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Clinical Scenario: The fascial relationship between scapular muscles and abdominal muscles has been documented from previous studies. However, it is not yet clear whether voluntary abdominal contraction has a beneficial effect on scapular muscle activity during shoulder exercises. Clinical Question: Do scapulothoracic muscle activation levels increase if shoulder exercises are performed with voluntary abdominal activation? Summary of Key Finding: After the literature review, 4 cross-sectional studies met the inclusion criteria and were included in this critically appraised topic. Clinical Bottom Line: There is moderate evidence to support dynamic shoulder exercises with voluntary abdominal contraction can increase trapezius and serratus anterior muscle activation level in asymptomatic shoulders. Strength and Recommendation: Findings from 4 cross-sectional trials indicate that there is moderate evidence supporting that dynamic shoulder exercises performed with voluntary abdominal contraction can increase scapular muscle activity. [ABSTRACT FROM AUTHOR]

Background: Weakness of the shoulder girdle muscles has been reported in patients with chronic lateral elbow tendinopathy. The aim of this study was to assess the short- and long-term effects of a conventional treatment plus scapular exercises program in patients with chronic lateral elbow tendinopathy. Methods: A single-group prestudy and poststudy were conducted. The primary outcome was the Patient-Rated Tennis Elbow Evaluation questionnaire score. Secondary outcomes were grip strength; Disabilities of the Arm, Shoulder, and Hand questionnaire score; Visual Analogue Scale score at rest and at grip, and presence of scapular dyskinesis. Results: A total of 65 patients (72.3% females), with a mean age of 41.8 years, were analyzed. At the end of 6 weeks, the results showed clinically and statistically significant differences (P< .05). At 1-year follow-up, the differences were: Patient-Rated Tennis Elbow Evaluation -31 points (P<.001); grip strength +33.6% (P<.001); Disabilities of the Arm, Shoulder, and Hand -34.2 points (P < .001); Visual Analogue Scale at rest -2.5 cm (P < .001); and Visual Analogue Scale at grip -2.3 cm (P < .001). Conclusion: At the end of 6 weeks and at 1-year follow-up, conventional treatment plus scapular exercises program showed statistically and clinically significant differences in all functional outcomes assessed in patients with lateral elbow tendinopathy. [ABSTRACT FROM AUTHOR]

There is mixed evidence on the role that biological sex plays in shoulder biomechanics despite known differences in musculoskeletal disorder prevalence between males and females. Additionally, advancing age may contribute to shoulder kinematic changes. The purpose of this study was to determine if sex and age influenced scapular and thoracohumeral kinematics during a range of functional tasks. Sixty healthy participants aged 19–63 years (30 males; 30 females) completed a functional task protocol while their upper limb motion was recorded. Scapular and humeral angles were calculated and compared with multiple linear regressions to assess the interaction effects of sex and age. Shoulder kinematics were not different between sex and age groups for many of the functional tasks. However, females had lower humeral external rotation in the overhead lift task (15°, P <.001), and less scapular anterior tilt angles in the forward transfer task (6°, P <.001) than males. Age was positively associated with humeral elevation (R2 =.330, P <.001) and scapular rotation (R2 =.299, P <.001) in the Wash Axilla task. There exist some kinematic differences between sex and with advancing age for select functional tasks, which should be considered for musculoskeletal disorder development. [ABSTRACT FROM AUTHOR]

