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PubMed2002

Rotator cuff alterations resulting from humeral head fractures.

Most complex humeral head fractures are associated with a longitudinal tear of the rotator cuff. Reconstruction of this tear is frequently omitted from surgical reduction and fixation procedures. In 48 patients treated by surgery or by conservative means, we investigated the relationship between rotator cuff integrity and the functional results. The rotator cuff was assessed by ultrasonography, the functional results by the Constant Score. Common signs of rotator cuff alterations were partial or complete atrophy. In all patients affected, a longitudinal defect located at the rotator interval was detected. A classification of rotator cuff alterations resulting from humeral head fractures was introduced, yielding three categories: none, moderate, or severe. In three patients, sonographic results were confirmed by magnetic resonance imaging (MRI). Rotator cuff alterations were often associated with displaced consolidation results. Furthermore, the integrity of the rotator cuff significantly correlated with the function achieved. The results support the need for a careful rotator cuff repair in order to optimise treatment results.

Adult↗

PubMed2003

Supernumerary humeral heads of the biceps brachii muscle revisited.

Supernumerary humeral heads of the biceps brachii muscle were found in 27 (15.4%) of 175 cadavers. They were bilateral in five cadavers and unilateral in 22 (8 left, 14 right), giving a total of 32 examples in 350 arms (9.1%). Depending on their origin and location, the supernumerary heads were classified as superior, infero-medial, and infero-lateral humeral heads. Previous studies were reviewed using this classification. The infero-medial humeral head was observed in 31 of 350 (9%) arms and was therefore the most common variation. The superior humeral head was observed in five (1.5%). The infero-lateral humeral head was the least common variation, observed only in one (0.3%) of 350 arms. A biceps brachii with three heads was observed in 27 of 350 (7.7%) arms and with four heads in five (1.4%) arms.

Aged↗

PubMed1997

[Osteochondral lesions of the humeral head: the usefulness of echographic study].

PURPOSE: In the cranial humeral end, osteochondral injuries localize in a circular crown including part of the humeral head and part of the major and minor tuberosities. Since this region is easy to depict with US, we investigated the potentials of this technique in detecting osteochondral injuries. MATERIALS AND METHODS: Seventy-five osteochondral injuries found at 492 US examinations performed in 12 months with a 7.5 MHz linear probe were retrospectively reviewed. Clinical history taking was focused on the following: a) previous trauma or b) luxation-instability and c) if the patient was a sportsman devoted to activities requiring forced abduction-external rotation or adduction-internal rotation. Since the site of the head's humeral injury is an important clue for diagnosis, we subdivided the humeral circle into four ideal quadrants by two perpendicular lines with the main line passing through the bicipital groove. Then, each injury was ascribed to a quadrant. All patients were also submitted to radiography (at least two films) and to MRI; CT was performed in 12 patients. Ten patients underwent surgery. RESULTS: We found 34 Hill-Sachs lesions, 15 traumas, 9 arthrotic lesions, 7 cases of anterointernal and 4 of posterosuperior impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. In our experience, US was an accurate tool in the identification of humeral head conditions, which were confirmed at CT and/or MRI in all patients (no false positives). As for the injury nature, US diagnosis was confirmed in all Hill-Sachs lesions (34/34 cases), traumas (15/15 cases) and 50% of the cases of posterosuperior impingement (2/4 cases). These conditions made up about 2/3 of the whole cases (51/75 cases). US failed to establish the injury nature in the 9 arthrotic lesions, 7 cases of anterointernal impingement, 4 cases of infraspinatus enthesopathy and 2 erosions due to perihumeral calcifications. CONCLUSIONS: US can be suggested as the method of choice in the study of the osteochondral lining of the humeral head.

Calcinosis↗

PubMed2006

Biomechanical characterization and in vitro mechanical injury of elderly human femoral head cartilage: comparison to adult bovine humeral head cartilage.

