coronal and sagittal width measurements, The mean coranal width measurement of the L-type tear group was 12.62 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). The mean sagittal width of the L-type tear group was 34.95 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on GTA, CSA, and AI data, the mean GTA measurement of the L-type tear group was 73.03 ± 0.95 degrees, which was significantly higher than all other groups (p < 0.05). The mean CSA measurement of the L-type tear group was 34.77 ± 0.66 degrees, which was significantly higher than all other groups (p < 0.05). The mean AI measurement of the L-type tear group was 0.77 ± 0.02, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on LAA data, the mean LAA measurement of the L-type tear group was 76.98 ± 1.04 degrees, which was significantly lower than all other groups (p < 0.05). Conclusion: In our study, especially in L-shaped tears, measurements of GTA, CSA, AI, LAA, coronal and sagittal width were found to be different compared to the control group. These results suggest that shoulder anatomy affects the mechanisms of rotator cuff tear formation and that these parameters play a more significant role in L-shaped tears. [ABSTRACT FROM AUTHOR]

Introduction: Acromial stress fracture (ASF) is an uncommon but acknowledged complication of reverse total shoulder arthroplasty (RTSA). There is no standardised method to directly measure the bone mineral density of the acromion to allow a detailed analysis of the potential mechanism of ASF. The aim is to establish a reliable and reproducible technique for measurement of acromial density on computer tomography (CT). Methods: A retrospective review on CT scans obtained for three groups of patients: those planned for RTSA (n = 26); age and gender‐matched non‐operative (n = 26); and young non‐operative patients (n = 28) were performed. Standardised axial images of 1 mm thickness at 1 mm increments were created following horizontal straightening on the coronal and sagittal views. To assess inter‐rater reliability, two senior CT radiographers performed density measurements using standard region of interest (ROI) tool on the CTs with the ROI placed on the mid (ROI 1) and posterior (ROI 2) acromion. ROIs were selected as the most common locations for acromion fracture post RTSA. Measurements were repeated at least 6 weeks apart. Intra‐class coefficients (ICC) were used to determine intra‐ and inter‐rater reliability. Results: ICCs demonstrated good to high intra‐rater and inter‐rater reliability for both ROI 1 and ROI 2 across all three groups. The lower margin of 95% confidence intervals was more than 0 for all intra‐class coefficients. Conclusion: This study demonstrates a reliable method of measuring acromion density on CT. This method can be used to assess bone mineral density in the clinical setting and in future studies investigating ASF following RTSA. [ABSTRACT FROM AUTHOR]

Background: Graft failure is a common complication after superior capsule reconstruction (SCR). The graft in SCR is fixed on the greater tuberosity and superior glenoid, and graft failure has been reported on both sides. Purpose: To evaluate the clinical manifestations of patients with graft failure after SCR and identify the clinical and radiological differences between medial and lateral graft failure. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent SCR with a dermal allograft for symptomatic irreparable rotator cuff tears between March 2018 and September 2021 were retrospectively reviewed. All patients had minimum 2-year follow-up and underwent magnetic resonance imaging at 6 months postoperatively. Patients with graft failure were divided into 2 groups: those with lateral graft failure on the greater tuberosity side (group I) and those with medial graft failure on the glenoid side (group II). Patients with intact grafts were included in group III as a control group. Intergroup differences in clinical and radiological characteristics were analyzed, and multiple regression analysis was performed. Results: Among the 93 patients included, there were 18 patients in group I, 15 in group II, and 60 in group III. Overall, 11 patients (61.1%) in group I and 9 patients (60.0%) in group II had a partial graft rupture at one anchor. The postoperative graft volume was significantly lower in group I than in groups II and III (2514.0 ± 564.3 mm3, 3183.5 ± 547.1 mm3, and 3198.0 ± 584.8 mm3, respectively; P =.002 for group I vs II; P <.001 for group I vs III). The acromiohumeral distance (AHD) was significantly increased at 6 months postoperatively compared with before surgery in group I (6.6 ± 1.6 mm vs 4.3 ± 1.9 mm, respectively; P <.001) and group II (7.4 ± 1.3 mm vs 5.7 ± 1.7 mm, respectively; P =.002). However, group I exhibited a significantly greater decrease in the AHD over time than group II (P <.001) and a significantly lower AHD at the final follow-up than the other groups (P <.001). The postoperative American Shoulder and Elbow Surgeons score was significantly lower in group I than in the other groups (P <.001). On multiple regression analysis, fatty infiltration of the infraspinatus muscle, Hamada grade, and graft width were independent factors for lateral graft failure. Conclusion: Patients with lateral graft failure had inferior clinical outcomes and lower postoperative graft volumes than those with medial graft failure after SCR using a dermal allograft. The AHD of patients with lateral graft failure improved postoperatively; however, it deteriorated over time. [ABSTRACT FROM AUTHOR]

Background: Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. Purpose: To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD). Study Design: Network meta-analysis of comparative studies; Level of evidence, 3. Methods: A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R. Results: A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P =.732) or age (P =.469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P =.017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P =.041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P =.013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P <.001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P =.007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P =.005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P <.001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, –16.70; 95% CI, −31.20 to −2.20; P =.024). Conclusion: For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion. [ABSTRACT FROM AUTHOR]

Unexpectedly abundant remains of herbivorous therapsids in the Late Triassic strata of southern Poland have significantly supplemented knowledge of their evolution. The skeletal morphology of the Late Norian (or Rhaetian) dicynodont Lisowicia bojani supports its close relationship to the Carnian Woznikella , both known from the Polish part of the Germanic Basin. Three evolutionary lineages of dicynodonts—Laurasian–Gondwanan Rhadiodromus klimovi  → Jachaleria candelariensis lineage, Laurasian lineage Shaanbeikannemeyeria xilougouensis  → Lisowicia bojani , and the Gondwanan lineage Kannemeyeria simocephalus  → Dinodontosaurus brevirostris —are distinguished based on characters of cranial and postcranial elements. In the lineages characterized by the parietal oval in cross-section and the two distinct articulations on the sternum, there is a tendency to exclude the frontal from the orbital margin and to reduce the number of sacral vertebrae. In the lineage with the parietal narrow and triangular in cross-section, the frontal forms part of the orbit margin, there is a single joint on the sternum, and there is a tendency towards flattening the skull roof. In both lineages the shoulder girdle is convergently modified, the acromion process decreased, and joints on the sternum moved posteriorly. [ABSTRACT FROM AUTHOR]