Purpose: To verify whether training the iron cross (IC) with assistive devices (herdos; HIC) and added external load (LHIC) to equate the moments of force developed on the rings could be considered an intermediate step between the nonoverloaded herdos situation (HIC) and the IC performed on the rings. Methods: Relative levels of surface electromyography (sEMG) activity were normalized with respect to a standing IC before comparing gymnasts who can perform the IC on the rings (achievers) and gymnast who cannot (nonachievers) in the 2 herdos conditions (HIC and LHIC). Seven muscles were chosen for sEMG analysis, namely, pectoralis major (PM), latissimus dorsi, teres major, lower trapezius, serratus anterior, biceps brachii (BB), and triceps brachii. Additionally, 3 indices were calculated to measure levels of coactivation: Elbowidx, Scapulaidx, and Shoulderidx. Results: The bigger magnitude of differences in sEMG activity among situations was found for the PM and BB (F ≥ 30.7; P <.001). When comparing the global and the PM, teres major, BB, and triceps brachii activity across groups, nonachievers activated their musculature to a greater extent than the achievers independently of the herdos situation (P ≤.046). Achievers' Elbowidx was the only index that was significantly higher (P ≤.005) in the IC in comparison to LHIC and HIC. Conclusion: sEMG activity of PM and BB was particularly sensitive between situations, independently of the level of achievement. We recommend training the IC by adding external load in the herdos situation to increase muscle activity to levels closer to the rings situation but avoiding the potential factor of injuries. [ABSTRACT FROM AUTHOR]

