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Introduction: Massive and irreparable posterior-superior rotator cuff tears present a difficult treatment problem. Chronic rotator cuff tears can cause tendon retraction and fatty atrophy of the muscles. Full-thickness rotator cuff tears involves more than one tendon cause superior migration of the humeral head in relation to the glenoid with altered glenohumeral forces, and ultimately leading to rotator cuff arthropathy. Transfer of the latissimus dorsi muscle is considered a surgical option in the treatment of younger patients without glenohumeral arthritis and with functional deficits caused by an irreparable posterior-superior rotator cuff tear.Presentation of Case: This report presents a case of Right Supraspinatus and Infraspinatus Chronic tear with Subscapularis tear. The case was chronic with non-subsidence of symptoms in spite of conservative treatment. Our treatment in this case consisted of Right Subscapularis and Infraspinatus Repair with Lattisimus Dorsi Transfer to Greater Tubercle. Post operatively ultrasling was used to keep the shoulder in neutral with slight abduction. Rehabilitation protocol was begun after 3 weeks of immobilization. Discussion: Latissimus Dorsi Tendon Transfer has been considered to be a means of restoring function and providing pain relief in patients with irreparable tears involving the infraspinatus and supraspinatus tendons in the absence of substantial glenohumeral arthritis.The aim of this case presentation is to report an example for this case, highlight the difficulties in diagnosis and the treatment options.Conclusion: The Latissimus Dorsi Tendon Transfer for irreparable postero-superior cuff deficiency in selected patients reduce pain and improve shoulder function in the medium term.

In this study, in tuberculum majus fractures, which are proximal humerus fractures; Morphometric measurements were made to guide surgeons and future implants. With the morphometric measurement of the greater tubercle, the length of the base, the length of the height, the length at its widest part, and its circumference were calculated. A 3D scanning device (Faro Focus 3D S120 Scanner Rental) was used to scan the proximal part of the humerus, and the proximal ends of the scanned humerus were transferred to the computer and morphometric measurements were made with the software program. As a result of the measurements made: Average base length of the large tubercle 26±2.34 mm, average anterior height of the greater tubercle 30±2.50 mm, average posterior height of the greater tubercle 9.5±0.4 mm and average Widest sagittal length of the greater tubercle 28.75±2.02 mm. We think that the morphological and morphometry of the tuberculum majus, which is one of the formations at the proximal end of the humerus, will guide surgeons with anatomically designed implants in surgical applications. [Med-Science 2021; 10(2.000): 555-9]

Background: The range of motion (ROM) in reverse shoulder arthroplasty (RSA), is mechanically limited by the surrounding bony obstacles especially in abduction and rotation planes. However, the clinical effect of implant positioning, prosthesis design, and individual differences in bone morphology, on ROM is obscure. The aim of this study was to investigate the correlation between radiographic geometry and clinical glenohumeral (GH) ROM after RSA. Methods: RSA patients operated at Turku University Hospital during 2007–2013 were called for radiological and clinical follow-up. Pre- and postoperative true anteroposterior radiographs were obtained and the positioning of the center of rotation (COR) in relation to the surrounding bony structures was measured. Active and passive shoulder and GH abduction, flexion, internal and external rotation ROM were measured with goniometer. The Constant score (CS) and pain visual analogue scale (VAS) were recorded. The correlation between the radiographically measured parameters and the active and passive ROM and clinical outcome was statistically analyzed. Results: 91 shoulders were available for analyses with a mean follow-up of 38.7 months ± SD 20 (range 12–83) months. 77% of the patients were female, the mean age was 73 (SD 9) years. The mean angle between the line of supraspinatus fossa, and the line between COR and lateral edge of the acromion (α-angle) was 127° (SD 14) and the mean angle between the lines from lateral edge of the acromion to COR, and from there to the superior edge of the greater tubercle (β-angle) was 54° (SD 11). The mean active shoulder flexion at follow-up was 118° (SD 26), abduction 104° (SD 32), external rotation 41° (SD 22), internal rotation 77° (SD 21). The mean passive GH flexion was 80° (SD 19), abduction 67° (SD 15), external rotation 31° (SD 16) and internal rotation 34° (SD 14). The mean Constant score at follow-up was 53 (SD 18) and pain VAS 2 (SD 3). The positioning of the radiographically measured COR did not statistically significantly correlate with the ROM or clinical outcome scores. Conclusions: Postoperative radiographically measured two-dimensional geometry and positioning of the COR does not significantly correlate with the glenohumeral range of motion or clinical results after RSA. Level of evidence: Level 3, retrospective cohort study publishedVersion

IntroductionFull-thickness rotator cuff tear is present in almost 50% of patients over age 65 years, and its degree is known to be a good predictor of the severity of muscle-wasting (MW) sarcopaenia, also known as fatty degeneration (FD). A FD CT grade > 2° is recognized as a borderline of its reversibility. A disuse model of supraspinatus FD (grade 2) in rabbits provides clinically relevant data. Therefore, the present study evaluates the correlation between eccentric mechanotransduction, neuromuscular transmission (NT), and reversibility of muscle fatty infiltration (MFI) in rabbit supraspinatus FD > 2°.Material and methodsThe supraspinatus tendon was detached from the greater tubercle, infraspinatus, and subscapularis in 16 rabbits. The tendon was reinserted after 12 weeks, and the animals were euthanized 24 weeks after reconstruction. MFI was measured in the middle part of the supraspinatus. Single-fibre EMG (SFEMG) examination of the supraspinatus NT was performed on 4 animals.ResultsThe power of analysis was 99%. Significant differences in MFI volume were found between the operated (4.6 ±1.1%) and the opposite control sides (2.91 ±0.61%) (p < 0.001). SFEMG revealed no significant differences between the disuse and the control supraspinatus muscles (p > 0.05); however, 6.5% of the examined muscle fibres exhibited NT disorders combined with blockade of conduction in 2.5% of muscle fibres.ConclusionsCritical MFI in a disuse model of rabbit supraspinatus FD, CT grade > 2°, is substantially reversible by eccentric training despite subclinical impairment of neuromuscular transmission. In addition, 0.63% reversal of MFI is correlated with 1% hypertrophy of type I and II muscle fibre diameter.

Background: Cranial luxation of the scapulohumeral has been rarely reported in dogs and there is limited information available regarding surgical management of this condition, particularly with respect to long-term functional outcomes.Case Description: This report describes the successful resolution of a chronic traumatic cranial scapulohumeral joint luxation in a dog that was stabilized by cranial transposition of the biceps brachii tendon of origin. At surgery, an osteotomy of the greater tubercle was performed and a trough was made in the exposed bed of the osteotomy. The transverse humeral ligament was incised, and the bicipital tendon was levered into the trough and secured in that location by reattachment of the greater tubercle using multiple Kirschner wires and a figure-of-eight tension band wire. Postoperatively, the dog was maintained in a Spica splint for 2 weeks. Although surgical reduction was performed 4 months after the original injury, the luxation did not recur and the dog did not have appreciable lameness 14 months following the surgery.Conclusion: Although cranial transposition of the bicipital tendon is an invasive procedure, this dog’s scapulohumeral luxation did not recur and the procedure yielded an excellent long-term functional outcome.