The prevalence of acromial fracture after reverse total shoulder arthroplasty (RSA) is reportedly 2.6%-8.4%, and clinical outcomes differ among fracture sites. However, few studies have investigated the factors affecting fracture sites. This study aimed to reproduce acromial fractures after RSA by replicating the postoperative displacement of the humerus using finite element models (FEMs), and to investigate the effect of humeral displacement on the fracture site. Six patients (mean age, 76.3 ± 7.9 years; 5 women and 1 man) with acromial fractures after RSA treated at our institution were included. Among them, 3 had Levy Type 1 fractures, whereas the other 3 had Levy Type 2 fractures. Preoperative computed tomography data were used to create a 3-dimensional FEM. All elements within the proximal 2 cm of the clavicle and the scapular body were completely constrained. The entire humerus was forcibly displaced following its displacement after RSA, as measured by preoperative and postoperative computed tomography. The fracture sites, total displacement, external constraint of the humerus at the initial fracture, and bone density from the acromion to the scapular spine were investigated. Values of P <.05 were considered statistically significant in tests of statistical inference but were interpreted as reference values due to the small number of cases. There were no major differences in humeral displacement between Type 1 and Type 2 fractures. Although the fracture sites in the FEM were slightly more medial than the actual fracture sites, they were similar. The total displacement and external constraint of the humerus at the initial fracture were similar in Type 1 and Type 2 fractures. The distribution of bone density from the acromion to the scapular spine differed between fracture types. We were able to reproduce acromial fractures after RSA by replicating humeral displacement using FEM. The extent and direction of humeral displacement may not significantly affect the acromial fracture site, whereas the bone density distribution from the acromion to the scapular spine may affect it. [ABSTRACT FROM AUTHOR]

Lateralizing the center of rotation in reverse shoulder arthroplasty (RSA) decreases the risk of scapular notching due to inferior impingement but may limit range of motion (ROM) in abduction and forward flexion related to superior acromial impingement. Our primary hypothesis was that, using a 3-dimensional (3D) computer model, a virtual acromioplasty (with or without tuberoplasty) could improve abduction and forward flexion following RSA for cuff tear arthritis (CTA) or massive cuff tear. Our secondary hypothesis was that, based on the virtual planning, a surgical acromioplasty could be performed safely during RSA, without increasing the risk of postoperative acromial fracture. Eighty seven patients with CTA scheduled for RSA were analyzed with a 3D software and impingement-free ROM was measured. After virtual prosthesis implantation, early acromio-humeral impingement (abduction ≤ 80° or forward flexion ≤ 120°) was observed in 25% of the cases (22/87). A virtual acromioplasty (with or without tuberoplasty) was then performed and glenohumeral ROM was measured again. Based on this 3D planning, a surgical acromioplasty (with or without tuberoplasty) was performed to improve ROM in the vertical plane in these 22 patients with early acromial impingement. Patients were followed with minimum 24 months of follow-up to assess final shoulder ROM and complications. After virtual acromioplasty alone (n = 11) or acromioplasty with tuberoplasty (n = 11), glenohumeral abduction significantly increased from 75° ± 6.9 before to 89.5° ± 23.4, and forward flexion from 119.3° ± 12 to 135.2° ± 10 (P <.001). After surgical acromioplasty/tuberoplasty, the final mean global forward flexion was 148° ± 5 and mean global abduction 150° ± 8 in these patients. At last follow-up, no acromial fracture was observed. In a 3D model, early acromial impingement may limit abduction (≤80°) or forward flexion (≤120°) after virtual RSA implantation for CTA or massive cuff tear. Virtual acromioplasty (with or without tuberoplasty) shows improved ROM in abduction and flexion. In patients with early impingement, a surgical acromioplasty can be performed safely during RSA, through a deltopectoral approach, without increasing the risk of postoperative acromial fracture. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acromion morphology is the most important external factor of degenerative rotator cuff tear, and studies on acromion morphology and acromion coverage have been continuing. OBJECTIVE: To investigate the coverage of acromion on rotator cuff tissue in three-dimensional space, measure coronal and sagittal parameters, and explore the relationship of acromial overhang, acromioglenoid angle and acromial coverage angle with degenerative full-thickness rotator cuff tears. METHODS: A total of 56 patients diagnosed with full-thickness rotator cuff tears by shoulder arthroscopic surgery or MRI in the Affiliated Hospital of Xuzhou Medical University from January 2022 to June 2023 were retrospectively collected as the tear group, while 48 patients with non-rotator cuff tear were included as the control group. Clinical data and chest CT data of the patients of the two groups were collected, and the shoulder blades of the patients were reconstructed using Mimics software. Acromial overhang, acromioglenoid angle and acromial coverage angle were measured in 3-matic software. The differences between the measurement parameters were compared between the two groups. Binary Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the ability of the measurement parameters to predict rotator cuff tear. It is generally believed that the parameter had good diagnostic value when the area under the receiver operating characteristic curve was greater than 0.8. RESULTS AND CONCLUSION: (1) The mean acromial overhang in patients with rotator cuff tears was greater than that in controls (P < 0.001). The mean acromial coverage angle was also greater in patients with rotator cuff tears than in controls (P < 0.001). There was no significant difference in the acromioglenoid angle between the two groups (P > 0.05). (2) Binary Logistic regression analysis showed that acromial overhang and acromial coverage angle were both risk factors for rotator cuff tear (P < 0.05). (3) Receiver operating characteristic curve analysis indicated that the areas under the curve of acromial overhang and acromial coverage angle were 0.725 and 0.865, respectively, and the optimal cutoff values were 36.15 mm and 60.65°. (4) The results showed that the acromial overhang and acromial coverage angle were greater in patients with rotator cuff tears than in patients without rotator cuff tears. Both were associated with degenerative full-thickness rotator cuff tears, and they could be used to predict rotator cuff tears, and the acromial coverage angle was more effective in predicting rotator cuff tears. [ABSTRACT FROM AUTHOR]