Purpose: Subacromial balloon spacer implantation (SBSI) efficacy for massive rotator cuff tear treatment was evaluated based on perceived shoulder function, active shoulder mobility, pain, complications and research study methodological quality. The purpose was to better discern the efficacy of this device from both surgical and rehabilitative perspectives to improve patient outcomes. Methods: PubMed, EMBASE and Cochrane Library databases were searched (1 January 2010 to 1 June 2024) using 'balloon spacer', 'subacromial spacer', 'subacromial balloon spacer', 'shoulder spacer' and 'inspace' terms. Pre‐surgery (baseline), 12‐month (12‐m) and 24‐month (24‐m) post‐SBSI mean changes were compared using one‐way ANOVA and Scheffe post hoc tests, and comparative study effect sizes were calculated (p ≤ 0.05). Results: This review consists of 27 studies with 894 patients (67.8 ± 5 years of age) and 29.4 ± 17‐month follow‐up. Modified Coleman Methodology Scores (MCMS) revealed fair overall quality (mean = 61.4 ± 11). Constant–Murley scores improved from 34.8 ± 6 (baseline), to 64.2 ± 9 (12‐m) and 67.9 ± 8 (24‐m) (12‐m, 24‐m > baseline, p < 0.001). ASES scores improved from 35.1 ± 14 (baseline), to 83.3 ± 7 (12‐m) and 81.8 ± 5 (24‐m)(12‐m, 24‐m > baseline, p < 0.001). VAS pain scores improved from 6.6 ± 1 (baseline), to 2.6 ± 1 (12‐m) and 2.0 ± 1 (24‐m) (12‐m, 24‐m < baseline, p < 0.001). Flexion increased from 108.5 ± 25° (baseline), to 128.5 ± 30° (12‐m) and 151.2 ± 14° (24‐m) (24‐m > 12‐m, baseline, p = 0.01). Abduction increased from 97.7 ± 24° (baseline) to 116.3 ± 23° (12‐m) and 142.3 ± 15° (24‐m) (24‐m > 12‐m, baseline, p = 0.02). External rotation (ER) in adduction changed from 33.1 ± 7° (baseline) to 32.5 ± 4° (12‐m) and 53.9 ± 9° (24‐m)(24‐m > 12‐m, baseline, p = 0.01). ER at 90° abduction increased from 56.3 ± 3° (baseline) to 83.5 ± 5° (12‐m) and 77.1 ± 4° (24‐m) (24‐m, 12‐m > baseline, p = 0.01). Comparison studies, however, displayed insignificant results with small effect sizes. Conclusion: Despite overall fair MCMS scores, at 24‐m post‐SBSI, shoulder function improved and pain decreased. More rigorous comparative studies, however, revealed insignificant findings. Patients with the potential to re‐establish the essential glenohumeral joint force couple that depresses the humeral head on the glenoid fossa and who comply with physical therapy may be more likely to achieve success following SBSI. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to investigate the efficacy of targeted scapular stabilization exercise in shoulder pain. Design: This is an evaluator-blinded, multicenter, randomized con- trolled trial. The scapular stabilization exercise group (n =45)received scapular stabilization exercise based on the type of scapular dyskinesis for 6 wks; the conventional exercise group (n = 45) received pendu- lum, wall climbing and stick exercises for 6 wks. Constant-Murley score, numerical rating scale, range of motion, type of scapular dyskinesis, lateral scapular sliding test, pectoralis minor index, scapu- lar index, and satisfaction were assessed at baseline, 2-, 4-, and 6-wk treatment as well as a 6-wk follow-up. Results: After a 6-wk intervention, the improvement of Constant- Murley score was greater in the scapular stabilization exercise group than in the conventional exercise group, and improvement continued at the 6-wk follow-up (F =15.39, P < 0.001, partial η² =0.17).The results were also significant for numerical rating scale during activity, lateral scapular sliding test, pectoralis minor index, type of scapular dyskinesis, and satisfaction in favor of the scapular stabilization exercise group (P < 0.05). Conclusions: Targeted scapular stabilization exercise is an effective intervention program that might be applied to the rehabilitation of shoulder pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: People with forward head posture (FHP) and rounded shoulder posture (RSP) may experience shifts in scapular position and alterations in the strength of the muscles surrounding the scapula. Therefore, a reliable scapula position and scapula muscle strength test are required to identified scapula problem and provided appropriate intervention programs. OBJECTIVE: This study aimed to determine the reliability of scapular position measurements obtained using a modified digital inclinometer and palpation meter, as well as muscle strength using a hand-held dynamometer (HHD) in individuals with FHP and RSP. METHODS: Thirty healthy subjects underwent scapular position tests (upward rotation, anterior tilt, depression, and protraction) and strength tests of periscapular muscles (serratus anterior, upper trapezius, middle trapezius, and lower trapezius) on both the dominant and non-dominant sides. The reliability of the measurements was confirmed by computing the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Test and re-tests were conducted over a period of one week and actual values for each measurement were also obtained and assessed. RESULTS: The ICC ranged from 0.802 to 0.935 for the scapular position tests and from 0.808 to 0.949 for muscle strength tests on the dominant and non-dominant sides. For scapular position tests, SEM values ranged from 0.3 cm to 0.6 cm (protraction and depression), from 1.0∘ to 1.7∘ (upward rotation and anterior tilt) and MCID values ranged from 0.7 cm to 1.6 cm (protraction and depression), from 2.8∘ to 4.7∘ (upward rotation and anterior tilt). Regarding muscle strength tests, SEM and MCID values were in the range 14.4N–27.3N and 39.9N–75.7N, respectively. CONCLUSIONS: Scapular position and periscapular muscle strength can be reproducibly measured in healthy subjects individuals with FHP and RSP. These instruments can hence be recommended for evaluating these functional traits in subjects with FHP and RSP. [ABSTRACT FROM AUTHOR]