Massive rotator cuff tears present a challenging problem for surgeons. According to various authors, from 10 to 40 % of ruptures are massive and more often affect patients over 60 years of age with low-intensity injuries. There is currently no consensus on the classification of rotator cuff injuries. The use of MRI is the gold standard in diagnostics and surgical tactics. Treatment of patients with severe fatty degeneration, muscular atrophy and retraction of the damaged tendon presents certain difficulties. Reinsertion of the damaged rotator cuff tendon is not possible in such patients. There are many different methods of surgical and conservative treatment. In our opinion, transposition of the latissimus dorsi is the method of choice for young and active patients. With the development of new technologies, transposition of the latissimus dorsi muscle began to be performed arthroscopically. This article presents a clinical case: a woman with chronic total rupture of the supraspinatus tendon, Patte grade 3 and fatty degeneration of grade 3 by Thomazeau. The patient was also diagnosed with a secondary superior subluxation of the humeral head. The patient underwent surgical treatment: arthroscopic- associated transposition of the latissimus dorsi muscle to the greater tubercle of the humerus. There was a positive trend, an improvement in the functional result occurred already in the early postoperative period. Considering the above, the method of choice in the treatment of patients with massive ruptures of the rotator cuff tendons can be considered as transposition of the latissimus dorsi muscle, performed by the arthroscopic-associated method.

We present a case of a 22-year-old university sportsman who presented at a private hospital in Lahore in December 2018 with complaint of severe pain in the anterolateral aspect of the right shoulder after playing cricket. On palpation, greater tubercle of the right shoulder was found to be tender along with the muscle belly of supraspinatus. A muscle trigger point was identified during palpation, while painful arc was also present on abduction. Physical tests, including Hawkins- Kennedy, Neers sign and empty can test, were found to be positive. The musculoskeletal ultrasound revealed that supraspinatus and bicep tendons were intact. The patient was managed by dry needling technique. The novelty of this clinical trial was the application of trigger point dry needling for the management of subacromial pain syndrome. Muscle trigger point symptoms can present as rotator cuff tears, supraspinatus tendonitis and bicipital tendonitis leading to misdiagnosis. Clinicians should look for muscle trigger points before making a differential diagnosis.

Background: Swimming is used for rehabilitation and conditioning purposes in equine sports medicine despite the lack of understanding of equine swimming kinematics. The aim of this study was to assess forelimb joints kinematics (elbow, carpus, and fetlock) in swimming horses. The specific objectives were 1- to calculate and compare joint angles in swimming vs. passive mobilizations (PM), 2- to determine joint angular velocities during a swimming stride cycle.Methods: Eleven elite endurance horses swam in a 100-m straight pool. Underwater (swimming) and overground (PM) videos were recorded from the horses' left side. Joint markers were applied on the lateral hoof wall, lateral metacarpal epicondyle, ulnar carpal bone, lateral humeral epicondyle, and the greater tubercle of humerus, from which elbow, carpus and fetlock angles, and angular velocities were obtained. As a reference, maximal fetlock, carpus, and elbow flexion/extension angles were determined during PM overground. Differences between angle extrema, angular velocities and range of motion (ROM) were compared.Results: Carpus and fetlock ROM were significantly smaller (p < 0.001) during swimming when compared with PM, while there was no difference in elbow ROM between both situations. The carpus had the greatest ROM of all joints during swimming. Absolute angular velocities values of all joints during swimming were greater during retraction than protraction (p < 0.001). When compared to other joints during protraction, the carpus joint reached the highest angular velocity.Conclusion: Swimming, as a rehabilitation exercise, has the potential to benefit horses where great elbow ROM with a moderate carpus and fetlock extension are wanted.

Musculoskeletal computer models allow us to quantitatively relate morphological features to biomechanical performance. In non‐human apes, certain morphological features have long been linked to greater arm abduction potential and increased arm‐raising performance, compared to humans. Here, we present the first musculoskeletal model of a western lowland gorilla shoulder to test some of these long‐standing proposals. Estimates of moment arms and moments of the glenohumeral abductors (deltoid, supraspinatus and infraspinatus muscles) over arm abduction were conducted for the gorilla model and a previously published human shoulder model. Contrary to previous assumptions, we found that overall glenohumeral abduction potential is similar between Gorilla and Homo. However, gorillas differ by maintaining high abduction moment capacity with the arm raised above horizontal. This difference is linked to a disparity in soft tissue properties, indicating that scapular morphological features like a cranially oriented scapular spine and glenoid do not enhance the abductor function of the gorilla glenohumeral muscles. A functional enhancement due to differences in skeletal morphology was only demonstrated in the gorilla supraspinatus muscle. Contrary to earlier ideas linking a more obliquely oriented scapular spine to greater supraspinatus leverage, our results suggest that increased lateral projection of the greater tubercle of the humerus accounts for the greater biomechanical performance in Gorilla. This study enhances our understanding of the evolution of gorilla locomotion, as well as providing greater insight into the general interaction between anatomy, function and locomotor biomechanics., In non‐human apes, certain morphological features have long been linked to greater arm abduction potential and increased arm‐raising performance, compared to humans. Here, we present the first musculoskeletal model of a western lowland gorilla shoulder to test some of these long‐standing proposals. We find that of the glenohumeral abductors only supraspinatus is mechanically enhanced in gorillas, and the deltoid partially changed to an adductor action.

Introduction The superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One of the strategies currently proposed in the event of a massive cuff rupture is to reconstruct this superior capsule. The main objective of this anatomical study was to describe the superior joint capsule of the embryonic glenohumeral joint and its relationship to the tendons of the rotator cuff. Hypothesis The hypothesis was that this structure was an anatomical entity, morphologically identifiable from the embryogenesis of the joint (more pronounced tissue boundaries in the fetus). Material and methods In total, 101 continuous fetal anatomical sections (4 fetuses of 336 mm), in the frontal plane, made it possible to identify and measure: diameters of the humeral head and glenoid, dimensions of the joint capsule insertion zone at the level of the greater tubercle, as well as the different thicknesses of this insertion zone. The ratios above the head of the biceps and against the superior labrum were also measured. Results At the level of its distal insertion on the greater tuberosity, the thickness of the superior joint capsule varies on average between 0.8 mm laterally and 1.2 mm next to the tendons of the supraspinatus and infraspinatus; the thickness is 0.9 mm next to the middle part of the supraspinatus tendon (the “rotator cable” zone). For its insertion at the level of the glenoid labrum, the superior capsule measures 0.6 mm thick on average. The capsule around the tendon of the long head of the biceps is 1.5 mm thick on average. Discussion Here, we confirm the existence of this superior joint capsule, which can potentially be reconstructed. It is inserted on the greater tubercle covering 30 to 60% of its surface with variations in thickness. The joint capsule is fused to the supraspinatus tendon at the rotator cuff insertion area, preventing independent reinsertion of the tendon. Level of evidence IV; anatomical study.