Background: Acromial stress fractures following reverse shoulder arthroplasty (RSA) have gained attention among specialized surgeons over the past decades craving answers regarding predisposing factors and technical aspects as how to avoid the complication. This study introduces the acetabularization index (AI) for the preoperative estimation of acromial bone loss attributed to acetabularization in cases of cuff tear arthropathy (CTA). Methods: The acromiohumeral interval (AHI), extent of acromial acetabularization (AA), acromial height (AH), and width of acetabularization (r) were measured on preoperative radiographs and two-dimensional computed tomography scans (2D CT) of patients who underwent RSA within the timeline 2019–2023 for CTA. The AI calculated AI % = AA mm ÷ AH mm . The CTA grade was determined according to the Hamada classification. The AI values on radiographs and 2D CT were compared by a Student's t-test. Possible correlation between the AI and AHI was investigated via Pearson's coefficient. The intraclass correlation coefficient (ICC) was employed to test the interobserver reliability among two independent testers. Results: The radiographs and 2D CT scans of thirty-three patients who underwent RSA were analyzed. The mean AHI, AH, AA, r, and AI values on radiographs were 5.5 ± 2 mm, 10 ± 2 mm, 2 ± 2 mm, 30 ± 4 mm, 16 ± 16%, respectively. On 2D CT, the corresponding mean values were 4.7 ± 2.5 mm, 10.8 ± 2.65 mm, 2.45 ± 2.35 mm, and 30 ± 4.5, and 22.3 ± 22%, respectively. There was a statistically significant difference between the AI values on radiographs and 2D CT (P =.000). The Pearson's correlation coefficient demonstrated a negative correlation between AI and AHI (r = − 0.33). Excellent reliability was observed by the ICC values for all parameters in both groups among two testers. Conclusion: The AI is a reliably measurable tool on radiographs and 2D CT scans; however, the measurements derived from radiographs vary significantly from CT based measurements due to projection restrictions. Grade IVB of the Hamada/Fukuda classification is associated with the highest AI values. Further research is warranted to assess the clinical utility of this index as a predictive tool for postoperative acromial stress fractures. [ABSTRACT FROM AUTHOR]

Bizarre parosteal osteochondromatous proliferation (BPOP) is a benign but rare periosteal-originating chondrogenic tumor. It commonly arises from the hands and feet. It is slow-growing and often presents as a painless lump. On imaging, the mass is well-marginated and almost always remains contiguous with the cortical bone. Histologically, the lesion is composed of a disorganized admixture of fibrous tissue, bone, and cartilage with bizarre features. Treatment is surgical and local recurrence is common contiguous with bone. This case report demonstrates an uncommon acromial BPOP with the first reported recurrence not contiguous with the underlying cortex. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the interobserver reliability of measurements of the Acromiohumeral Distance (AHD) first described by Golding et al., the Critical Shoulder Angle (CSA), the Acromion Index with Glenoid Humeral (GH) and Glenoid Acromial (GA) distances, following the measuring method by Nyffeler et al., the Lateral Acromion Angle (LAA), as well as the morphology of the acromion according to Bigliani and the humeral head position according to Maloney in X-rays and MRI. Furthermore, the study assessed the correlation of measurement results in X-ray with those in MRI for AHD, CSA, GA, GH, AI, and LAA. Methods: A total of 187 patients who underwent shoulder joint X-ray and MRI examinations from 09/2016 to 05/2023 were included in the study. Patients with poor imaging quality, arthrosis or radical prior surgeries, like shoulder prosthetic surgery, status post humerus fractures, that have undergone surgery and therefore changed the anatomical features were excluded, what lead to a total study population of 78. X-ray measurements were performed by two observers in the true anteroposterior view, so that the humeral head and the glenoid are shown without overlap, providing a clear view into the joint space. MRI measurements were performed in oblique coronal MRI slices, using the most accurately depicted glenoid surface as a landmark. Results: Interobserver measurement results showed a significance with p < 0.001 for the assessment of acromion type according to Bigliani, humeral head offset assessment according to Maloney, and AHD. No significance was found for interobserver reliability in measuring LAA. Additionally, there was a high correlation of measurement results in X-ray with measurements in MRI for, CSA, GH/GA, and consequently AI, a good correlation for AHD but no correlation could be shown for LAA. Conclusions: These findings provide valuable insights into the robustness of radiological parameters for evaluating shoulder pathology, offering promising prospects for clinical applications and further research. Nevertheless, the specific methodological considerations and patient characteristics should be taken into account when interpreting the results to ensure their accurate application in clinical practice. [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]

Background: Whether to perform acromioplasty in arthroscopic rotator cuff repair (ARCR) is controversial, and the optimal surgical approach for rotator cuff tear repair is unknown. The purpose of this study was to compare the reoperation rate, retear rate and patient-reported outcomes (PROs) of ARCR with those of ARCR combined with acromioplasty (ARCR-A). Methods: PubMed, Embase and Cochrane Library were searched for relevant literature dated between database inception and 4 December 2023. The primary outcomes of this study were the reoperation rate and the retear rate. The secondary outcomes were PROs, including the visual analogue scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the University of California-Los Angeles (UCLA) score, the Constant score and the Western Ontario Rotator Cuff (WORC) score. The quality of the included studies was evaluated by using the risk of bias assessment tool. RevMan 5.3 software was used for meta-analysis. Fixed (I2 <50%) or random (I2 ≥50%) effects models were applied to calculate the effect size. Results: Meta-analysis revealed that ARCR-A had a lower reoperation rate (OR = 0.35, 95%CI: 0.15–0.85, p = 0.02), but the difference in the retear rate between ARCR-A and ARCR was not significant (p = 0.25). In type 2 acromion patients, the reoperation rate was not significantly different between ARCR and ARCR-A (p = 0.12), but, for type 3 acromion patients, the retear rate was lower for ARCR-A than for ARCR (OR = 0.12, 95%CI: 0.01–0.94, p = 0.04). There were statistically significant differences in the 6-month postoperative Constant scores (p < 0.001), VAS pain scores (p = 0.003) 12-month postoperative ASES scores (p = 0.02) and 24-month postoperative WORC scores (p = 0.04), but these differences were not clinically significant. Conclusions: Combining ARCR with acromioplasty can reduce the rate of reoperation, especially in patients with type 3 acromion, but it provides no clinically important change in the retear rate and postoperative PRO compared with ARCR. [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]

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]

Purpose: Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark–specific nerve position data. The purpose of this study is to address this gap by investigating such relationships. Method: This cadaveric study examines axillary, radial and suprascapular nerves' relation with acromion, coracoid and greater tuberosity of the humerus (GT). It also correlates this data with humeral lengths and explores nerve dynamics in relation to arm positions. Results: The mean distance from the axillary nerve to (i) GT was 4.38 cm (range 3.32–5.44, SD 0.53), (ii) acromion was 6.42 cm (range 5.03–7.8, SD 0.694) and (iii) coracoid process was 4.3 cm (range 2.76–5.84, SD 0.769). Abduction brought the nerve closer by 0.36 cm, 0.35 cm and 0.53 cm, respectively. The mean distance from radial nerve to (i) GT was 5.46 cm (range 3.78–7.14, SD 0.839), (ii) acromion was 7.82 cm (range 5.4–10.24, SD 1.21) and (iii) tip of the coracoid process was 6.09 cm (range 4.07–8.11 cm, SD 1.01). The mean distance from the suprascapular nerve to the acromion was 4.2 cm (range 3.1–5.4, SD 0.575). The mean humeral length was noted to be 27.83 cm (range 25.3–30.7, SD 1.13). There was no significant correlation between these distances and humeral lengths. Conclusion: It is essential to exercise caution to avoid axillary nerve damage during the abduction manoeuvre, as its distance from the greater tuberosity and tip of the coracoid process has shown a significant reduction. The safe margins, in relation to the length of the humerus and consequently the patient's stature, exhibit no significant variation. In situations where the greater tuberosity (GT) and the border of the acromion are inaccessible due to reasons such as trauma, the tip of the coracoid process can serve as a dependable bone landmark for establishing a secure surgical margin. [ABSTRACT FROM AUTHOR]