Whether the forelimb‐digging apparatus of tooth‐digging subterranean mammals has similar levels of specialization as compared to scratch‐diggers is still unknown. We assessed the scapular morphology and forelimb musculature of all four solitary African mole rats (Bathyergidae): two scratch‐diggers, Bathyergus suillus and Bathyergus janetta, and two chisel‐tooth diggers, Heliophobius argenteocinereus and Georychus capensis. Remarkable differences were detected: Bathyergus have more robust neck, shoulder, and forearm muscles as compared to the other genera. Some muscles in Bathyergus were also fused and often showing wider attachment areas to bones, which correlate well with its more robust and larger scapula, and its wider and medially oriented olecranon. This suggests that shoulder, elbow, and wrist work in synergy in Bathyergus for generating greater out‐forces and that the scapula and proximal ulna play fundamental roles as pivots to maximize and accommodate specialized muscles for better (i) glenohumeral and scapular stabilization, (ii) powerful shoulder flexion, (iii) extension of the elbow and (iv) flexion of the manus and digits. Moreover, although all bathyergids showed a similar set of muscles, Heliophobius lacked the m. tensor fasciae antebrachii (aiding with elbow extension and humeral retraction), and Heliophobius and Georychus lacked the m. articularis humeri (aiding with humeral adduction), indicating deeper morphogenetic differences among digging groups and suggesting a relatively less specialized scratch‐digging ability. Nevertheless, Heliophobius and Bathyergus shared some similar adaptations allowing scratch‐digging. Our results provide new information about the morphological divergence within this family associated with the specialization to distinct functions and digging behaviors, thus contributing to understand the mosaic of adaptations emerging in phylogenetically and ecologically closer subterranean taxa. This and previous anatomical studies on the Bathyergidae will provide researchers with a substantial basis on the form and function of the musculoskeletal system for future kinematic investigations of digging behavior, as well as to define potential indicators of scratch‐digging ability. [ABSTRACT FROM AUTHOR]

Radiographic evaluation of the implant configuration after reverse shoulder arthroplasty (RSA) is time-consuming and subject to interobserver disagreement. The final configuration is a combination of implant features and surgical execution. Artificial intelligence (AI) algorithms have been shown to perform accurate and efficient analysis of images. The purpose of this study was to develop an AI algorithm to automatically measure glenosphere inclination, humeral component inclination, and the lateralization and distalization shoulder angles (DSAs) on postoperative anteroposterior radiographs after RSA. The Digital Imaging and Communications in Medicine files corresponding to postoperative anteroposterior radiographs obtained after implantation of 143 RSAs were retrieved and used in this study. Four angles were analyzed: (1) glenoid inclination angle (GIA, between the central fixation feature of the glenoid and the floor of the supraspinatus fossa), (2) humeral alignment angle (HAA, between the long axis of the humeral shaft and a perpendicular to the metallic bearing of the prosthesis), (3) DSA, and (4) lateralization shoulder angle (LSA). A UNet segmentation model was trained to segment bony and implant elements using manually segmented training (n = 89) and validation (n = 22) images. Then, an image-processing–based pipeline was developed to measure all 4 angles using AI-segmented images. Measures performed by 3 physician observers and the AI algorithm were then completed in 32 additional images. The agreements among human observers and between observers and the AI algorithm were evaluated using intraclass correlation coefficients (ICCs) and absolute differences in degree. The ICCs (95% confidence interval) for manual measurements of LSA, DSA, GIA, and HAA were 0.79 (0.55, 0.90), 0.90 (0.80, 0.95), 0.96 (0.93, 0.98), and 0.99 (0.97, 0.99), respectively. The AI algorithm measured the 32 images in the test set in less than 2 minutes. The agreement between observers and the AI algorithm was lowest when measuring the LSA for observer 2, with an ICC of 0.77 (0.52, 0.89), and an absolute difference in degrees (median [interquartile range]) of 5 (4). Better agreements were found between the AI measurements and the average manual measurements: absolute differences in degree for LSA, DSA, GIA, and HAA were 3 (5), 2 (3), 2 (2), and 2 (1), respectively; ICCs for LSA, DSA, GIA, and HAA were 0.89 (0.79, 0.95), 0.96 (0.93, 0.98), 0.85 (0.68, 0.93), and 0.98 (0.95, 0.99), respectively. The AI algorithm developed in this study can automatically measure the GIA, HAA, LSA, and DSA on postoperative anteroposterior radiographs obtained after implantation on RSA. [ABSTRACT FROM AUTHOR]

