Sternoclavicular joint hypertrophy after neck dissection and upper trapezius myocutaneous flap transposition.
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The use of Kirschner wires (K-wires) for bone and joint fixation carries the risk of migration of the wire from the fixation site over time. However, review of the literatures disclosed rather few reports on this issue. We describe such a case in order to emphasize the potential complication and serious hazard that migration of such metallic devices can result in, especially when the fixation site is close to the thoracic cavity.
The literature suggests that approximately 93% of all pacemaker lead fractures occur in the segment of the lead lateral to the venous entry, and costoclavicular compression has been implicated. While blood vessels can be compressed by movements of the clavicle, our research suggests that lead and catheter damage in that region is caused by soft tissue entrapment rather than bony contact. Dissection of eight cadavers with ten leads revealed that two entered the cephalic vein, and were not included in the study. Of the other eight leads, four passed through the subclavius muscle, two through the costoclavicular ligament, and two through both these structures before entering the subclavian, internal jugular, or brachiocephalic vein. Anatomical studies demonstrated that entrapment by the subclavius muscle or the costoclavicular ligament could cause repeated flexing of leads during movements of the pectoral girdle. Cineradiology of patients with position dependent catheter occlusion confirmed entrapment by the subclavius muscle. Soft tissue entrapment imposes a static load upon leads and catheters, and repeated flexure about the point of entrapment may be responsible for damage previously attributed to cyclic costoclavicular compression.
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Plain-film radiography is an important and basic element in the assessment of inflammatory rheumatic diseases. Its various uses include assessment of inflammatory osseous destruction and the activity of inflammatory changes. Furthermore, the inflammatory collateral phenomena can indicate an acute clinical phase, and the articular soft tissue swelling and tenosynovitis are shown directly and indirectly very clearly. On the other hand, high-resolution computed tomography is very capable of showing cortical structures of bone complementary to MR. In some special clinical questions and anatomical regions, especially the axial skeleton, it delivers information of high specifity, partly for definitive diagnosis and partly for planning surgical procedures. The assessment of changes in the sacroiliac joints, sternoclavicular joints and craniocervical junction are domains of computed tomography.
The shoulder joint is a complex structure composed of intricate bony architecture and an ornate system of muscles, tendons, and ligaments. What many refer to as the "shoulder joint" is actually a combination of 4 articulations--the glenohumeral joint, acromioclavicular joint, sternoclavicular joint, and the scapulothoracic articulation. These structures work together to provide the shoulder complex with multiple degrees of freedom, which allow the upper extremity to be abducted, adducted, rotated, flexed, and extended. Although this flexibility is vital for positioning the arm in space, it can make the evaluation of pathology difficult. Furthermore, neck pathology can refer pain to the shoulder, which may require a screening evaluation of the neck. This article reviews the relevant anatomy and discusses an approach to the differential diagnosis of shoulder pain.
OBJECTIVE: Movements of the human shoulder represent the result of a complex dynamic interplay of structural bony anatomy and biomechanics, static ligamentous and tendinous restraints, and dynamic muscle forces. Injury to 1 or more of these components through overuse or acute trauma disrupts this complex interrelationship and places the shoulder at increased risk. A thorough understanding of the functional anatomy of the shoulder provides the clinician with a foundation for caring for athletes with shoulder injuries. DATA SOURCES: We searched MEDLINE for the years 1980 to 1999, using the key words "shoulder," "anatomy," "glenohumeral joint," "acromioclavicular joint," "sternoclavicular joint," "scapulothoracic joint," and "rotator cuff." DATA SYNTHESIS: We examine human shoulder movement by breaking it down into its structural static and dynamic components. Bony anatomy, including the humerus, scapula, and clavicle, is described, along with the associated articulations, providing the clinician with the structural foundation for understanding how the static ligamentous and dynamic muscle forces exert their effects. Commonly encountered athletic injuries are discussed from an anatomical standpoint. CONCLUSIONS/RECOMMENDATIONS: Shoulder injuries represent a significant proportion of athletic injuries seen by the medical provider. A functional understanding of the dynamic interplay of biomechanical forces around the shoulder girdle is necessary and allows for a more structured approach to the treatment of an athlete with a shoulder injury.
Thirty-three fresh human cadaver shoulders were harvested and bone-ligament-bone specimens of acromioclavicular joint, coracoclavicular joint and sternoclavicular joint were obtained. A test fixture and clamps specifically designed for this ligament study and a high-speed Instron machine were used. One quasi-static rate (nominally 0.1 %/sec) and two high rates (nominally, high rate 1 = 40,000 %/sec and high rate 2 = 15,000 %/sec) were used in this study. In the acromioclavicular joint tests, ligament failure was the most common failure mode. Bone fractures occurred most often at the clavicle rather than acromion. In the coracoclavicular joint tests, the majority of specimens failed at the ligament and bone fractures occurred at the coracoid. In the sternoclavicular joint tests, the specimen failed at the bone in most cases. In the acromioclavicular joint and coracoclavicular joint tests, high rate 2 tests and quasi-static tests had more bone fracture cases than high rate 1 tests. Cross sectional area, deflection at failure, load at failure, strain at failure, stress at failure and Young's modulus of these three shoulder joints were found. The Young's modulus, ultimate stress and ultimate load of the three joints were found to be significantly lower in the quasi-static rate tests compared to the high rate 2 tests but not significantly different between high rate 1 and high rate 2 tests. There are no significant relationships between cross-sectional area and age, height or weight, nor between the mechanical properties of the shoulder joint and age, height or weight.
The shoulder joint and its associated joints form one of the most complex joint systems of the human locomotor apparatus. Its large range of motion is made possible by the interplay of 5 joints: sternoclavicular-joint, acromioclavicular-joint, glenohumeral joint, thoracoscapular joint and subacromial joint. The rotator cuff works mostly as an active stabilizer of the shoulder joint. The supraspinatus muscle causes a compression of the humerus in the glenoid mainly, furthermore it effects synergistic the abduction with the delta muscle. On the basis of its lever-arm the supraspinatus works between 0 and 60 degrees abduction the most optimally. With failure of the supraspinatus, the deltoideus can almost completely take its function. The inferior glenohumeral ligament-complex is the main passive stabilizer. The blood supply of the humerus head is ensured mainly by the a. circumflexa anterior and its rami ascendents, by several small branches from the a. circumflexa posterior and over intraosseous anastomoses. The most important vessel of the cap is the intraosseous a. arcuata out of the ramus ascendens lateralis of the a. circumflexa anterior.
A three-dimensional biomechanical model of the shoulder is developed for force predictions in 46 shoulder structures. The model is directed towards the analysis of static working situations where the load is low or moderate. Arbitrary static arm postures in the natural shoulder range may be considered, as well as different kinds of external loads including different force and moment directions. The model can predict internal forces for the shoulder muscles, for the glenohumeral, the acromioclavicular and the sternoclavicular joint as well as for the coracohumeral ligament. A solution to the statistically indeterminate force system is obtained by minimising an objective function. The default function chosen for this is the sum of the squared muscle stresses, but other objective functions may be used as well. The structure of the model is described and its ingredients discussed. The internal consistency of the model, its structural stability and the compatibility of the elements that go into it, is investigated.