OBJECTIVES: In vitro mechanical injury of articular cartilage is useful to identify events associated with development of post-traumatic osteoarthritis (OA). To date, many in vitro injury models have used animal cartilage despite the greater clinical relevance of human cartilage. We aimed to characterize a new in vitro injury model using elderly human femoral head cartilage and compare its behavior to that of an existing model with adult bovine humeral head cartilage. DESIGN: Mechanical properties of human and bovine cartilage disks were characterized by elastic modulus and hydraulic permeability in radially confined axial compression, and by Young's modulus, Poisson's ratio, and direction-dependent radial strain in unconfined compression. Biochemical composition was assessed in terms of tissue water, solid, and glycosaminoglycan (GAG) contents. Responses to mechanical injury were assessed by observation of macroscopic superficial tissue cracks and histological measurements of cell viability following single injurious ramp loads at 7 or 70%/s strain rate to 3 or 14 MPa peak stress. RESULTS: Confined compression moduli and Young's moduli were greater in elderly human femoral cartilage vs adult bovine humeral cartilage whereas hydraulic permeability was less. Radial deformations of axially compressed explant disks were more anisotropic (direction-dependent) for the human cartilage. In both cartilage sources, tissue cracking and associated cell death during injurious loading was common for 14 MPa peak stress at both strain rates. CONCLUSION: Despite differences in mechanical properties, acute damage induced by injurious loading was similar in both elderly human femoral cartilage and adult bovine humeral cartilage, supporting the clinical relevance of animal-based cartilage injury models. However, inherent structural differences such as cell density may influence subsequent cell-mediated responses to injurious loading and affect the development of OA.

Aged↗

PubMedDate not supplied

Variations in the retroversion of the humeral head.

It is generally accepted that the humeral head in adults is retroverted between 25 degrees and 35 degrees. To assess the validity of this belief, 336 dry bone specimens of humeral heads were measured. The specimens were taken from various ethnic groups: white Americans, black Americans, New Mexican Indians, northern Chinese, Alaskan Eskimos, and Negev Desert bedouins. There was significant variation in retroversion angle between specimens from different ethnic groups and even wider variation between specimens within particular groups--a finding contrary to popular belief. Retroversion angle in the specimens ranged from -8 degrees to +74 degrees. In addition, 50 fetal skeletons of white and black Americans were studied. The mean humeral head retroversion angle in the fetal skeletons was 78 degrees, much greater than that in adults. It was evident that the large retroversion angle in the very young decreases with growth and that it does so to a varying extent among different ethnic groups and individuals. It is of clinical importance to understand the variations in humeral head retroversion among individuals undergoing operation and the ways in which this parameter might be manipulated to surgical advantage.

Adult↗

PubMed2004

Position of the humeral head and rotator cuff tear: an anatomical observation in cadavers.

BACKGROUND: The relationship between the humeral head position and rotator cuff tears is not well described. MATERIAL AND METHODS: We performed an anatomical study of 22 cadaveric shoulders to find out the relationship between the normal anatomical position of the humeral head and tears of the rotator cuff. After dissection, the rotator cuff pathology was documented. The position of the humeral head was noted in relation to the acromion. The humeral head with intact acromion and articulated shoulder joint was photographed from the superior aspect of the joint and the area of the humeral head outside the acromion was measured, i.e. the part of the humeral head lateral to the lateral border of the acromion process. The relationship between rotator cuff pathology and uncovering of the humeral head was determined. RESULTS: 9 specimens had a partial cuff tear, while 4 had a complete tear. Those specimens with a rotator cuff tear had a mean area of 83% of the humeral head under the acromion. The specimens that did not show a rotator cuff tear had a mean area of 61% of the humeral head under the acromion. INTERPRETATION: We suggest that there is individual variation in anatomical position of the humeral head in relation to the acromion and that this position correlates with the occurrence of rotator cuff pathology.

Cadaver↗

PubMed2006

Humeral head replacement for the treatment of osteoarthritis.

BACKGROUND: Humeral head replacement has been used successfully for the treatment of osteoarthritis of the shoulder for decades. The purpose of this study was to define the results of this form of treatment, the risk factors for an unsatisfactory outcome, and the rates of failure over time. METHODS: Between 1978 and 1997, sixty humeral head replacements were performed at our institution for the treatment of osteoarthritis. Five patients (seven shoulders) died less than five years postoperatively, and one patient (two shoulders) was lost to follow-up. Fifty-one humeral head replacements in forty-nine patients with a complete postoperative evaluation and operative records who had been followed for a minimum of five years (mean, 11.3 years) or until revision were included in the study. All sixty shoulders were included in the survival analysis. RESULTS: Overall, there was significant long-term pain relief (p<0.0001) as well as improvement in active abduction (p<0.0001), internal rotation (p<0.024), and external rotation (p<0.0001) following the humeral head replacement. However, moderate pain was reported in nine shoulders and severe pain, in seven. Ten of the fifty-one shoulders underwent revision surgery, which was done to treat painful glenoid arthrosis in nine of the ten. Radiographs were available for thirty-nine shoulders, and they demonstrated an increase in glenoid erosion at a mean of 10.7 years postoperatively (p<0.0001). Five shoulders had humeral periprosthetic lucent lines of 1.5 mm in thickness, and three of them had a complete line; one humeral component had shifted in position. According to a modification of the Neer result rating system, there were ten excellent results, twenty satisfactory results, and twenty-one unsatisfactory results. CONCLUSIONS: Substantial clinical improvement can occur after humeral head replacement for osteoarthritis of the shoulder, but there is a high rate of unsatisfactory results and revision surgery. The decision as to whether this is the optimal surgical procedure for the treatment of osteoarthritis of the shoulder requires careful consideration.