Purpose: While Clavicle hook plates have demonstrated favorable results regarding bone and shoulder function, their design can potentially lead to complications due to pressure concentration at the plate's tip. This study aims to investigate the impact of different hook implantation angles on the contact surface area between the hook plate and acromion, with the goal of minimizing mismatch and maximizing contact surface area. Methods: Twenty soft shoulder cadavers were included in the study, and the contact surface area of the hook plate was measured in different positions based on the hook implantation angle. Results: The results showed variations in compatibility, width, and length of the contact surface area depending on the hook implantation angle and the medial or lateral row placement. The lateral row generally demonstrated superior compatibility (84.0% vs 46.67%, p-value < 0.001), with a broader contact area (3.55 ± 0.08 mm vs 3.09 ± 0.10 mm, p-value = 0.004) and a longer contact area (7.36 ± 0.19 mm vs 5.10 ± 0.23 mm, p-value < 0.001) at specific angles. A detailed analysis of the lateral position revealed that the zero angle of implantation resulted in the greatest contact surface area, measuring 3.91 ± 0.70 mm in width (p value = 0.083) and 8.85 ± 1.24 mm in length (p value < 0.001). Conclusion: Placing the hook laterally and at the zero position according to the hook implantation angle can maximize contact surface area, may reduce stress concentration, and minimize complications in hook plate fixation. Further research and consideration of anatomical variations are warranted to refine the placement technique and enhance patient outcomes. Level of Evidence: Level V evidence. [ABSTRACT FROM AUTHOR]

Background: It is necessary to better understand the structural characteristics of the supraspinatus tendon and associated muscle after rotator cuff repair and in the event of retear. Purpose: To study structural differences between the repaired and contralateral shoulders 1 year after rotator cuff repair in patients who received either progressive exercise therapy (PR) or usual care (UC) in a randomized controlled trial and to investigate whether there was interaction with tendon retear and limb dominance. Study Design: Cohort study; Level of evidence, 2. Methods: Patients with surgically repaired traumatic full-thickness rotator cuff tears involving the supraspinatus tendon were included. After surgery, they were randomized to PR or UC (active from postoperative week 2 or 6, respectively). The subacromial structures (acromiohumeral distance, supraspinatus tendon thickness, and vascularity) and the supraspinatus muscle thickness were examined with ultrasound at the 1-year follow-up. Results: A total of 79 patients were included. The characteristics of the 2 intervention groups (PR and UC) were comparable, including the Western Ontario Rotator Cuff Index score and number of retears. The authors found significantly thinner supraspinatus tendon (PR, P <.001; UC, P =.003) and reduced acromiohumeral distance (PR, P =.023; UC, P =.025) in the repaired versus the contralateral shoulders in both intervention groups. For neovascularization, there was no interlimb difference in either of the groups or between groups (PR vs UC). In patients with intact tendons, there was no interlimb difference in the muscle thickness, but in patients with tendon retear the muscle was significantly thinner on the repaired side (P =.024 and P <.001, respectively). When the dominant supraspinatus tendon was repaired (both groups), it was significantly thinner than the nondominant healthy tendon, but this difference was not seen when the nondominant supraspinatus tendon was repaired (P =.006). Conclusion: One year after rotator cuff surgery, the repaired supraspinatus tendon was significantly thinner and the corresponding acromiohumeral distance was reduced. In patients with retear, the supraspinatus muscle was significantly thinner on the repaired side and early initiation of tendon-loading exercises did not affect these findings. Registration: NCT02969135 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of the current study was to assess the biomechanical utility of a posterior acromial bone block (PABB) in addressing posterior glenohumeral instability. Secondary goals included evaluating the biomechanical relationships between various posterior acromial morphology metrics such as posterior acromial height (PAH), posterior acromial coverage (PAC), and posterior acromial tilt (PAT) using a posterior glenohumeral instability model. Our hypothesis was that the addition of a PABB would increase the force required to translate the humeral head posteroinferiorly when compared to cadaveric specimens with a simulated posterior capsulolabral lesion, both before and after capsulolabral repair. Secondarily, we hypothesized that the maximum force required to translate the humeral head 10 mm posteroinferiorly in both intact specimens and those augmented with a PABB will be inversely related to PAH (higher values denoting a higher, flatter acromion) but positively correlated with PAC (a metric of posterior acromial humeral head coverage). Methods: An a priori power analysis was performed based upon prior posterior glenohumeral instability biomechanics research performed at our institution, and determined that 10 specimens would be required to obtain a power of 0.84. Therefore, 10 cadaveric shoulder specimens were obtained for testing. These specimens were ≤ 65 years of age and free of known pre-existing shoulder pathology or surgeries as confirmed by Computed Tomography (CT). These specimens were dissected to preserve as much native anatomy as possible, and a 2-2.5 cm bone block from the scapular spine was harvested at its mid-aspect. These specimens were potted with the humerus in 30 degrees of abduction and 30 degrees of flexion. Biomechanical testing was performed using the KUKA industrial robot, which is a 6-axis robot containing integrated software and a multi-axis load cell. All testing was performed with a 50-N compressive force applied to the humeral head to maintain its compression in the glenoid, as per the joint forces in the native shoulder. The humeral head was translated 30 degrees posteroinferiorly from the center of the glenoid 10 mm at a rate of 1.0 mm/s, and the maximum force required to obtain this translation was recorded in several conditions. The conditions included: intact specimen, intact with PABB, posterior instability lesion (capsulolabral lesion from 6 to 11 o'clock on the glenoid face), addition of the PABB (oriented at the posterolateral border of the acromion, fixed with two, 3.5 mm cortical screws), the removal of the PABB and repair of the capsulolabral lesion, and finally the addition of the PABB with the capsulolabral repair (Figure 1). Each capsulolabral repair was performed with 4 transosseous, #2, high tensile suture. Fluoroscopic images were obtained to measure pre- and post-PABB posterior acromial morphology measurements. Paired T-tests and linear regression analyses were performed. A P-value of 0.05 was used to determine statistical significance. Results: 10 cadavers with mean age 54.4 years (Standard Deviation (SD) ± 13.1 years) and mean glenoid version of 6.6 degrees of retroversion (SD ± 1.0 degrees) were studied. The PABB significantly increased the peak force required to translate the humeral head 10 mm posteroinferiorly in the setting of a posterior capsulolabral tear when compared to no PABB (PABB, 49.1 ± 21.5N ; posterior labral tear, 30.3 ± 15.7N; P = 0.0019) (Figure 2). Compared to a capsulolabral repair alone, the PABB again showed to have a significantly higher peak force (PABB, 49.1 ± 21.5N; repaired capsulolabral tear, 35.4 ± 21.2 N; P = 0.0024). The addition of the PABB to a labral repair did not significantly increase the peak force when compared to a PABB alone (PABB, 49.1 ± 21.5N ; PABB plus labral repair 54.7 ± 30.6 N P = 0.30).In both the intact specimens, as well as the specimens after undergoing the PABB, there were weak, negatively correlated relationships between the peak force during testing and PAH (Figure 3). On the contrary, there were weak, positively correlated relationships between the peak force and PAC (Figure 4). Conclusions: The addition of a posterior acromial bone block is biomechanically superior to capsulolabral repair alone in increasing peak forces required to translate the humeral head posteroinferiorly using a well-studied posterior glenohumeral instability model. Our findings also demonstrate that posterior acromial height was inversely correlated with peak forces, while posterior acromial coverage was positively correlated with peak forces. These results reinforce the emerging literature that suggests that posterior acromial morphology plays an important role in the biomechanics of glenohumeral instability. Our results support the consideration of this bone block technique to be used in all-comers with posterior glenohumeral instability, but this technique may be particularly useful in revision cases when repair of the posterior capsulolabral complex may be deemed insufficient or in cases with a patient who has a high, flat acromion. However, future research evaluating glenoid bone loss and bipolar lesions will be useful to elucidate the usefulness of this technique in these more complex pathologies. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether scapular morphology could predict isolated supraspinatus tendon tear propagation after exercise therapy. We hypothesised that a larger critical shoulder angle (CSA) and type III acromial morphology predict a positive change in tear size. Methods: Fifty‐nine individuals aged 40–70 years with isolated symptomatic high‐grade partial or full‐thickness supraspinatus tendon tears were included. Individuals participated in a structured, individualised 12‐week exercise therapy programme and underwent ultrasound to measure tear size at baseline and 12 months following therapy. Computed tomography images were segmented to create three‐dimensional subject‐specific bone models and reviewed by three trained clinicians to measure CSA and to determine acromion morphology based on the Bigliani classification. A binary logistic regression was performed to determine the predictive value of CSA and acromion morphology on tear propagation. Results: The CSA was 30.0 ± 5.4°. Thirty‐one individuals (52.5%) had type II acromial morphology, followed by type III and type I morphologies (25.4% and 22.0%, respectively); 81.4% experienced no change in tear size, four (6.8%) individuals experienced tear propagation and seven (11.9%) individuals had a negative change in tear size. No significant difference in tear propagation rates based on CSA or acromion morphology (not significant [NS]) was observed. The model predicted tear size status in 81.4% of cases but only predicted tear propagation 8.3% of the time. Overall, CSA and acromion morphology only predicted 24.3% (R2 = 0.243) of variance in tear propagation (NS). Conclusions: CSA and acromion morphology were NS predictors of tear propagation of the supraspinatus tendon 12 months following an individualised exercise therapy programme. Level of Evidence: II. [ABSTRACT FROM AUTHOR]