Preoperative planning has gained popularity in the management of reverse shoulder arthroplasty (RSA). Commercially available software provides 3-dimensional segmentation of scapula and humerus, as well as providing arc of motion for the implanted articulation and identifying potential areas of bony impingement. However, these software algorithms use a fixed scapula model, disregarding the preoperative clinical range of motion (C-ROM) of the patient, be it glenohumeral or scapulothoracic, as well as any soft tissue parameters. This study aims to compare the ROM based on preoperative planning software by using the implant position from postoperative computed tomography (CT) images (predicted ROM using preoperative planning software [P-ROM]), with the C-ROM assessed at minimum of 2 years of follow-up. Preoperative and postoperative CT scans of 46 patients who underwent primary RSA between 2017 and 2021 were analyzed. At the postoperative 2-year review, each patient was assessed for active ROM. Implant size and position based on operative notes and postoperative CT scans were used to replicate the performed surgery in the planning software. Abduction, flexion, and external rotation motion were simulated and recorded. The relationship between C-ROM and P-ROM was investigated using linear regression analysis, Pearson correlation coefficient, and paired t -test. P-ROM was significantly lower than C-ROM at 2 years postoperatively (P <.001), with an average discrepancy of 78° in abduction, 47° in flexion, and 37° in external rotation (C-ROM: abduction 155° ± 21° [80°-180°]; flexion 160° ± 17° [90°-180°]; external rotation 52° ± 14° [10°-80°] vs. P-ROM: abduction 77° ± 13° [53°-107°]; flexion 112° ± 25° [67°-180°]; external rotation 15° ± 21° [0°-79°]). The linear regression analysis indicated weak agreement between C-ROM and P-ROM (abduction R2 = 0.03; flexion R2 = 0.01; external rotation R2 = 0.04). Pearson's correlation coefficients revealed weak correlations of −0.18, 0.03, and 0.21 for abduction, flexion, and external rotation, respectively. P-ROM based on preoperative software in its current form does not allow the prediction of the C-ROM at 2 years of follow-up for patients undergoing RSA. [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]

Restoration of an anatomic joint line after anatomic total shoulder arthroplasty and of the optimal lateral offset after reverse total shoulder arthroplasty may be relatively straightforward when the glenoid does not present with severe erosion. However, in cases of severe glenoid bone loss, the surgeon is left with no preoperative landmark to restore these parameters. The objective of this study was to use statistical shape modeling, to predict the premorbid morphology of the glenoid. We hypothesized that this would allow us to accurately determine premorbid glenoid version and inclination, in addition to accurately quantifying bone loss and medialization. Fifty-six bilateral computed tomography scans of the shoulders of patients scheduled for shoulder arthroplasty and determined to have unilateral osteoarthritis (primary osteoarthritis or cuff tear arthropathy with a healthy contralateral side) were obtained. A statistical shape model was automatically applied on the pathologic arthritic side to predict its premorbid anatomy. Glenoid version, inclination, height, width, and glenoid and scapula lateral offset were measured automatically. These measurements were obtained on the pathological arthritic cases, on the contralateral control healthy cases, and on the premorbid predictions of the pathological arthritic cases and were compared pair by pair. The mean difference between the pathological arthritic side and the contralateral healthy side was 9.1° ± 7.3° for version, 4.8° ± 4.8° for inclination, 4.9 ± 4.5 mm for height, 4.7 ± 5.3 mm for width, 2.4 ± 1.9 mm for scapula lateral offset, and the glenoid lateral offset was 1.5 ± 1.5 mm. The mean difference between the premorbid prediction of the pathological side and the contralateral healthy side was reduced to 3.3° ± 2.4° for version, 3.4° ± 2.6° for inclination, 3.0 ± 1.9 mm for height, 2.3 ± 1.4 mm for width, 2.2 ± 1.7 mm for scapula lateral offset, and the glenoid lateral offset was 0.9 ± 0.8 mm. This study shows that statistical shape modeling can allow accurate prediction of the premorbid morphology of the glenoid. This could help optimize implant selection and positioning after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty to restore optimal soft-tissue tension. [ABSTRACT FROM AUTHOR]

