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At least 19 recordsLinked to original sources
PubMed2002

Outcomes of scapula stabilization in obstetrical brachial plexus palsy: a novel dynamic procedure for correction of the winged scapula.

Among the late consequences of obstetrical brachial plexus palsy is winging of the scapula, a functional and aesthetic deformity. This article introduces a novel surgical procedure for the dynamic correction of this clinical entity that involves the dynamic transfer of the contralateral trapezius muscle and/or rhomboid muscles and anchoring to the affected scapula. In more severe cases of scapula winging, the contralateral latissimus dorsi muscle may also need to be transferred to achieve dynamic scapula stabilization. The outcomes of this novel surgical procedure were analyzed in relation to the effect on abduction, external rotation, growth of the scapula, and distance of the scapula from the posterior midline. The results were analyzed in 26 patients who underwent this procedure and had adequate follow-up. The mean patient age was 6.39 years. Fourteen (54 percent) had a diagnosis of Erb palsy, and 12 (46 percent) had a diagnosis of global paralysis. All 26 patients had an additional secondary procedure performed prior to or simultaneously with the scapula stabilization procedure. In 19 patients, the contralateral trapezius was transferred and anchored to the medial border of the winged scapula alone, but in seven cases the underlying rhomboid major was transferred along with the trapezius muscle to provide sufficient scapula stabilization. In five cases in which the scapula winging was severe, the contralateral latissimus dorsi muscle was transferred at a second stage. After this procedure, all patients demonstrated improved scapula symmetry. The mean increase in abduction was 18 degrees (p < 0.001), the mean increase in external rotation was 19 degrees (p < 0.001), and the mean increase in anterior flexion was 12 degrees (p = 0.015). The improvement of the relative position of the winged scapula on the posterior thorax was analyzed by measuring the distance of the inferior angle of both scapulae from the midline, then calculating the difference between normal and affected sides and comparing this value before and after the scapula stabilization procedure. This value preoperatively was 3.24 cm; postoperatively it decreased to 0.36 cm (p < 0.001), demonstrating a statistically significant improvement.

Adolescent↗
PubMed2001

Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: a noninvasive evaluation.

OBJECTIVES: To determine whether scapular downward tilt (ScDT) and dynamic scapular lateral rotation (ScLR) in subjects with and without stroke is associated with subluxation, and to prove the reliability of a Scapula Locator System in an elderly population. DESIGN: Repeated measures of ScLR by 2 observers. SETTING: Outpatient rehabilitation department of a district general hospital. PARTICIPANTS: To test device reliability, 5 healthy men (mean age +/- standard deviation, 72 +/- 5 yr). To test scapula position, 30 stroke patients (19 men, 11 women; mean age, 73 +/- 6 yr) and 15 healthy controls (12 men, 3 women; mean age, 62 +/- 6 yr). INTERVENTIONS: The control subjects' ScDT was compared with stroke subjects' ScDT after stratification according to 3 patterns of ScLR symmetry and the presence of palpable glenohumeral subluxation. MAIN OUTCOME MEASURES: For device reliability, 3-way analysis of variance. For scapula position, triangulated location by Scapula Locator System of acromion, inferior angle, and root of the scapular spine; then measurement of scapula motion to determine symmetry, lag, or lead. RESULTS: The inter- and intraobserver reliability of the Scapula Locator System device was high (1% of variance each). Normal ScDT was positive (left side: 10.94 degrees +/- 2.62 degrees; right side: 9.69 degrees +/- 4.36 degrees ), indicating a downward-facing glenoid fossa. This finding was unchanged by stroke (10.46 degrees +/- 2.42 degrees ). All controls and 16 stroke subjects had symmetry between shoulders for ScLR rate and ScDT. Two other patterns (p <.01) of ScLR were found after stroke: 8 subjects had a slower rate of affected arm ScLR (lag) with a correspondingly greater ScDT on the affected side (2.61 degrees +/- 6.7 degrees ); 6 subjects had a faster rate of affected arm ScLR (lead) but with an upward-facing glenoid fossa on the affected side (ScDT: -11.84 degrees +/- 8.48 degrees ). No significant inter- or intrasubject difference in ScDT existed in the 6 cases of glenohumeral subluxation. CONCLUSIONS: The scapula normally tilts downward with or without stroke. The effect of stroke is similar on tonic (ScDT) and phasic (ScLR) control of scapula position. Subluxation is not linked with a particular scapular resting position after stroke.

Aged↗
PubMed2003

Ontogenesis of the scapula in marsupial mammals, with special emphasis on perinatal stages of didelphids and remarks on the origin of the therian scapula.