The acromioclavicular joint frequently experiences dislocations and fractures with ligament injuries during traumatic shoulder injuries, with clavicle hook plate fixation being a common treatment method. However, no studies have been conducted on the biomechanical analysis of plates and the average Korean clavicle–acromion dimensions. In this study, finite element analysis (FEA) was used to assess various parameters for biomechanical analysis. To assess the stress distribution in the acromion, clavicle, and plate, FEA models with the implantation of 36 clavicle hook plate models with different hook depths (12 mm, 15 mm, and 18 mm), hook lengths (15 mm, 17 mm, and 19 mm), and hook angles (90°, 95°, 100°, and 105°) were established. Moreover, three-dimensional chest computed tomography (CT) images and scanned CT image data were used for comparisons between the average Korean clavicle–acromion dimensions and the model dimensions. The study shows that the acromion experienced the least stress when the clavicle hook plate had dimensions of 12 mm depth, 19 mm length, and 105° angle. For the clavicle, the lowest stress occurred with a depth of 15 mm, length of 19 mm, and 105° angle. Additionally, the lowest stress on the clavicle hook plate was observed with dimensions of 18 mm depth, 19 mm length, and 100° angle. Based on the results, orthopedic surgeons can make an optimal selection for the plate geometry suitable for the bone length of each patient, which can reduce the incidence of adverse events, such as peri-plate fractures at the acromion or clavicle and postoperative pain due to the burrowing of the plate hook into the acromion. [ABSTRACT FROM AUTHOR]

Purpose: The overall distribution pattern of intramuscular nerves and the regions with the highest spindle abundance in deep cervical muscles have not been revealed. This study aimed to reveal neuromuscular compartmentalization and localize the body surface position and depth of the center of the region of highest muscle spindle abundance (CRHMSA) in the deep cervical muscles. Methods: This study included 36 adult cadavers (57.7 ± 11.5 years). The curved line joining the lowest point of the jugular notch and chin tip was designated as the longitudinal reference line (line L), and the curved line connecting the lowest point of the jugular notch and acromion was designated as the horizontal reference line (line H). Modified Sihler's staining, hematoxylin-eosin staining and computed tomography scanning were employed to determine the projection points (P) of the CRHMSAs on the anterior surfaces of the neck. The positions (PH and PL) of point P projected onto the H and L lines, and the depth of each CRHMSA, and puncture angle were determined using the Syngo system. Results: The scalenus posterior and longus capitis muscles were divided into two neuromuscular compartments, while the scalenus anterior and longus colli muscles were divided into three neuromuscular compartments. The scalenus medius muscle can be divided into five neuromuscular compartments. The PH of the CRHMSA of the scalenus muscles (anterior, medius, and posterior), and longus capitis and longus colli muscles, were located at 36.27, 39.18, 47.31, 35.67, and 42.71% of the H line, respectively. The PL positions were at 26.53, 32.65, 32.73, 68.32, and 51.15% of the L line, respectively. The depths of the CRHMSAs were 2.47 cm, 2.96 cm, 2.99 cm, 3.93 cm, and 3.17 cm, respectively, and the puncture angles were 87.13°, 85.92°, 88.21°, 58.08°, and 77.75°, respectively. Conclusion: Present research suggests that the deep cervical muscles can be divided into neuromuscular compartments; we recommend the locations of these CRHMSA as the optimal target for administering botulinum toxin A injections to treat deep cervical muscle dystonia. [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]