SUMMARY: Variation in the biceps brachii muscle is extremely frequent and has a clinical significance. During an educational dissection, third head of the biceps brachii muscle was found on the left side in a Korean cadaver. The short and long heads showed normal morphology and course: however, additional head originated from the greater tubercle connected to long head of biceps brachii muscle and crossed the musculocutaneous nerve perpendicularly. And then, it was inserted into short head of the biceps brachii muscle. The author describes this previously novel case report and discusses the clinical implications of such a variant.

Objective To evaluate the value of radiographs during the diagnostic work-up of rotator cuff tears, using arthroscopy as reference standard.Materials and methods This retrospective study included 236 shoulders of 236 patients. All radiographs were evaluated for inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, greater tubercle cysts, and subacromial space calcifications. Predictive value of these radiographic signs in predicting rotator cuff tears was determined with arthroscopy as reference standard.Results According to arthroscopy, 131 shoulders were diagnosed with rotator cuff tears. Seventy-two out of 131 shoulders (55%) had inferior cortical acromial sclerosis, 37 (28%) lateral acromial spur, 21 (16%) superior migration of the humeral head, 7 (5%) greater tubercle cysts and 15 subacromial space calcifications (11%). Inferior cortical acromial sclerosis (P = 0.001), lateral spur (P = 0.001), superior migration (P = 0.002), and cysts (P = 0.03) were significantly and independently associated with rotator cuff tears, whereas subacromial calcifications (p = 0.21) was not. Inferior cortical acromial sclerosis, superior migration, lateral acromial spur, and cysts combined have a positive predictive value of 78%.Conclusions The combination of inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, and greater tubercle cysts has a high positive predictive value for the presence of full-thickness rotator cuff tears. In patients with a high suspicion for having a rotator cuff tear based on radiographic findings, MRI can be performed directly without the delay and costs caused by an additional ultrasound exam.

The proximal humerus is a common, yet understudied site for osteoporotic fracture. The current study explored the impact of prolonged physical activity on proximal humerus bone health by comparing bone properties between the throwing and nonthrowing arms within professional baseball players. The proximal humerus in throwing arms had 28.1% (95% CI, 17.8 to 38.3%) greater bone mass compared to nonthrowing arms, as assessed using dual-energy x-ray absorptiometry. At the level of the surgical neck, computed tomography revealed 12.0% (95% CI, 8.2 to 15.8%) greater total cross-sectional area and 31.0% (95% CI, 17.8 to 44.2%) greater cortical thickness within throwing arms, which contributed to 56.8% (95% CI, 44.9 to 68.8%) greater polar moment of inertia (i.e., estimated ability to resist torsional forces) compared to nonthrowing arms. Within the humeral head and greater tubercle regions, throwing arms had 3.1% (95% CI, 1.1 to 5.1%) more trabecular bone, as assessed using high-resolution magnetic resonance imaging. Three-dimensional mapping of voxel- and vertex-wise differences between arms using statistical parametric mapping techniques revealed throwing arms had adaptation within much of the proximal diaphysis, especially the posterolateral cortex. The pattern of proximal diaphysis adaptation approximated the pattern of strain energy distribution within the proximal humerus during a fastball pitch derived from a musculoskeletal and finite element model in a representative player. These data demonstrate the adaptive ability of the proximal humerus to physical activity-related mechanical loads. It remains to be established how they translate to exercise prescription to improve bone health within the proximal humerus, however, they provide unique insight into the relationship between prolonged loading and skeletal adaptation at a clinically relevant osteoporotic site.

ResumoNo contexto do tratamento cirúrgico dos pacientes jovens com lesões irreparáveis da porção posterossuperior do manguito rotador, a técnica mais usada é a transferência do tendão do grande dorsal para a porção superolateral do tubérculo maior, conforme descrita e preconizada por Gerber et al. Entretanto, duas características dessa técnica podem levar a resultados ruins e complicações: (i) a deiscência da origem do deltoide, que ocorre devido à sua violação durante a criação da via em golpe de sabre e (ii) a ruptura pós-operatória da inserção da transferência. Na tentativa de solucionar esses dois problemas, as seguintes modificações foram feitas à técnica cirúrgica original. Por meio de uma única via deltopeitoral, o tendão do grande dorsal é isolado e desinserido do úmero. Ele é então alongado e reforçado com um enxerto tendíneo homólogo, transferido ao redor do úmero e fixado à porção superolateral do tubérculo maior. Não foi usada imobilização pós-operatória com órtese toracobraquial rígida.

Computer-assisted orthopedic surgery and patient-specific instruments are widely used in orthopedic fields that utilize contralateral side bone data as a template to restore the affected side bone. The essential precondition for these techniques is that the left and right bone features are similar. Although proximal humerus fracture accounts for 4% to 8% of all fractures, the bilateral asymmetry of the proximal humerus is not fully understood. The aim of this study is to investigate anthropometric differences of the bilateral proximal humerus. One hundred one pairs of Korean humerus CT data from 51 females and 50 males were selected for this research. To investigate bilateral shape differences, we divided the proximal humerus into three regions and the proximal humerus further into five sections in each region. The distance from the centroid to the cortical outline at every 10 degrees was measured in each section. Differences were detected in all regions of the left and right proximal humerus, however, males had a larger number of significant differences than females. Large bilateral differences were measured in the greater tubercle. Nevertheless, using contralateral data as a template for repairing an affected proximal humerus might be possible.

The size of rotator cuff tears affects clinical outcomes following rotator cuff repair and is correlated with risk of re-injury. This study aimed to understand how defect size influences the structural and mechanical outcomes of the injured rotator cuff attachment in vivo. We used our previously established model of full-thickness injury of the rotator cuff tendon-bone attachment in Long Evans rats to compare differences in healing outcomes between small and large defects. Biomechanical properties, gross morphology, bone remodeling, and cell and tissue morphology were assessed at 3- or 8-weeks of healing. At the time of injury (no healing), large defects had decreased mechanical properties compared to small defects, and both defect sizes had decreased mechanical properties compared to intact attachments. The mechanical properties of the defect groups were comparable after 8-weeks of healing and significantly improved compared to no healing but failed to return to intact levels. Local bone volume at the defect site was higher in large compared to small defects on average and increased from 3- to 8-weeks. Contrastingly, bone quality, measured as bone volume percentage and trabecular morphometry, of the total epiphysis and greater tubercle decreased from 3- to 8-weeks of healing and these changes were not dependent on defect size. Qualitatively, we observed that large defects had increased disorganized collagen and neovascularization compared to small defects. In this study, we demonstrated that not only small but also large defects do not regenerate the mechanical and structural integrity of the intact rat rotator cuff attachment following healing in vivo.Statement of Clinical SignificanceOur rat model of full-thickness rotator cuff tears may be beneficial to understand and prevent tear enlargement in vivo.

