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Purpose To evaluate the intra and interobserver reproducibility of a new system that assesses the three-dimensional humero-scapulo-thoracic kinematics using wearable technology in an outpatient setting. To obtain normative data with the system for scapular angular motions in three planes. Methods The SHoW Motion 3D kinematic tracking system is a motion analysis system that uses wireless wearable non-invasive inertial-magnetic sensors to assess the three-dimensional kinematics of the shoulder girdle. The sensors are placed over the skin in the sternum, scapular spine and arm to precisely define angular motions of the humerus and the scapula with three Degrees of Freedom (DOF) for each segment. The system was used to measure the scapular angular motions in three planes (upward/downward rotation, internal/external rotation and anterior/posterior tilt) during two shoulder full-range movements (flexion/extension and abduction/abduction) in both shoulders of 25 healthy volunteers (13 males and 12 females, mean age: 37 [standard deviation 11.1] years). In a first measuring session one examiner made two evaluations alternating with another examiner that made a third evaluation. In a second session, one week apart, the first examiner made a fourth evaluation. A mean curve was computed from the normalized data for each measurement to obtain normative data for scapular angular kinematics. Intra and inter-observer reproducibility was evaluated using Root Mean Square Error Estimation (RMSE) and Coefficients for Multiple Correlations (CMC). Results Both shoulders of the 25 volunteers were evaluated four times. The two hundred resulting kinematic analyses were pooled to get normative values for relations between humeral elevation angles and the three angular movements of the scapula. The system showed at least very good (CMC > 0.90) intra and inter-observer reproducibility for scapular tilt and upward-downward rotations both in flexion and abduction. For scapular internal-external rotation the results were acceptable (CMC > 0.75) but not as good, especially for the abduction movement. RMSE calculations showed consistently good reproducibility with RSME Conclusion The SHoW Motion 3D kinematic tracking system is a quick, reproducible and easy to use system for the assessment of scapular angular kinematics in healthy adults. The data obtained is similar to that obtained with other validated methods. Level of evidence Level II. Clinical relevance The presented system is portable, easy to use and fast. It also has good intra and inter-observer reproducibility, making it a good tool to assess objectively scapular dyskinesis in the clinical setting. The normative data obtained is consistent with previous information available.

Endoscopic sinus surgery (ESS) failure and frontal ostium (FO) stenosis are commonly due to inadequate or incomplete removal of ethmoid cells. Residual cells may be found in 10-96% of cases of revision sinus surgery. Furthermore, the frontal sinus outflow tract is the region where disease recurrence is most likely to occur. Frontal sinusotomy represents a risk to residual or newly created disease due to scarring, osteoneogenesis, middle turbinate or amputated superoanterior stump lateralization. Intraorbital or intracranial violation and anterior ethmoid artery injury are possible complications in this region. Exposure is crucial and it may be obtained by the punch-out procedure (Metson). The first step is the identification of the uppermost attachment of the uncinate process (the “vertical bar” of Stamm). Removing the dome of the terminal recess, the agger nasi cell, in most cases, provides surgeons with a clear view of the frontal ostium and, therefore, according to Wormald, it plays the key role in endoscopic frontal sinusotomy. The frontal cells, type 1, 2 and 3, according to Kuhn, or SAC, SAFC, SBC, SBFC according to the new terminology, are less commonly encountered. The intact bulla technique allows following the natural sinus outflow tract and, at the same time, it reduces the risk of injuring the anterior ethmoid artery (AEA). Pneumatized ethmoid bulla or SBFC, when contacted, anteriorly, the dome of the terminal recess, can extremely narrow the outflow tract and obstacle dissection. In these cases, the ethmoid bulla should be partially resected while leaving the superior attachment to the skull base before identifying the frontal ostium. The AEA is mostly located between the second and third lamella, posterior to the superior attachment of the bulla lamella and constitutes an optimal landmark. The evidence guiding the selection of patients who may benefit from more aggressive surgery is lacking. A type I-II drainage procedure (Draf) is recommended in the frontal sinuses with a large A–P diameter. The correct interpretation of the CT and preop rebuilding the 3D anatomy are mandatory in frontal sinusotomy, allowing to identify step by step the anatomic landmarks. It is important to use cutting instruments and not to grasp and pull out, and the anatomy must be followed, the anatomical route predesigned by nature (Stammberger).