This article discusses a case study of a rare vascular tumor called epithelioid hemangioma that developed in the acromion of the scapula. The tumor exhibited locally aggressive behavior and had features that could be mistaken for a malignant neoplasm. The patient underwent various imaging tests, including computed tomography (CT) and magnetic resonance imaging (MRI), which revealed the infiltrative nature of the lesion. The tumor was successfully treated with bone curettage, and no further treatment was required. The correct diagnosis of epithelioid hemangioma is crucial as the treatment differs significantly from more malignant tumors. [Extracted from the article]

Acromial stress fractures (ASFs) after reverse total shoulder arthroplasty (RSA) can have a potentially devastating impact on shoulder function. They are often difficult to effectively treat. Multiple studies have shown a higher incidence of ASF after RSA in patients with cuff tear arthropathy (CTA). This study introduces and explores a new hypothesis. Our hypothesis is that 1) patients with CTA experience a preoperative pathologic superiorly directed force on their acromion, and 2) this leads to acromial bending moments on the acromion that are very different from patients with glenohumeral osteoarthritis (GHOA) and after RSA, and finally 3) these pathologic loads may result in abnormal bony remodeling and adaptations in CTA, which may then predispose patients to ASF after RSA. A finite element analysis model was developed to compare three loading conditions on the acromion: preoperative CTA, preoperative GHOA, and postoperative-RSA. Regions of the highest tensile and compressive stresses were identified and compared between groups. The finite element analysis model presented shows that patients with a preoperative diagnosis of CTA experience a stress distribution reversal after RSA, whereas GHOA patients do not. The results support that in CTA, the humerus produces pathologic strains and torques on the acromion. Over time, the acromion may slowly remodel in response, resulting in bony adaptations. Abrupt reversal of stresses and strains in CTA after RSA may lead to ASFs, as the acromion has adapted to a different stress pattern. This study introduces one potential contributing factor for the higher rates of ASF after RSA in patients with a preoperative diagnosis of CTA; understanding this phenomenon is the first step to preventing it. Once the forces seen in CTA are abruptly reversed after RSA, the biological race is on between the formation of an acromial stress fracture and the body's ability to again remodel the acromion to accommodate its new loading state. Additional clinical studies are needed to further investigate this new theory. [ABSTRACT FROM AUTHOR]

Acromion and scapular spine fractures (ASFs) after reverse total shoulder arthroplasty have been reported at a rate of 3.9 percent. Radiographs have been shown to be unreliable at identifying these fractures, with an estimated 20% false negative rate. A computed tomography (CT) scan is typically performed when initial radiographs are inconclusive and clinical suspicion for ASF remains high. However, the accuracy of identifying ASF fractures after reverse shoulder arthroplasty (RSA) with CT has not been studied. The purpose of this paper is to evaluate the ability of CT scans to detect clinically suspected ASF fractures after RSA when initial radiographs are inconclusive. A retrospective review of our institution's shoulder and elbow repository identified 111 patients treated with RSA from 2006 to 2022 that subsequently sustained an ASF. Upon clinical suspicion of an ASF, a 4-view radiographic series was obtained. If no fracture was clearly identified, a thin-cut CT was obtained. Additional four-view radiographic series were taken at each subsequent follow-up. Rate of detection by CT scan was defined using the number of cases with positive scans out of the number in which both a CT scan was performed, and a fracture was identified on either CT scan or other additional follow-up imaging. After inconclusive radiographs, a CT was ordered for 61 patients (55%) at a median of 1.3 weeks after the onset of signs/symptoms suspicious for ASF. Fractures were identified in 52 cases (85.2%) at a median of 1.6 weeks after the onset of sign/symptoms. The fracture was not seen on CT in 9 cases at a median of 0.9 week after the onset of sign/symptoms, representing a false negative rate of 14.8%. These fractures were later identified on radiographs at a median of 5.9 weeks following the CT scan. No statistical differences were observed in sensitivity of CT scan between fracture types. Fractures initially missed on CT scan eventually displaced and became nonunions. CT scans can be helpful in identifying and characterizing ASF following RSA, with an overall rate of detection (sensitivity) of 85%. Consideration of alternative advanced imaging may be needed for patients with negative CT scans and a high index of clinical suspicion for ASF. [ABSTRACT FROM AUTHOR]

A 7.2 kg, 7‐month old, male dachshund presented after a road traffic accident. Computer tomography revealed a pneumothorax, which was treated conservatively, and a type 1 extra‐articular unstable comminuted scapular fracture. A 5‐hole 2.0‐mm T‐plate was contoured to 90°, allowing the spine of the scapula to be fixated to the scapular body. Two locking‐compression plates were used in the infraspinatus and supraspinatus fossae to further stabilise the scapula. The above construct allowed for good reduction and stabilisation of the scapular fracture. Recovery was uncomplicated, and at 7 weeks post‐operatively the patient was sound on the operated leg with radiographic evidence of ongoing fracture healing, with minimal bony callus formation. The owners were contacted 7 months after surgery and reported an excellent recovery with no lameness. This report highlights that a contoured T‐plate can be used successfully to stabilise fractures of the scapular spine. [ABSTRACT FROM AUTHOR]

Introduction: Acromial apophysitis is a traction apophysitis caused by repetitive stress to the distal acromion. Although it is a common non-traumatic cause of shoulder pain in adolescence, data is scarce in the literature. There is a need for a better understanding of acromial apophysitis regarding its cause, diagnosis and management. Aim: To determine the cause, clinical features, radiological findings, management, and outcome of the patients diagnosed with acromial apophysitis. Materials and Methods: A longitudinal descriptive study was carried out at Jaipur National University Institute for Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India, from August 2018 to August 2022. A total of 30 patients aged 10-20 years with shoulder pain, diagnosed with acromial apophysitis based on history, clinical, and radiological examination, were included in the study. The treatment given, duration of disease, and outcome were noted. Descriptive statistics were performed using Microsoft Office Excel. Results: Out of 30 patients diagnosed with acromial apophysitis, 24 (80%) were male, and 6 (20%) were female, with a mean age of 13.47 (range 10-18) years. The cause was repetitive micro-trauma following chronic overuse during athletic and sports activities in 24 patients (80%). Among these patients, 13 played cricket, three played basketball, three played volleyball, two did weightlifting, one was a wrestler, one was a tennis player, and one was a judo player. Six patients (20%) did not give a history of playing any kind of sports. All patients had anterior shoulder pain with tenderness at the antero-lateral acromion. Radiographs showed fragmentation, sclerosis, and irregularity of the acromial apophysis. Conservative treatment included rest and restriction of sporting activities. The duration for the analgesics taken by patients was 8.9 days (range 3-21). The duration from the onset of symptoms to recovery was 5.8±1.61 weeks. None of the patients showed a recurrence of symptoms after complete recovery. Conclusion: Acromial apophysitis is a common cause of shoulder pain in paediatric and adolescent age. It occurs due to repeated overhead abduction, overuse, and throwing activities, mostly in sports persons. It is diagnosed clinically and confirmed with plain radiographs. It is a self-limiting disease with a short benign course. It is treated conservatively with rest and analgesics and has an excellent outcome. This diagnosis should be kept in mind for shoulder pain in young patients to prevent undue investigations and surgery.