Adult↗

PubMedDate not supplied

Quantification of anterior translation of the humeral head in the throwing shoulder. Manual assessment versus stress radiography.

Clinical evaluation of humeral head translation relies mainly on manual tests to measure laxity in the human shoulder. The purposes of this study were to determine whether side-to-side differences exist in anterior humeral head translation in professional baseball pitchers, to compare manual laxity testing with stress radiography for quantifying humeral head translation, and to test intrarater reliability of the manual humeral head translation and stress radiography tests. Twenty professional baseball pitchers underwent bilateral manual anterior humeral head translation and stress radiographic tests. Stress radiography was performed by imparting a 15-daN anterior load to the shoulder in 90 degrees of abduction with both neutral and 60 degrees of external rotation and recording the glenohumeral joint translation at rest and under stress in each position. Eight subjects were retested to assess the reliability of these methods. Results showed no significant difference between the dominant and nondominant extremity in the amount of anterior humeral head translation measured manually and with stress radiography, nor significant correlation between anterior humeral head translation measured manually and by stress radiography. Test-retest reliability was moderate-to-poor for the manual humeral head translation test and moderate for stress radiography.

Adolescent↗

PubMed2001

[Conservative or operative treatment of humeral head fractures in the elderly?].

The humeral head fracture in the elderly represents an unresolved problem, which is reflected by the variety of existing therapeutic strategies ranging from conservative treatment to humeral head replacement. The main factors influencing the prognostic outcome are the fracture type, age of the patient and biologic criteria such as osteoporosis, blood supply at the fragments, and the degree of soft tissue trauma. For selection of the optimal treatment, the general condition of the patient, additional injuries and chronic diseases have to be respected as much as the patient's compliance and personal demands. According to experimental and clinical findings, for displaced two- and three-part fractures of the elderly patient minimal osteosynthesis and in the future plate osteosynthesis with angular stability should be preferred. For these fracture types, conservative treatment must be included in the therapeutic spectrum. In contrast, displaced four-part fractures and fracture dislocations are indications for primary humeral head replacement. This is explained by the fact that neither conservative treatment nor surgical reconstruction procedures meet the main goal of primary therapy, aiming for early painless mobilization and for timely discharging the elderly patients in their social environment.

Aged↗

PubMedDate not supplied

Inferior subluxation of the humeral head after trauma or surgery.

Inferior subluxation of the humeral head can occur after shoulder trauma or surgery. One hundred consecutive patients were evaluated prospectively after shoulder surgery or injury. The radiographic incidence of inferior subluxation of the humeral head 2 weeks after rotator cuff repair was 10%. The radiographic incidence of inferior subluxation after fracture of the proximal humerus was 42%, and the incidence 2 weeks after prosthetic humeral head replacement was 60%. The immediate postoperative radiograph showed an inferior subluxation of the humeral head in 4% of patients after prosthesis insertion, but no subluxations were seen immediately after rotator cuff repair. Radiographs made immediately after fracture of the humerus showed a 16% incidence of inferior subluxation. The inferior subluxation resolved by 6 weeks in 92% of patients with humeral fractures, 96% of patients with humeral head prostheses, and all patients who had undergone rotator cuff repair. No subluxations were seen 2 years after injury or surgery. The treatment used--early active exercises and a sling when not exercising--was effective.

Adult↗

PubMedDate not supplied

MR patterns of involvement of humeral head osteonecrosis.