Scapular orientation may play an important role in preoperative planning for shoulder arthroplasty; however, there is currently no defined method for producing standardized three-dimensional measurements. The purpose of this study is to develop a reproducible measurement system of scapular orientation and to evaluate differences between unaffected shoulders and those with diagnoses of primary glenohumeral osteoarthritis (GHOA) and rotator cuff tear arthropathy (CTA). Patients receiving computed tomography scans for preoperative shoulder arthroplasty planning were enrolled prospectively. Thin sliced axial images that included bilateral shoulders and the thorax were reformatted. The pathology of the bilateral glenohumeral joints was defined as GHOA, CTA, or unaffected. Scapular orientation was defined relative to the thorax using three-dimensional models to define the protraction, rotation, and tilt angles in the supine position. Univariate analysis was performed to compare demographics and scapular measurements between patients with GHOA, CTA, and unaffected shoulder pathology. Multivariate linear regression analysis was performed to identify independent predictors of scapular orientation. One hundred fifty-eight shoulders, comprising 79 patients were included. Twenty-seven percent (n = 21/79) of patients had an unaffected contralateral shoulder. Shoulders with GHOA had significantly greater downward scapular rotation (-14 ± 7 degrees) than both unaffected shoulders (-8 ± 7 degrees; P <.001) and those with CTA (-7 ± 8 degrees; P <.001). Increased downward scapular rotation was predicted by a shoulder pathology of GHOA in multivariate analysis (beta -7.09; P <.001). The magnitude of side-to-side difference was greatest in scapular rotation for patients with GHOA compared to CTA, with no significant differences in tilt or protraction. Scapular rotation in the supine position varies by shoulder pathology, with greater downward rotation seen in patients with primary GHOA. These findings underscore the need for awareness of scapular orientation in addition to glenoid morphology when evaluating and planning shoulder arthroplasty cases. [ABSTRACT FROM AUTHOR]

Introduction: Alterations of scapular kinematics are generically reported as scapular dyskinesis (SD), and are a nonspecific response to various shoulder pathologies. The most widely used classification is Kibler's (K), which is, however, characterized by poor sensitivity. To overcome this limit, using a 3D motion analysis system, we identified a specific pattern for each type of SD according to Kibler. Materials and methods: We analyzed 34 patients with a total of 68 shoulders who came to our observation for shoulder pain. All patients underwent clinical examination, video-recording and motion analysis with SHoW Motion 3D kinematic tracking system (SM). Three independent observers classified SD into K types I, II and III. Only patients with concordant classification among the 3 operators were studied to identify a characteristic graphic pattern by type of SD. Results: Typical patterns emerged from the examination with SM. K. type 1 consists of decreased or reversed posterior tilt and increased protraction in flexion–extension (FE) in early degrees of motion. K. type 2 consists of increased protraction and marked reversal of lateral rotation in abduction–adduction (Ab–Ad) in early degrees of movement. K. type 3 has been subdivided into two subgroups: K. type 3-A, composed of patients with massive rotator cuff lesions, shows an increase in all scapular movements in both FE and Ab–Ad. K. type 3-B, composed of patients with scapular stiffness and/or impingement, presents a slight increase in posterior tilt and lateral rotation in the final grades of FE and Ab–Ad. Conclusions: The SM system allows reproducible dynamic analyses with low intra- and intra- operator variability. In our study, we demonstrated its applicability in the classification of SD. It also provides an objective and quantitative assessment of motor pattern alteration that is essential in the follow-up of patients to evaluate the effectiveness of rehabilitation and/or surgical treatment. Level of Evidence 3: According to "The Oxford 2011 Levels of Evidence". [ABSTRACT FROM AUTHOR]