Rationale: Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. However, anomalous insertion sites of the pectoralis major tendons have been noted. Patient concerns: The cadaver of a 95-year-old Japanese man was selected from the bodies used for gross anatomy practice at the Tokai University School of Medicine in 2018. Diagnosis: In this cadaver, the left side of the pectoralis major tendon appeared to insert at the crest of the greater tubercle and lesser tubercle of the humerus, forming a tunnel measuring 2.5 cm in total length. Intervention: We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. Outcomes: The medial side of the insertion of the pectoralis major tendon was not into the humerus but had combined with the tendon of the latissimus dorsi, which then loosely inserted into the humerus. As the roof and both walls comprised the tendon of the pectoralis major and the floor was formed by the tendon of the latissimus dorsi and humerus, the structure formed a tunnel. Lessons: This study is important for orthopedic and rehabilitation physicians in treating diseases of the long head of the biceps brachii tendon. As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography.

Objectives The inability to identify landmarks is an absolute contraindication for intraosseous access. The feasibility of landmark identification using ultrasound (US) has been demonstrated on human cadavers. We aimed to study the feasibility of point-of-care US in identifying proximal humerus landmarks in living human patients. Methods This was a prospective cohort study conducted from May 3 to June 7, 2017, after approval from the Institutional Review Board at the Cleveland Clinic. Sixty upper extremities of 30 consenting participants across 3 distinct body mass index (BMI) groups (normal, obese, and morbidly obese) were alternately examined with a 12 L-RS linear US transducer (GE Healthcare, Chicago, IL) by 2 investigators. Six anatomic landmarks were identified: the humeral shaft, the surgical neck of the humerus, the lesser tubercle, the greater tubercle, the inter tubercular sulcus, and the target site for needle insertion on the greater tubercle. Rates of successful identification of all 6 landmarks as defined by independent agreement between the investigators were reported as estimated incidence rates with 95% bootstrap confidence interval (CI) sampling at the participant level. Results Ultrasound had an overall success rate of 0.87 (95% CI, 0.78-0.95) in identifying all 6 landmarks with slight variability among various BMI groups. After excluding the surgical neck, the overall success rate improved to 0.93 (95% CI, 0.87-0.98), with minimum variability across BMI groups and no change in the ability to identify the target site. Conclusions Ultrasound is reliable in identifying proximal humerus intraosseous landmarks, with reasonable accuracy across various BMI groups.

Background This study aimed to compare the ultrasonographic and histological features of the supraspinatus tendon (ST) and its peculiar appearance in contrast with the biceps brachii tendon. Methods For this purpose, 19 non-lame dog cadavers were subjected to an ultrasonographic and histologic evaluation of both shoulders after postmortem examination. Results Close to their insertion on the greater tubercle, all STs displayed a widened portion with a deep central hypoechoic area lacking a fibrillar pattern, when compared with its more proximal aspect and adjacent biceps brachii. Histologically this deep portion corresponded to poorly organised collagen bundles interspersed within a myxoid substance mainly composed of mucopolysaccharides. This central myxoid area with collagen disarray was responsible for the reduced echogenicity on ultrasound. Conclusion The focal widening of the ST insertion and its central mucopolysaccharidic composition could be an anatomical adaptation to marked forces specifically applied to this tendon. However, the ultrasound and histological appearances are very similar to those described in tendinosis, which represents a confounding factor in diagnosing tendonitis at the insertion of the supraspinatus. In the absence of other ultrasonographic criteria of tendinopathy, a hypoechoic central area in the ST near its insertion should be considered normal.

Despite the development in shoulder surgery, massive irreparable rotator cuff tears still remain challenging for orthopaedic surgeons. Many surgical methods are addressed to this kind of pathology, but each of them has its own limitations. We decided to fuse the ideas of superior capsular reconstruction, “GraftJacket” technique, and partial rotator cuff repair. In this way, the technique using the long head biceps tendon simultaneously as a vascularized bridge between rotator cuff remnants and greater tubercle and as a depressor for the humeral head was created. This Technical Note describes the technique.

Abstract Postoperative tendon healing is still a matter of concern after rotator cuff repair. Several techniques have been introduced to help improve this healing process. Among them, the bone marrow is commonly used source and a research subject for methods using stem cells to promote wound healing process. A number of studies have shown that bone marrow stem cells can travel up through the holes on the rotator cuff insertion sites, contributing into the rotator cuff repair process, increasing the efficiency of tendon healing and improving clinical results. Patients and methods Cross-sectional descriptive study was performed on 41 rotator cuff tear patients. The microfractures for these patients were calculated beforehand, which have great depth but small diameter, based on the anatomical characteristic of the rotator cuff tear insertions of Vietnamese people. Patients' rotator cuff tendon healing processes were evaluated using ultrasound after surgery. Final tendon healing and clinical results ultimately rely on MRI assessments, classified according to Sugaya's classification, UCLA and ASES scale. Results No cases of rupture and fracture of the greater tubercle was recorded. There was a clear progression of tendon healing on ultrasound according to postoperative follow-up time-stamps (1 month, 3 months). MRI images evaluation also reveals at the latest follow-up time, according to Sugaya classification, the ratio of tendon healing was 87.8%, while the percentage of re-rupture was 12.2%. ASES and average UCLA scale were collected at the end of the study, respectively as 95.41 ± 5.45 and 32.36 ± 2.53. Conclusion The technique's microfractures characteristics based on the rotator cuff tear insertion anatomy ensures a secure, straightforward approach along with promising results in terms of tendon healing rate and postoperative functional outcomes.