The development of the scapula was studied in embryonic and postnatal specimens of Monodelphis domestica and perinatal specimens of Philander opossum, Caluromys philander, and Sminthopsis virginiae using histological sections and 3D reconstructions. Additionally, macerated skeletons of postnatal M. domestica were examined. This study focused on the detachment of the scapulocoracoid from the sternum and on the acquisition of a supraspinous fossa, a supraspinatus muscle, and a scapular spine, all these events associated with the origin of the therian shoulder girdle. In none of the specimens is there a continuity of the cartilaginous scapulocoracoid with the sternum, even though the structures are in close proximity, especially in S. virginiae. At birth, the first rib laterally presents a pronounced boss that probably contacts the humerus during certain movements. Only the acromial portion of the scapular spine, which originates from the anterior margin of the scapular blade, is preformed in cartilage. The other portion is formed by appositional bone ("Zuwachsknochen"), which expands from the perichondral ossification of the scapula into an intermuscular aponeurosis between the supra- and infraspinous muscles. This intermuscular aponeurosis inserts more or less in the middle of the lateral surface of the developing scapula. Thus, the floor of the supraspinous fossa is present from the beginning of scapular development, simultaneously with the infraspinous fossa. The homology of the therian spine with the anterior border of the sauropsid and monotreme scapula is questioned. We consider the dorsal portion (as opposed to the ventral or acromial portion) of the scapular spine a neomorphic structure of therian mammals.

Animals↗
PubMed1996

Variations in the anatomy of the scapula with reference to the snapping scapula.

Two clinical cases led to an examination of 700 scapular dry bone specimens in an effort to understand variations in anatomy of possible relevance to the development of a painful snapping scapula. The medial superior border and the inferior pole of the scapula respectively displayed areas of bony variability that appeared to be of clinical consequence in these 2 cases. The 2 areas are common sites of clinical symptomatology in the painful snapping scapula. Variations in the bony anatomy require consideration during the workup and evaluation of this condition.

Adult↗
PubMed1989

Fractures of the scapula: a retrospective study of 40 fractured scapulae.

Forty fractured scapulae in 39 patients treated by nonoperative means were retrospectively reviewed. The nature of injury, associated injuries, site of fracture, and results were evaluated. The data obtained in this series were compared to data from previous studies. Various associated injuries were found in these patients with scapula fractures. Many of these injuries were life threatening although some could have been easily overlooked on initial presentation. Adequate followup was achieved in 67% of the patients. Seventy-three per cent of the patients had good to excellent results using the criteria of subjective complaints, strength, and range of motion. Three of the 39 patients had poor results. These were multiply injured patients or elderly patients in whom early range of motion was not done.

Adolescent↗
PubMedDate not supplied

Arthroscopic partial resection of the scapula for snapping scapula: a new technique.

We describe a new method of arthroscopic bony surgery to the superomedial corner of the scapula in patients with painful snapping caused by bony impingement. Seven patients who had failed conservative treatment were monitored prospectively. In 5 patients we used 3-dimensional computed tomography as a diagnostic aid. The condition was successfully managed in 6 cases. One procedure was abandoned because of intraoperative swelling; there was 1 minor wound infection. In all cases the operation relieved symptoms. Two of the 5 patients scanned had narrowing of the superomedial interval. The advantages of this technique are in cosmesis and early rehabilitation, and the early results are good. Provided due care is taken in portal placement, complications should be minimal. Three-dimensional reconstruction computed tomography scanning may be useful in some patients to show narrowing between the superomedial corner and the chest wall, but we cannot at present recommend its routine use.

Adult↗
PubMed1990

[Trans-trapezial approach to the incisura scapulae in incisura scapulae syndrome. An anatomic study].

Suprascapular entrapment neuropathy represents a chronic lesion of the suprascapular nerve due to compression, traction and/or friction within the area of the suprascapular notch. The surgical treatment consists of excision of the entire suprascapular ligament. The surgical exposure of the suprascapular notch through the trapezius muscle is illustrated using anatomical dissections.

Humans↗
PubMed2003

Multiple trauma and scapula fractures: so what?