Purpose: The scapula is the second most popular donor site for mandibular reconstruction after the fibula. Scapula harvest is generally performed in the lateral decubitus position and the requirement of positional changes hamper the widespread use of the scapula. This study compared scapula harvest for immediate mandibular reconstruction between the supine and lateral decubitus positions. Methods: We reviewed the outcomes of 16 patients who underwent segmental mandibulectomy and immediate reconstruction of the scapula based on the angular branch of the thoracodorsal artery. The scapula was harvested in the lateral decubitus (lateral decubitus group) or supine position (supine group) in eight patients each. Several perioperative parameters were compared between the two groups. Results: One scapula was lost because of inadvertent injury of the angular branch in the supine group. The operative time was significantly shorter in the supine group than in the lateral decubitus group. Conclusion: Harvesting of the scapula in the supine position is a feasible option for immediate mandibular reconstruction. Although deep anatomic knowledge and technical expertise are necessary, this strategy can eliminate positional change and significantly reduce the operative time. [ABSTRACT FROM AUTHOR]

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

Background: Currently, multiple tools exist to teach and learn anatomy, but finding an adequate activity is challenging. However, it can be achieved through haptic experiences, where motivation is the means of a significant learning process. This study aimed to evaluate a haptic experience to determine if a tactile and painting with color marker interactive experience, established a better learning process in comparison to the traditional 2D workshop on printed paper with photographs. Methods: Plaster bone models of the scapulae, humerus and clavicle were elaborated from a computerized scan tomography. Second year undergraduate medical students were invited to participate, where subjects were randomly assigned to the traditional 2D method or the 3D plaster bone model. A third group decided not to join any workshop. Following, all three groups were evaluated on bone landmarks and view, laterality, muscle insertions and functions. 2D and 3D workshop students were asked their opinion in a focus group and answered a survey regarding the overall perception and learning experience. Evaluation grades are presented as mean ± standard deviation, and answers from the survey are presented as percentages. Results: The survey demonstrated the students in the 3D model graded the experience as outstanding, and in five out of the six questions, answers were very good or excellent. In contrast, for students participating in the 2D workshop the most common answers were fair or good. The exception was the answer regarding the quiz, where both groups considered it good, despite the average among all groups not being a passing grade. Conclusions: To learn the anatomy of the shoulder, the conventional methodology was compared with a haptic experience, where plaster bone models were used, enabling students to touch and paint on them. Based on the focus group and survey this study revealed the 3D workshop was an interactive experience where, the sense of touch and painting greatly contributed to their learning process. Even though this activity was useful in terms of learning bone landmarks, view muscle insertions, and establish relations, further activities must be developed to increase their understanding regarding their function, and its relevance in a clinical setting. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Scapular dyskinesis (SD) is closely related to imbalance of the rotator cuff (RC) muscles. However, previous studies have only focused on isometric strength. To our knowl-edge, there has been no study examining potential differences in concentric and eccentric strength and functional strength ratio (FSR) of the RC muscles based on functional parameters related to throwing in with or without SD. Objects: This study aimed to determine whether there was a difference in the RC muscle strength and FSR between the dominant shoulder with SD and the non-dominant shoulder without SD in adolescent baseball players. Methods: Forty adolescent baseball players participated and classified types of SD based on movement patterns using the SD test by two examiners. The isokinetic concentric and ec-centric peak torque of the internal rotation (IR) and external rotation (ER) were measured and quantified as peak torque to body weight (PT/BW). Also, the FSR was obtained by calculating the strength ratios of eccentric IR to concentric ER (IRecc/ERcon) and eccentric ER to concentric IR (ERecc/IRcon), respectively. Results: There was a significant decrease in the IR and ER PT/BW in the dominant shoulder with SD compared to the non-dominant shoulder without SD (p < 0.05), regardless of con-traction types. However, no significant difference was observed in the FSR in both IRecc/ERcon and ERecc/IRcon ratios. Conclusion: The findings indicate that the isokinetic concentric and eccentric PT/BW of the IR and ER muscles were significantly lower in the dominant shoulder with SD than in the nonthrowing shoulder without SD. Therefore, when establishing a strategy for addressing RC muscle weakness in adolescent baseball players with SD, it is essential to consider an approach that accounts for scapular kinematic recovery.