Due to the approach within antegrade humerus nail osteosyntheses, lesions of the supraspinatus tendon with a consecutive functional limitation of the rotator cuff (RC), insufficiencies, adhesions and chronic shoulder pain in the long term can result. The evidence respectively the study data situation is limited regarding the evaluation of this issue.We are the first to present by means of a case report with a geriatric female patient and a dislocated diaphyseal humerus fracture a rotator cuff sparing osseous approach to the proximal humerus in antegrade nail osteosynthesis without harming the vulnerable supraspinatus tendon (SSP). This is possible through a limited osteotomy of the greater tubercle with the preparation of a 10 mm deep and 15 to 20 mm wide osseous SSP base. The medullary cavity is then opened for inserting the nail in an antegrade manner and closed after fracture stabilization through reposition of the attached osteotomy of the greater tubercle by means of a suture anchor, for example. The procedure also includes a biceps tenodesis. Besides the description of the intraoperative approach and procedure, the clinical and functional results were recorded by established scores as well as radiologically respectively sonographically 6 weeks (T1) and 3 months (T2) postoperatively.The patient was very satisfied regarding pain and function after the modified operative procedure. The rotator cuff tests were negative and there were no impingement like symptoms or indications for an adhesive capsulitis. Range of motion as well as the Constant and (Quick) DASH-Score showed a very good function in the course. The implant was located regularly in the radiological control and the fracture showed a good osseous consolidation. A bland joint without effusion or periarticular fluid and no adhesion with the delta fascia could be presented by sonography. The RC and especially the SSP showed a normal sonographic separation. The functional results are comparable to the other publications so far.The described surgical technique shows a significantly less invasive approach for the implantation of an antegrade humerus nail in the case of a humerus shaft fracture with an excellent function of the affected shoulder in a short-term follow-up. This novel approach should be evaluated by means of prospective studies regarding the functional outcome to justify the establishment of this modified procedure in the long term. Other modified approaches have been depicted but are essentially differing from our described procedure with regards to the invasiveness of the vulnerable tendinous structure of the SSP respectively RC.Im Rahmen der antegraden Humerusmarknagelosteosynthese können zugangsbedingte Läsionen der Supraspinatussehne mit einer postoperativen Funktionseinschränkung der Rotatorenmanschette (RM), Insuffizienzen oder Adhäsionen einhergehen und dadurch zu chronischen Schulterschmerzen führen. Diesbezüglich besteht jedoch eine überschaubare Datenlage bzw. Evidenz.Anhand eines Fallbeispiels beschreiben wir erstmals bei einer dislozierten diaphysären Humerusfraktur einer geriatrischen Patientin einen die RM aussparenden ossären Zugang, ohne die vulnerable Supraspinatussehne (SSP) zu schädigen. Dies ist mittels einer begrenzten Osteotomie des Tuberculum majus durch Präparation eines ca. 10 mm tiefen und 15 – 20 mm breiten knöchernen SSP-Ansatzes möglich. Der Markraum wird zum Einbringen des Nagels eröffnet und nach Stabilisierung der Fraktur wieder verschlossen durch Reposition der hierdurch angelegten Tuberculum-majus-Osteotomie, bspw. mit einem Fadenanker. Das Vorgehen beinhaltet auch eine Bizepssehnentenodese. Neben der Darstellung des intraoperativen Vorgehens wurden die Ergebnisse klinisch-funktionell anhand etablierter Scores sowie radiologisch und sonografisch 6 Wochen (T1) und 3 Monate (T2) postoperativ erfasst.Die Patientin zeigte sich hinsichtlich Schmerzen und Funktion mit dem OP-Ergebnis sehr zufrieden. Die RM-Tests waren negativ und es bestanden keine Impingement-ähnlichen Symptome oder Hinweise für eine adhäsive Kapsulitis. Die Bewegungsausmaße, der Constant- sowie (Quick)DASH-Score zeigten im Verlauf eine sehr gute Funktion. Radiologisch zeigte sich eine regelrechte Implantatlage und gute knöcherne Konsolidierung. Die sonografische Kontrolle des linken Schultergelenkes stellte ein reizloses Gelenk dar ohne Erguss bzw. periartikuläre Flüssigkeit und keine Adhäsionen mit der Deltafaszie. Die RM, insbesondere die SSP, zeigte eine normale sonografische Abgrenzbarkeit. Die funktionellen Ergebnisse sind mit den bisherigen Publikationen vergleichbar.Die hier beschriebene OP-Technik zeigt einen deutlich weniger invasiven Zugang zur Implantation eines antegraden Humerusmarknagels mit einer freien Schultergelenkfunktion im kurzfristigen Nachuntersuchungszeitraum. Dieser neuartige Zugang sollte zukünftig durch prospektive Studien hinsichtlich des funktionellen Outcomes untersucht werden, um die dauerhafte Etablierung des Verfahrens begründen zu können. Andere Zugangsmodifikationen wurden beschrieben, unterscheiden sich jedoch essenziell von dem hier beschriebenen Vorgehen hinsichtlich der Invasivität der vulnerablen tendinösen Struktur der SSP bzw. RM.

Background Our first-line choice of surgical method for massive shoulder rotator cuff tears not amenable to primary repair is a patching method that uses a graft consisting of a section of the iliotibial band with an attached bone block. The objective of this study was to examine the functional and structural results. Methods The study included 5 patients who were not eligible for primary repair, received iliotibial band autografts with an attached bone block, and could be monitored for 2 years or more. The grafting method involved suturing the ligament part of the graft to the remaining rotator cuff and fixing the bone part to the greater tubercle of the humerus by means of a suture-bridge technique. Clinical evaluation was performed for 24 months postoperatively. Postoperative structural evaluation was performed using computed tomography at 3 to 4 months and magnetic resonance imaging at 6, 12, and 24 months. Results A clear improvement was seen at the final clinical evaluation. Fusion of the bone graft with the greater tubercle of the humerus was confirmed on computed tomography in all patients. No retearing was observed on magnetic resonance imaging at the 24-month point, and the thickness of the ligament part of the graft was maintained. Conclusion The patching method using an iliotibial band with an attached bone block as the graft enabled good reconstruction of the rotator cuff, including the greater tubercle footprint. Moreover, good clinical results were seen at 24 months.

The literature currently contains no descriptions of the rotator cuff tendons, which also describes in relation to the presence and characteristics of the rotator cable (anatomically known as the ligamentum semicirculare humeri). The aim of the current study was to elucidate the detailed anatomy of the rotator cuff tendons in association with the rotator cable. Anatomic dissection was performed on 21 fresh-frozen shoulder specimens with an average age of 68 years. The rotator cuff tendons were dissected from each other and from the glenohumeral joint capsule, and the superior glenohumeral, coracohumeral, coracoglenoidal and semicircular (rotator cable) ligaments were dissected. Dissection was performed layer by layer and from the bursal side to the joint. All ligaments and tendons were dissected in fine detail. The rotator cable was found in all specimens. It was tightly connected to the supraspinatus (SSP) tendon, which was partly covered by the infraspinatus (ISP) tendon. The posterior insertion area of the rotator cable was located in the region between the middle and inferior facets of the greater tubercle of the humerus insertion areas for the teres minor (TM), and ISP tendons were also present and fibres from the SSP extended through the rotator cable to those areas. The connection between the rotator cable and rotator cuff tendons is tight and confirms the suspension bridge theory for rotator cuff tears in most areas between the SSP tendons and rotator cable. In its posterior insertion area, the rotator cable is a connecting structure between the TM, ISP and SSP tendons. These findings might explain why some patients with relatively large rotator cuff tears can maintain seamless shoulder function.