A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.

Objective: The authors aimed to investigate the acromiohumeral interval (AHI) using Ellman's classification in patients with isolated supraspinatus tendon tears. The AHI differences between patients and controls, in addition to controls, partial tears, or total supraspinatus ruptures, were compared concerning AHI differences. Methods: The imaging was performed using a 1.5 Tesla (T) magnetic resonance imaging (MRI) device and a shoulder coil. The AHI measurements were determined by taking the average of measurements in 3 different planes. For Ellman's classification, the grading of the tear was graded based on how much the depth of the tear or the thickness of the tendon was affected. Results: A total of 304 shoulder MRIs meeting the criteria were included in our study. The study included 41.4% (126/304) without rotator cuff pathology, 30.9% (94/304) with grade 1 tear in the isolated supraspinatus tendon, 6.6% (20/304) individuals with grade 2 tear, 11.8% (36/304) with isolated supraspinatus tendon grade 3 tear, and 9.2% (28/304) with grade 4 tear in the isolated supraspinatus tendon. The AHI values in men were found to be statistically significantly higher than in women. The patient group and the control group showed a significant difference regarding the AHI values. The AHI measurements were significantly lower for the patients with total rupture. Conclusion: The AHI values in isolated supraspinatus tendon injuries, including all tear groups, were found to be significantly lower than those in the patients without rupture; however, there was also a significant difference between total and partial-tear groups. [ABSTRACT FROM AUTHOR]

Background: Balance assessment is very important to assess the balance abilities of an individual. Functional Reach Test (FRT) is a test which is used for assessing balance. The result of this test has been found to be influenced by the age of the children. Multi directional Reach Test (MRT) is a test which is used for assessing balance abilities by making the individual reach in four different directions without flexing limbs or losing balance. Objective:The objective of the present study is to establish the normative values for reference of MRT among children between 5 to 17 years of age group. Methodology: In the present study a self-designed MRT instrument was used to fulfill the purpose. The instrument is made up of three wooden frames placed adjacent to each other. It consists of two metallic rulers at the top of the wooden frames such that one ruler is present between set of two adjacent wooden frames. Each ruler is 600 mm in length. To perform this test, the subject was asked to remove the shoes and stand in front of the instrument. The rulers were adjusted according the level of the acromion process of the subjects. Next they were asked to stand with outstretched hands such that the shoulder is at 90o and feet together and firmly in support with the ground. Subjects then attempted to reach in all four directions namely forward reach (FR), backward reach (BR), left lateral reach (LLR) and right lateral reach (RLR). Measurements were taken for all the four directions from initial position to the end position up to which the participant could reach without losing balance. The middle finger was taken as the reference for taking all the measurements. Result: The results of the present study reveal that MRT scores increases with advancing age according to the trends observed among different age groups of children. The result of the present study also showed that maximum reach score was obtained in forward reach among 12- year-old age group [score 21.33 (skewness 0.08 kurtosis 0.97)] whereas the lowest score was obtained in backward reach among 8-year-old age group [score 6.58 (skewness 1.20 kurtosis 0.91)]. In all the age groups it has been found that the scores of forward reach are higher than the scores of backward reach. Conclusion: MRT instrument is an effective and time saving tool for assessing balance abilities among children. It is an instrument which is easy to understand and use without any special knowledge or training. The normative reference scores for the given age group has also been established in this study. [ABSTRACT FROM AUTHOR]

Introduction: Acromial apophysitis is a traction apophysitis caused by repetitive stress to the distal acromion. Although it is a common non-traumatic cause of shoulder pain in adolescence, data is scarce in the literature. There is a need for a better understanding of acromial apophysitis regarding its cause, diagnosis and management. Aim: To determine the cause, clinical features, radiological findings, management, and outcome of the patients diagnosed with acromial apophysitis. Materials and Methods: A longitudinal descriptive study was carried out at Jaipur National University Institute for Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India, from August 2018 to August 2022. A total of 30 patients aged 10-20 years with shoulder pain, diagnosed with acromial apophysitis based on history, clinical, and radiological examination, were included in the study. The treatment given, duration of disease, and outcome were noted. Descriptive statistics were performed using Microsoft Office Excel. Results: Out of 30 patients diagnosed with acromial apophysitis, 24 (80%) were male, and 6 (20%) were female, with a mean age of 13.47 (range 10-18) years. The cause was repetitive microtrauma following chronic overuse during athletic and sports activities in 24 patients (80%). Among these patients, 13 played cricket, three played basketball, three played volleyball, two did weightlifting, one was a wrestler, one was a tennis player, and one was a judo player. Six patients (20%) did not give a history of playing any kind of sports. All patients had anterior shoulder pain with tenderness at the antero-lateral acromion. Radiographs showed fragmentation, sclerosis, and irregularity of the acromial apophysis. Conservative treatment included rest and restriction of sporting activities. The duration for the analgesics taken by patients was 8.9 days (range 3-21). The duration from the onset of symptoms to recovery was 5.8±1.61 weeks. None of the patients showed a recurrence of symptoms after complete recovery. Conclusion: Acromial apophysitis is a common cause of shoulder pain in paediatric and adolescent age. It occurs due to repeated overhead abduction, overuse, and throwing activities, mostly in sports persons. It is diagnosed clinically and confirmed with plain radiographs. It is a self-limiting disease with a short benign course. It is treated conservatively with rest and analgesics and has an excellent outcome. This diagnosis should be kept in mind for shoulder pain in young patients to prevent undue investigations and surgery. [ABSTRACT FROM AUTHOR]