PURPOSE: To characterize osteonecrosis of the humeral head on coronal and axial MR images. METHODS: We retrospectively reviewed MR examinations in patients with humeral head osteonecrosis. The angle of the entire affected articular surface at three levels was measured and an angle subtended by the margins of osteonecrosis was also measured. RESULTS: The appearance of osteonecrosis is identical to that in the femoral head with signal abnormality (13/13), double-line sign (7/13), and subchondral fractures (3/13). The superior aspect of the humeral head was the most common location of osteonecrosis. The MR staging resulted as follows: stage II (6/13), stage IIIA (1/13), stage IIIB (1/13), and stage IV (5/13). The maximum percentage of involvement of the articular surface demonstrated the following distribution: 0% to 25%, 0/11; 25% to 50%, 1/13; 50% to 75%, 5/13; and 75% to 100%, 7/13. CONCLUSIONS: Quantitative analysis of the percentage of involvement of the humeral head was performed and indicates that in most cases, 75% to 100% of the articular surface at the levels measured was involved.

Adult↗

PubMedDate not supplied

Computed tomography measurement of humeral head retroversion: influence of patient positioning.

For accurate humeral head arthroplasty, the surgeon needs to know some geometric data, such as, for example, the retroversion angle of the humeral head. Only a few reports have described and evaluated the use of computed tomography (CT) to measure humeral head retroversion. The humerus position relative to the roentgen beam is variable from one subject to another depending on the patients' morphology. It could influence the retroversion measurement and has not been investigated previously. This study analyzes in 9 cadaver humeri the variability of retroversion angle measurements with different humerus positioning relative to the roentgen beam during CT examination. The truest retroversion angle can be obtained when true axial slices, perpendicular to the humeral diaphysis, are obtained. Our study tries to clarify technical problems that occur during CT examination. Geometric considerations that can modify the measurements are presented. A reliable method of humeral head retroversion angle measurement is recommended, which could be useful to the shoulder surgeon.

Arthroplasty, Replacement↗

PubMed1998

Computed tomography in primary glenohumeral osteoarthritis without humeral head elevation.

Few studies have evaluated computed tomography in glenohumeral osteoarthritis without humeral head elevation. Two recent studies included only ten and 11 patients, respectively. We evaluated computed tomography findings in 113 cases of primary glenohumeral osteoarthritis without humeral head elevation. Glenoid retroversion was substantially increased, with a mean of 16 degrees versus 8 degrees in a control group. The method used to measure this parameter was reproducible, with a mean interobserver variability of 4 degrees for a 95% confidence interval (P < or = 0.05). Humeral retrotorsion was apparently decreased (8 degrees), but osteoarthritis-related changes in the humeral head resulted in substantial measurement errors (interobserver variability, 11 degrees for a 95% confidence interval; P < or = 0.05). Humeral head subluxation was found in 35% of cases and measurement of this parameter was reproducible (interobserver variability, 4 degrees for a 95% confidence interval). Changes in the glenoid over time were dependent on the position of the humeral head in the glenoid fossa, which classified the shape of the glenoid with satisfactory reproducibility (intra- and interobserver Kappa, 0.68). The subscapularis and infraspinatus muscles were normal (stage 0 or 1) in 98% and 91% of cases, respectively and the method of Goutallier and Bernageau used for muscle evaluation proved highly reproducible (Kappa, 0.85). Computed tomography is invaluable for planning surgical treatment for primary glenohumeral osteoarthritis without humeral head elevation.

Adipose Tissue↗

PubMed1992

Osteochondritis dissecans of the humeral head.

A rare case of osteochondritis dissecans (OCD) occurring in the humeral head is presented. As there are only six available records in the literature concerning OCD in the humeral head, clinical features, treatment, and etiology of OCD involvement of this anatomical part remains unclear. These points are discussed on the basis of the previous cases and ours. Osteochondritis dissecans of the humeral head commonly affects middle-aged and young males rather than females. The prevalent location of involvement is the anterosuperior aspect of the humeral head. We propose that repetitive microtrauma is one of the important causes of OCD in the humeral head. Moreover, we suggest that the most authentic treatment for OCD with a partial detached osteochondral fragment is removal of this fragment and drilling.

Arthroscopy↗

PubMedDate not supplied

Superior excursion of the humeral head: a diagnostic tool in rotator cuff tear surgery.