Description of a new surgical technique for treating the shoulders of patients with sequelae of obstetric paralysis. Preliminary analysis on the results obtained from this technique.Five consecutive patients underwent the proposed surgical procedure, consisting of arthroscopic anterior joint release followed by transfer of the latissimus dorsi tendon (elongated and reinforced with a homologous tendon graft) to the posterosuperior portion of the greater tubercle, using a single deltopectoral approach. All the patients were reevaluated after a minimum postoperative period of twelve months. The functional assessment was based on the range of motion and the modified Mallet classification system. Statistical analyses were not possible because of the small sample.Overall, passive and active lateral rotations increased, while medial rotation decreased. The other movements (elevation, capacity to place a hand in the mouth and capacity to place a hand behind the neck) had less consistent evolution. The mean modified Mallet score improved by 4.2 points (from 11.4 to 15.6).The latissimus dorsi tendon can be transferred to the posterosuperior portion of the greater tubercle through a single deltopectoral approach when elongated and reinforced with a homologous tendinous graft.Descrição de uma nova técnica cirúrgica para o tratamento de ombro de pacientes com sequela de paralisia obstétrica. Análise preliminar dos resultados obtidos com essa técnica.Cinco pacientes consecutivos foram submetidos ao tratamento cirúrgico proposto, que envolve a liberação articular anterior por via artroscópica, seguida da transferência do tendão do músculo grande dorsal (alongado e reforçado com enxerto tendíneo homólogo) para a porção póstero-superior do tubérculo maior, com o uso de uma única via delto-peitoral. Todos foram reavaliados após um período pós-operatório mínimo de 12 meses. A avaliação da função baseou-se na amplitude de movimento e na classificação modificada de Mallet. A pequena casuística não permitiu análises estatísticas.De forma geral, as rotações laterais passiva e ativa melhoraram, enquanto a rotação medial piorou. Os outros movimentos (elevação, capacidade de colocação da mão na boca e capacidade de colocação da mão na nuca) tiveram evolução menos consistente. A média do escore de Mallet modificado melhorou 4,2 pontos (de 11,4 para 15,6).O tendão do músculo grande dorsal pode ser transferido para a porção póstero-superior do tubérculo maior por meio de uma única via delto-peitoral, quando alongado e reforçado com enxerto tendíneo homólogo.

Background Although clinical investigations indicate that the limit of reversibility of rotator cuff muscles fibers type I and II atrophy is grade 2 of fatty degeneration (FD) according to the Goutallier computed tomography classification, little is known about the morphometric verification of these findings. Methods The supraspinatus tendon was detached from the greater tubercle and the infraspinatus and subscapularis in 12 rabbits, and a 12-week observation period followed. This proved to be sufficient for development of grade >2 FD of the supraspinatus tendon. The tendon was then reinserted. The animals were euthanized 24 weeks after tendon reconstruction. The sections of middle part of supraspinatus were stained for adenosine triphosphatase reaction, and morphometric measurements were taken of type I and II muscle fiber diameters. The contralateral shoulders served as controls. Results The macroscopic inspection of the supraspinatus tendons revealed complete healing in all cases. No statistically significant differences were found between controls and operated-on shoulders for type I ( P = .13) and type II ( P = .55) muscle fibers. Conclusions Atrophy of type I and II muscle fibers in rabbit supraspinatus muscle, characterized by grade >2 fatty degeneration according to the Goutallier computed tomography classification, is reversible after 24 weeks from reattachment of its tendon. A requirement for type I and II muscle fibers hypertrophy is a change in the biomechanical and functional conditions of the muscle after its tendon is reconstructed.

The treatment of massive rotator cuff tears (MRCT) is challenging. Insufficient tissue quality, size, and retraction of the cuff often lead to failures of repair. Different techniques like direct repair, partial repair, and graft applications have been developed, but results are not yet predictable. In this arthroscopic technique the objective is not to reconstruct the rotator cuff as a tissue layer but to restore the biomechanical function of the rotator cable with an autograft of the long head of the biceps tendon. After glenohumeral inspection, the long head of the biceps tendon is harvested and the retracted cuff is released and, if possible, closed partially side-to-side. The biceps graft is positioned from the posterior aspect of the greater tubercle to the superior part of the lesser tubercle and fixed with 2 biotenodesis anchors. Finally, the cuff remnants are securely sutured to the biceps graft with standard cuff repair sutures. This arthroscopic technique has several advantages because the biceps autograft is easily harvested, autologous, and rich in collagen. Previous studies show use of the biceps tendon differently for reconstruction of the rotator cuff, with promising results. Future studies are needed to evaluate clinical outcomes.

The aim of this study was to accurately identify the distribution of sensory nerve branches running to bursa with mesoscopic dissection and boundaries following the injection of gelatin into the bursa. Eighteen shoulders of 11 Korean soft cadavers (average age, 65 years; age range, 43 - 88 years) were dissected. The most prominent point of greater tubercle of the humerus (GT) was used as a reference point. The horizontal line passing through GT was used as the x-axis while the vertical line passing through the GT was used as the y-axis. Average distances of the anterior, posterior, superior, and inferior from the GT were 1.9±0.6, 2.4±1.3, 2.1±0.7, and 3.2±1.5 cm, respectively. In 15 cases of 18 shoulders, the anterior branch of the axillary nerve was distributed to the subdeltoid bursa that was running posteriorly. The muscular branch of the anterior and middle parts of the deltoid was distributed to the branch of nerve that was running into the subdeltoid bursa. A branch of the posterior cord of brachial plexus was distributed to the subdeltoid bursa that was running anteriorly in three cases. Most of the branches of the axillary nerve were distributed into the posterolateral area. The branches of the posterior cord of brachial plexus were distributed in the anterolateral area. These results might be useful for preventing residual pain on the anterior shoulder region following an injection for the relief of shoulder pain.

A new specimen of Paleoparadoxia found from a marine lower Miocene deposit in the Chikubetsu area, Hokkaido, Japan, is described. The material consists of a distal part of the scapula, proximal end of the humerus from the right side, as well as a fragmentary rib, preserved in a float of calcareous fine sandstone. The specimen is referred to the order Desmostylia and subsequently to the genus Paleoparadoxia sp. The well preserved shoulder girdle of this specimen provides the first detailed morphology of this anatomical region in Paleoparadoxia. We compared the specimen with a wide range of desmostylid samples to reveal new diagnostic characters for the genus, such as the greater tubercle extending toward the proximal side above the head and the distinct lesser tubercle located on the medial side, projected medially. The lower Miocene Sankebetsu Formation outcrops in the area where the float was found, and the lithology and associated fossil fauna of the float indicate that it was derived from ther...