UNLABELLED: BACKGROUND Scapula fractures are rare and are presumed to indicate severe underlying trauma. We studied injury patterns and overall outcome in patients with multiple injuries with scapula fractures. METHODS: We carried out a retrospective review of patients with multiple injuries (Injury Severity Score [ISS] > or = 16) with chest and musculoskeletal injuries admitted to our institution between 1993 and 1999 to investigate whether the presence of a scapula fracture is a marker of increased morbidity and mortality. RESULTS: There were 1,164 patients admitted with multiple trauma. Seventy-nine (6.8%) of the 1,164 sustained a scapula fracture, forming the study group. The remainder of the patients (n = 1,085) formed the control group of the study. Both groups of patients were similar with regard to age and Glasgow Coma Scale score (age, 42 +/- 17.8 [+/- SD] vs. 40 +/- 22; GCS score, 11.2 +/- 5.1 vs. 11 +/- 5 in the study and control groups, respectively). The overall ISS was significantly higher in those with scapula fractures (27.12 +/- 15.13 vs. 22.8 +/- 14.4, p = 0.01). Patients with scapula fractures also had more severe chest injuries (Abbreviated Injury Scale score of 3.46 +/- 1.1 vs. 3.1 +/- 1.0, respectively), but not significantly so. However, the incidence of rib fractures was significantly higher in the patients with scapula fractures (p < 0.05). The incidence and severity of head and abdominal injuries were similar in the two groups. The severity of extremity injuries in patients with scapula fractures was significantly lower (2.4 +/- 0.6 vs. 2.7 +/- 0.7, p = 0.001). The rate of admission, the length of intensive care unit stay, and the overall length of hospital stay were similar in the two groups. The overall mortality rate was 11.4% in patients with scapula fractures and 20% in those without scapula fractures (p = 0.1). CONCLUSION: Patients with scapula fractures have more severe underlying chest injuries and overall ISS. However, this did not correlate with a higher rate of intensive therapy unit admission, length of hospital stay, or mortality.

Abbreviated Injury Scale↗
PubMed1999

The use of three-dimensional computed tomography in evaluating snapping scapula syndrome.

This article evaluates imaging of the scapula and scapulothoracic joint in patients with snapping scapula syndrome. Between 1990 and 1996, a total of 20 patients (10 men and 10 women) with snapping scapula syndrome were evaluated. Diagnosis was based on patient complaints and physical examination findings. There were 26 affected scapulae (6 patients had bilateral presentation). Imaging of the scapula included plain radiography, computed tomography (CT), and 3-dimensional computed tomography (3-D CT) reconstruction. Plain radiography revealed bony incongruity between the anterior aspect of the scapula and the chest wall in 7 scapulae, CT revealed such incongruity in 19 scapulae, and 3-D CT revealed incongruity in all 26 scapulae. Treatment was conservative, consisting of nonsteroidal anti-inflammatory drugs, a physiotherapy program, and subscapular injection of a local anesthetic and steroids. In 5 patients who responded poorly to conservative treatment, the region responsible for the snapping was resected. Pain relief and resolution of the snapping were complete following surgery in 4 patients, while pain and crepitation persisted in the fifth. Three-dimensional CT is recommended as the main imaging modality in the evaluation of any patient with snapping scapula syndrome who is a candidate for surgical intervention.

Adult↗
PubMed1981

[Roentgenographical examination on the tilted angle of the scapula in the resting position (author's transl)].

Roentgenographical examination was carried out in 56 normal subjects ranging from 12 to 80 years of age with the purpose of evaluating the degrees of the tilted angle of the scapula in three dimensions at the relaxed standing position. Bilateral roentgenograms of shoulder were taken in the standard antero-posterior position and at the 30 degrees of oblique projections. Five landmarks were selected on each roentgenogram and measured by X and Y coordinates. The degrees of tilted angles of the scapula in three dimension was determined by using the specific equations. Average angle of medial tilt of the scapula was 32.1 degrees (+/0 7.0 degrees) in the right and 31.9 degrees (+/- 8.0 degrees) in the left respectively. Average angle of the medial tilt of the scapula in both sexes was 29.9 degrees (+/- 7.7 degrees) in males and 34.0 degrees (+/- 6.5 degrees) in females. The average angle of medial tilt of the scapula tended to decrease in accordance with the aging process. Average angle of downward tilt of the scapula was 11.5 degrees (+/- 12.5 degrees) in the right and 12.3 degrees (+/- 11.1 degrees) in the left respectively. Average angle of the downward tilt of the scapula in both sexes was 12.9 degrees (+/- 12.7 degrees) in males and 10.8 degrees (+/- 10.7 degrees) in females. The average angle of downward tilt of the scapula statistically increased in accordance with age (r = 0.34). Average angle of upward rotation of the scapula was increased in accordance with the aging process. It was suggested that the restricted rotation of the scapula was one the major causes of the restricted abduction of the shoulder in the aged.

Adolescent↗