Superior excursion of the humeral head on the face of the glenoid was investigated to determine whether a relationship exists between the degree of humeral head excursion and the identity of the injured tendon in a shoulder with a torn rotator cuff. Twenty-seven patients with unilateral full-thickness rotator cuff tears diagnosed by either positive arthrogram or magnetic resonance imaging were included in this study. Three groups were formed based on intraoperative findings: 10 patients had isolated supraspinatus tendon tears (group 1), 11 patients had supraspinatus and infraspinatus tears (group 2), and 6 patients had supraspinatus, infraspinatus, and subscapularis tendon tears (group 3). There was no statistically significant difference between the degree of humeral head excursion in groups 1 and 2. However, patients in group 3 had a statistically significantly higher degree of excursion of the humeral head (P < .05) when compared with groups 1 and 2. In addition, an inverse relationship between the degree of humeral head excursion and preoperative Constant scores was found. Superior excursion of the humeral head on the glenoid had a significantly higher incidence in patients with subscapularis tears, and a larger amount of excursion was present in patients who had lower preoperative Constant scores.

Adult↗

PubMed2005

Three-dimensional morphological analysis of humeral heads: a study in cadavers.

BACKGROUND: Anatomy of the humeral head may be of importance for the kinematics of the shoulder joint. We therefore evaluated the three-dimensional morphology of humeral heads. MATERIAL AND METHODS: We performed three-dimensional morphological analysis of the articular surfaces of 14 humeral heads in the proximal humeri of 7 cadavers. The articular surface was divided into 9 portions, which were in turn equally divided into 3 sections by an angle in supero-inferior and antero-posterior directions. Each portion of the articular surface was fitted to a sphere, and we calculated the radius of the curvature of each portion. RESULTS: The mean radius of the superior portion was significantly greater than that of the central portion, and the mean radii of the anterior and posterior portions were significantly less than that of the central portion. INTERPRETATION: Our findings lead us to believe that the morphology of the humeral head is of importance for the kinematics of the shoulder joint.

Biomechanical Phenomena↗

PubMed2004

Benefits of an anatomical reconstruction of the humeral head during shoulder arthroplasty: a finite element analysis.

OBJECTIVE: To study the influence of the shape of the prosthetic humeral head on shoulder biomechanics and then to evaluate the benefits of an anatomical reconstruction of the humeral head after shoulder arthroplasty. DESIGN: A 3D numerical model of a healthy shoulder was reconstructed. The model included the proximal humerus, the scapula and, for stability purposes, the subscapularis, infraspinatus and supraspinatus rotator cuff muscles. BACKGROUND: Shoulder prostheses used nowadays, called third generation, allow for a better adaptation of the implant to the anatomy of the proximal humerus than previously used implants. However, no biomechanical study has shown the benefits of this anatomical reconstruction of the humeral head. METHODS: The model was used to compare the biomechanics of a shoulder without implant with the biomechanics of the same shoulder after humeral hemiarthroplasty. Two humeral components were tested: a second-generation prosthesis and an implant with an anatomically reconstructed humeral head. RESULTS: The anatomical reconstruction of the humeral head restored the physiological motions and limited eccentric loading of the glenoid. Conversely, the second-generation implant produced contact forces in the superior extremity of the glenoid surface leading to bone stresses up to 8 times higher than for the intact shoulder. CONCLUSIONS: This analysis provided insights into the mechanical effects of different reconstructions of the humeral head and highlighted the advantages of anatomical reconstructions of the humeral head during shoulder arthroplasty.

Arthroplasty, Replacement↗

PubMed2004

[Reconstruction of humeral head retroversion in the treatment of anterior shoulder instability].

Reduction of the physiologic retroversion of the humeral head can lead to shoulder luxation. After shoulder luxation it can also lead to shoulder instability. The aim of the paper was to check the level of humeral head retroversion in patients with anterior shoulder instability and to estimate the effectiveness of treatment of this instability with the derotational Weber osteotomy. The study included 38 patients, 34 males and 4 females, ranged 16-48 yr. (mean 31) treated in our Clinic. Every patient was done CT in order to estimate the level of humeral head retroversion. Patients with reduced humeral head retroversion qualified for operational treatment with Weber method derotational osteotomy. The outcomes were estimated according to the Rowe and Zarins score. 34 patients had excellent or good results. Pain was retreated, patients could come back to their normal activities, before the first luxation. Only 4 patients had another luxation in spite of our treatment. The control CT showed that the humeral head retroversion was 30 or more degrees. The arthroscopy was performed, the Bankart lesion was found and the patients were qualified for treatment this lesion. Weber osteotomy could be the satisfactory method of treatment of anterior shoulder instability in patients with physiologic reduction of humeral head retroversion.

Adolescent↗