Calcium hydroxyapatite crystal deposition is a common disorder, which sometimes causes acute pain as calcifications dissolve and migrate into adjacent soft tissue. Intraosseous calcium penetration has also been described. We illustrate the appearance of these lesions using a series of 35 cases compiled by members of the French Society of Musculoskeletal Imaging (Société d'Imagerie Musculo-Squelettique, SIMS). The first group in our series (7 cases) involved calcification-related cortical erosions of the humeral and femoral diaphyses, in particular at the pectoralis major and gluteus maximus insertions. A second group (28 cases) involved the presence of calcium material in subcortical areas. The most common site was the greater tubercle of the humerus, accompanying a calcifying tendinopathy of the supraspinatus. In addition, an extensive intramedullary diffusion of calcium deposits was observed in four of these cases, associated with cortical erosion in one case and subcortical lesions in three cases. Cortical erosions and intraosseous migration of calcifications associated with calcific tendinitis may be confused with neoplasm or infection. It is important to recognize atypical presentations of hydroxyapatite deposition to avoid unnecessary investigation or surgery.

Background The objective of this study was to evaluate the topographic relationship between the morphology of the greater tubercle and the insertion of the tendon of the infraspinatus. Materials and methods First, we defined an impression of the greater tubercle, which has not been recognized in classic textbooks, as the "lateral impression" and then measured the dimensions of the "lateral impression" of the greater tubercle in 71 samples of dry bone of humeri. Next, we examined 16 cadaveric humeri with rotator cuff tendons by micro–computed tomography to analyze the positional relationship between the lateral impression and the infraspinatus tendon. Results In all samples of dry bones, the lateral impression could be identified as a triangle shape. The lateral impression was composed of the border with the highest impression (mean, 6.3 mm), the border with the middle impression (mean, 5.0 mm), and the border with the lateral wall of the greater tubercle (mean, 8.5 mm). In all samples of humeri with rotator cuffs, we could confirm the lateral impression, and the border between the highest impression and the lateral impression corresponded to the anterior border of the insertion of the infraspinatus tendon. Conclusion We propose a new anatomic concept of the lateral impression that could enable the precise diagnosis of and facilitate repair techniques for infraspinatus tear, according to specific anatomic characteristics, by applying 3-dimensional computed tomography assessment preoperatively.

It has been shown that anatomical reconstruction is an important step in achieving good function after shoulder arthroplasty. It is essential to reconstruct the distance between the coracoid process and greater tubercle as this relates to the moment arm of the deltoid and rotator cuff muscles. This study evaluated the reliability of measurement of the lateral humeral offset (LHO) on plain radiographs and on computed tomography (CT). Four independent observers performed measurements of LHO on radiographs and CT from 26 patients awaiting shoulder reconstruction. The interobserver reliability and intraobserver reproducibility were assessed. Interobserver reliability and intraobserver reproducibility of LHO in axial CT scans were excellent. Plain radiography showed fair to excellent interobserver reliability and variable intraobserver reproducibility. CT is a reliable tool to measure LHO supporting its use in preoperative planning. When AP radiography is used for preoperative planning the examiner should be aware of its limitations and standardisation protocols should be considered.

[Purpose] The main aim of this study was to identify the short-term effects of Kinesio taping (KT) on the static body alignment and overall balance function presented by the coordinate and foot balance in stroke patients. [Subjects and Methods] Thirty-eight stroke subjects were randomly allocated into the study groups. The kinematic analysis measured deviation or changes from standard body alignment and foot pressure by the human anatomy-based coordinates were examined using the Shisei Innovation System PA200 ver.9.0. [Results] The glabellas on the front view, larynx on the front view, rt. greater tubercle of the humerus (vertical changes), lt. greater tubercle of the humerus (vertical changes), posterior superior iliac spine, and greater trochanter (horizontal changes) showed statistically significant decreases, indicating dislocation from the axis center, after taping. [Conclusion] The clinical use of KT for stroke patients who have asymmetrical and imbalanced body posture could be an optimal therapeutic approach. Since more evidence based practices are needed, future studies should include large numbers of subjects and examine diverse KT application patterns.

Pulmonary embolism is a serious complication, which is well known in patients undergoing total hip or total knee arthroplasty or lower extremity fracture surgery. But, there are few literatures concerning pulmonary embolism after upper extremity surgery. Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We report a case of 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review.

OBJECTIVE To assess 3-D geometry of the humerus of dogs and determine whether the craniocaudal canal flare index (CFI) is associated with specific geometric features. SAMPLE CT images (n = 40) and radiographs (38) for 2 groups of skeletally mature nonchondrodystrophic dogs. PROCEDURES General dimensions (length, CFI, cortical thickness, and humeral head offset), curvature (shaft, humeral head, and glenoid cavity), version (humeral head and greater tubercle), and torsion were evaluated on CT images. Dogs were allocated into 3 groups on the basis of the craniocaudal CFI, and results were compared among these 3 groups. The CT measurements were compared with radiographic measurements obtained for another group of dogs. RESULTS Mean ± SD humeral head version was −75.9 ± 9.6° (range, −100.7° to −59.4°). Mean mechanical lateral distal humeral angle, mechanical caudal proximal humeral angle, and mechanical cranial distal humeral angle were 89.5 ± 3.5°, 50.2 ± 4.5°, and 72.9 ± 7.8°, respectively, and did not differ from corresponding radiographic measurements. Mean humeral curvature was 20.4 ± 4.4° (range, 9.6° to 30.5°). Mean craniocaudal CFI was 1.74 ± 0.18 (range, 1.37 to 2.10). Dogs with a high craniocaudal CFI had thicker cranial and medial cortices than dogs with a low craniocaudal CFI. Increased body weight was associated with a lower craniocaudal CFI. Radiographic and CT measurements of craniocaudal CFI and curvature differed significantly. CONCLUSIONS AND CLINICAL RELEVANCE CT-based 3-D reconstructions allowed the assessment of shaft angulation, torsion, and CFI. Radiographic and CT measurements of shaft curvature and CFI may differ.

The purpose of this study was to evaluate outcomes after reverse shoulder arthroplasty for the treatment of complex three- and four-fragment proximal humeral fractures after mean follow-up time of 45 months and to compare our results with the results published by other authors. Retrospectively we have analyzed 27 consecutive patients after total arthroplasty with less medialized reverse shoulder prosthesis used for the treatment of complex proximal humeral fracture. The median age and standard deviation was 67.5 ± 7.3 years (range 55–85). The average follow-up time was 45 months. Shoulder function was evaluated using Simple Shoulder Test and Constant scale. Patient satisfaction about the treatment was evaluated using Likert-type questionnaire. All patients were investigated radiologically for possible complications using standard lateral and anterior views. All patients were satisfied (74%) or highly satisfied (26%). The mean total Constant–Murley score was 57.6 pts. (range 37.4–80.2). Mean total Simple Shoulder Test score was 73.5 pts. (range 49.8–100). There were two cases with heterotopic ossification and one with greater tubercle malposition. We found no signs of scapular notching, implant failure or loosening. Results after reverse arthroplasty for complex proximal humeral fractures yield good clinical, functional, and radiological outcomes after mean follow-up time of 45 months. Results are comparable to other studies published in the recent literature.