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Background: Subacromial spurs are considered the one of the pathology underlying shoulder impingement syndrome. Furthermore, few studies have focused on the morphology of the subacromial spurs in normal Chinese people. This study aimed to study the spur distribution and to illustrate the morphology of spurs, which may help guide the extent of acromioplasty. Methods: A total of 93 normal individuals were enrolled, and both shoulders of all enrolled individuals were analyzed. The subjects were divided and classified into three different groups by ages: group I = 18–40 years, group II = 41–60 years, and group III ≥ 61 years. The osteophyte distribution, osteophyte area, subacromial surface area and osteophyte area/subacromial surface area ratio were measured and illustrated using Mimics and 3-matic software. The shape of the acromion was classified according to the Bigliani and Morrison classification system. The acromial angle was also classified. Then, the relationship between osteophytes, acromial classification and acromial angle was analyzed. Results: Type II (curved shape) was the most common type of acromion, and the hooked shape was a rare form. A significant increase in the left subacromial surface area in males was observed in group III compared with group I (P < 0.001) and group II (P = 0.004). The total spur/subacromial area ratio was significantly higher in group II than I. An obvious increase in the right subacromial area was observed in group III compared with group I (P = 0.004). Furthermore, there was a significant increase in the right spur area (P = 0.021) and total spur/subacromial area ratio (P = 0.006) in females in group II compared with group I. Fewer spurs were observed on the left than on the right side (p = 0.0482). One spur was most common among type II acromions (29/36) (80.56%) on the left side and the right side (34/52, 65.38%). Conclusions: Spurs osteophytes are mainly distributed with an irregular shape and mostly run through the medial and lateral sides of the subacromial surface in normal subjects. The characteristics of subacromial spurs are so diverse that a surgeon must conduct subacromial decompression completely based on the morphology of individual spurs. [ABSTRACT FROM AUTHOR]

Objective: The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA. Methods: A review was carried out in accordance with the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: “critical shoulder angle,” “rotator cuff tears,” and “rotator cuff lesions.” The methodological quality of the studies was assessed with the MINORS SCORE. Results: Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6. Conclusions: CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis affects the shoulder joint, causing pain and limiting motion. In clinical practice, the effectiveness of injections varies, and the factors influencing their success remain unclear. This study investigates the predictors of effective corticosteroid injections in patients with primary adhesive capsulitis. Design: This retrospective study enrolled adhesive capsulitis patients older than 35 yrs who received intra-articular corticosteroid injections. The response was determined based on patients' pain and range of motion 3 mos after the injection. Demographic data, medical comorbidities, and radiographic parameters (critical shoulder angle and acromial index) were compared between the effective and noneffective groups. Receiver operating characteristic curves and logistic regression were used to identify the predictors of injection effectiveness. Results: This study included 325 patients with primary adhesive capsulitis, who were divided into responder (189 patients, 58.2%) and nonresponder (136 patients, 41.8%) groups. The receiver operating characteristic curve revealed that the acromial index score indicated favorable discrimination for predicting a poor response to injections, whereas the critical shoulder angle score did not. Logistic regression revealed that the pain period, diabetes mellitus, and acromial index are predictors of nonresponders to injections. Conclusions: Long pain duration, the presence of diabetes mellitus, and an acromial index score greater than 0.711 were predictors of nonresponse to corticosteroid injections for primary adhesive capsulitis patients. [ABSTRACT FROM AUTHOR]

A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months. [ABSTRACT FROM AUTHOR]

Background: Although substantial motion at the acromioclavicular joint (ACJ) occurs during overhead shoulder motion, the influence of ACJ arthritis on postoperative outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) is unclear. We assessed the influence of ACJ arthritis, defined by degenerative radiographic changes, and its severity on clinical outcomes after primary rTSA. Methods: We conducted a retrospective review of a prospectively collected shoulder arthroplasty database of patients that underwent primary rTSA with a minimum 2-year clinical follow-up. Imaging studies of included patients were evaluated to assess ACJ arthritis classified by radiographic degenerative changes of the ACJ; severity was based upon size and location of osteophytes. Both the Petersson classification and the King classification (a modified Petersson classification addressing superior osteophytes and size of the largest osteophyte) were used to evaluate the severity of degenerative ACJ radiographic changes. Severe ACJ arthritis was characterized by large osteophytes (≥2 mm). Active range of motion (ROM) in abduction, forward elevation, and external and internal rotation as well as clinical outcome scores (American Shoulder and Elbow Surgeons Shoulder, Constant, Shoulder Pain and Disability Index, simple shoulder test, University of California, Los Angeles scores) were assessed both preoperatively and at the latest follow-up; outcomes were compared based on severity of ACJ arthritis. Multivariable linear regression models were used to determine whether increasing severity of ACJ arthritis was associated with poorer outcomes. Results: A total of 341 patients were included with a mean age of 71 ± 8 years and 55% were female. The mean follow-up was 5.1 ± 2.4 years. Preoperatively, there were no differences in outcomes based on the severity of ACJ pathology. Postoperatively, there were no differences in outcomes based upon the severity of ACJ arthritis except for greater preoperative to postoperative improvement in active internal rotation in patients with normal or grade 1 ACJ arthritis vs. grade 2 and 3 (3 ± 2 vs. 1 ± 2 and 1 ± 3, P = .029). Patients with ACJ arthritis and osteophytes ≥2 mm had less favorable Shoulder Pain and Disability Index scores, corresponding to greater pain (−49.3 ± 21.5 vs. −41.3 ± 26.8, P = .015). On multivariable linear regression, increased severity of ACJ arthritis was not independently associated with poorer postoperative ROM or outcome scores. Conclusion: Overall, our results demonstrate that greater ACJ arthritis severity score is not associated with poorer outcome scores and has minimal effect on ROM. However, patients with the largest osteophytes (≥2 mm) did have slightly worse pain postoperatively. Radiographic presence of high-stage ACJ arthritis should not alter the decision to undergo rTSA.

The present study was conducted on scapula of adult mithun to study the gross morphological anatomy and record certain biometrical measurements. The bones were procured by simple natural maceration process. The scapula of mithun was found to be a flat triangular bone having three angles, three borders and two surfaces. The dorsal border was convex and the scapular spine was found to be thickened and roughened at the middle and then bend/curved forward below and ended distally as a pointed projection, acromion process. The rim of glenoid cavity was found to be roughly quadrilateral in outline and presented a wide and a narrow notch at the lateral and cranio-medial aspect of the glenoid cavity, respectively. The average maximum length and width of the scapula were found to be 35.87±0.43 cm and 20.85±0.75 cm, respectively. [ABSTRACT FROM AUTHOR]

Abstract Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power (p< 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II, Diagnostic Study.