Purpose The aim of this study was to investigate the influence of footprint spongialization and radiofrequency ablation on rotator cuff repair outcomes compared with an untreated group in a rat model. Methods We randomly assigned 189 Sprague-Dawley rats to either a spongialization, radiofrequency ablation, or untreated group. After separation of the supraspinatus tendon from the greater tubercle, the footprint was prepared by removing the cortical bone with a burr (spongialization), was prepared by ablating soft tissue with a radiofrequency ablation device, or was left unaltered (untreated). Biomechanical testing (after 7 weeks, n = 165) and histologic analysis after 1 and 7 weeks (n = 24) followed reinsertion. Results The mean load to failure was 17.51 ± 4.46 N/mm 2 in the spongialization group, 15.56 ± 4.85 N/mm 2 in the radiofrequency ablation group, and 19.21 ± 5.19 N/mm 2 in the untreated group. A significant difference was found between the spongialization and radiofrequency ablation groups ( P = .0409), as well as between the untreated and radiofrequency ablation groups ( P = .0014). There was no significant difference between the spongialization and untreated groups ( P = .2456). The mean area of fibrocartilage transition, characterized by the presence of type II collagen, was larger after 1 and 7 weeks in the spongialization group (0.57 ± 0.1 mm 2 and 0.58 ± 0.1 mm 2 , respectively) and untreated group (0.51 ± 0.1 mm 2 and 0.51 ± 0.2 mm 2 , respectively) than in the radiofrequency ablation group (0.11 ± 0.1 mm 2 and 0.4 ± 0.1 mm 2 , respectively) with P P Conclusions The results of this study show that radiofrequency ablation of the footprint results in a poor biomechanical and histologic outcome in an animal model. No preparation of the footprint has the same effect as spongialization. Clinical Relevance Different techniques of footprint preparation in rotator cuff repair may influence tendon-to-bone healing.

An 18-month-old warmblood filly was 4/5 lame on the front right limb at referral and showed severe swelling of the right shoulder region and pain during manipulation of the shoulder region. Radiography revealed a roundish 5 × 7 cm radiolucent area with defined borders within the greater tubercle and the presence of a fracture of the lateral tubercle associated with the cyst. Cellular blood count was 27,500 WBC/μL and serum biochemical analyses revealed fibrinogen of 855 mg/dL. The fractured bone was removed surgically; the cyst debrided and filled with autologous cancellous bone graft. Three and five weeks after surgery the filly was reoperated on because of an osseous sequestrum and a periostal defect on the distal dorsolateral aspect of the pastern of the right hind limb and a septic synovitis of the DFTS of the left hind limb. Fifteen month after surgery the filly was not lame and was introduced to training. Unicameral bone cysts (UBC) are well described lesions, often associated to pathologic fracture in the proximal humerus of children but, until present, no scientific report exists of UBC in the foal. The prompt surgical management had a favorable outcome.

INAL, MIKAIL/0000-0003-0642-7913 WOS: 000457679200001 PubMed: 30798723 Purpose: The purpose of this study was to investigate the clinical results of arthroscopic rotator cuff repair in patients with anterior greater tubercle cyst in magnetic resonance imaging (MRI). Methods: The cyst-present group comprised 38 patients with anterior greater tubercle cyst in MRI, and age- and sex-matched 30 patients without cyst in humeral head were included in the control group. The cystic group was divided into two groups, smaller than 5 mm (21 patients) and larger than 5 mm (17 patients), according to the cyst size. A total of three groups were created. In the evaluation of clinical outcomes, modified University of California at Los Angeles (UCLA) and the Western Ontario Rotator Cuff Index (WORC) were used. The visual analog scale (VAS) was used to assess pain. One-way analysis of variance was used to compare VAS, UCLA, and WORC scores among the groups. Results: There was a statistically significant difference in the clinical results of VAS, UCLA, and WORC among the cystic and noncystic groups in the anterior greater tubercle (p < 0.05). There was also a statistically significant difference in the clinical results of UCLA, WORC, and VAS scores according to the cyst sizes in the anterior greater tubercle cyst group (p < 0.05). Conclusion: Anterior greater tubercle cysts have negative effects on rotator cuff repair results. If the anterior greater tubercle cyst size is greater than 5 mm, the negative effects of rotator cuff repair results are more pronounced. An understanding of anterior greater tubercle cysts has a critical importance for rotator cuff surgery planning.

Anterior shoulder dislocation is the most common type of joint dislocation. Lots of complications like fracture of greater tubercle and glenoid anterior rim or neurovascular injuries may occur at the time of dislocation or reduction of dislocated joint. We aimed to present a case; 76 year old female with anterior dislocation and fracture ; while we were trying close reduction by traction counter-traction method , we experienced a complication which was a non-circulated degloving like skin tear at dorsal middle part of forearm which was not presented in literature before. Since the thin skin has less collagen and elastin in elderly patients, skin tears with traction might occur easily. The fragility of the skin in the elderly patients has to be taken into consideration with other complications presented in the literature. Keywords: Elderly patient, shoulder dislocation, skin tear DOI: 10.12973/ejms.2014.129p

Osteochondrosis is a common developmental abnormality affecting the subchondral bone of immature, large breed dogs. The purpose of this retrospective study was to describe CT lesions detected in scapulohumeral joints of 32 immature dogs undergoing CT for thoracic limb lameness. Eight dogs (14 scapulohumeral joints) had arthroscopy following imaging. Thirteen dogs (19 scapulohumeral joints) were found to have CT lesions, including 10 dogs (16 scapulohumeral joints) with subchondral bone lesions and 3 dogs with enthesopathy of the supraspinatus tendon. In one dog, subchondral bone lesions appeared as large oval defects within the mid-aspect of the glenoid cavities, bilaterally. These lesions resembled osseous cyst-like lesions commonly identified in the horse. This is the first report of such a presentation of a subchondral bone lesion in the glenoid cavity of a dog. In all dogs, small, focal, round or linear lucent defects were visible within the cortical bone at the junction of the greater tubercle and intertubercular groove. These structures were thought to represent vascular channels. Findings from this study support the use of CT as an adjunct modality for the identification and characterization of scapulohumeral subchondral bone lesions in immature dogs with thoracic limb lameness.