1.A study of the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations.
Zheng XU ; Fei DAI ; Jinsong YANG ; Qing ZHANG ; Ming XIANG
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(9):1094-1097
OBJECTIVE:
To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations.
METHODS:
Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index.
RESULTS:
Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R 2=0.084.
CONCLUSION
Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.
Female
;
Male
;
Humans
;
Adult
;
Shoulder Joint/diagnostic imaging*
;
Shoulder Dislocation/diagnostic imaging*
;
Joint Dislocations
;
Scapula/diagnostic imaging*
;
Thorax
2.Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation for management of acute acromioclavicular joint dislocation and MRI follow-up study.
Wei YIN ; Hongxing LI ; Ding ZHOU ; Xianzhe HUANG ; Weihong ZHU
Journal of Central South University(Medical Sciences) 2020;45(4):400-405
OBJECTIVES:
To explore the safety and effectiveness of arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation.
METHODS:
From January 2016 to December 2017, 18 cases of acute acromioclavicular joint dislocation were carried out with arthroscopic reconstruction of coracoclavicular ligament by double Endobutton plate suspensory fixation. Anteroposterior view X-ray plain radiographs were obtained on the second day, 6 months and 12 months after the surgery, MRI was performed in 1 year after operation. Meanwhile, subjective and objective scoring were obtained by Vsual Analogue Scale (VAS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles Shoulder Rating Scale (UCLA).
RESULTS:
All patients were followed up for 12 to 30 months (an average of 18 months). There was no patient with infection, neurovascular injury, loosening and breakage of internal fixation, re-dislocation of acromioclavicular joint, clavicular fracture, coracoid process fracture, etc. Postoperative X-ray showed that all acromioclavicular joints were completely relocated. The follow-up of MRI after 1 year showed no obvious dislocation of acromioclavicular joint and good recovery of acromioclavicular space. Postoperative shoulder joint function, VAS, ASES, UCLA and acromioclavicular distance were significantly improved compared with those before surgery, with statistically significant differences (all <0.05).
CONCLUSIONS
Arthroscopic reconstruction of coracoclavicular ligament by suspensory fixation to manage the acute acromioclavicular joint dislocation has the advantages of minimal invasive, rapid functional recovery and less complications and satisfactory early clinical results.
Acromioclavicular Joint
;
diagnostic imaging
;
surgery
;
Follow-Up Studies
;
Humans
;
Joint Dislocations
;
diagnostic imaging
;
surgery
;
Magnetic Resonance Imaging
;
Shoulder Dislocation
;
diagnostic imaging
;
surgery
;
Treatment Outcome
3.Study on the evaluation of glenoid bone defects by MRI three-dimensional reconstruction.
Fei ZHANG ; Lin XU ; Baoxiang ZHANG ; Shoulong SONG ; Xianhao SHENG ; Wentao XIONG ; Ziran WANG ; Weixiong LIAO ; Qiang ZHANG
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(5):551-555
OBJECTIVE:
To investigate the feasibility of MRI three-dimensional (3D) reconstruction model in quantifying glenoid bone defect by comparing with CT 3D reconstruction model measurement.
METHODS:
Forty patients with shoulder anterior dislocation who met the selection criteria between December 2021 and December 2022 were admitted as study participants. There were 34 males and 6 females with an average age of 24.8 years (range, 19-32 years). The injury caused by sports injury in 29 cases and collision injury in 6 cases, and 5 cases had no obvious inducement. The time from injury to admission ranged from 4 to 72 months (mean, 28.5 months). CT and MRI were performed on the patients' shoulder joints, and a semi-automatic segmentation of the images was done with 3D slicer software to construct a glenoid model. The length of the glenoid bone defect was measured on the models by 2 physicians. The intra-group correlation coefficient ( ICC) was used to evaluate the consistency between the 2 physicians, and Bland-Altman plots were constructed to evaluate the consistency between the 2 methods.
RESULTS:
The length of the glenoid bone defects measured on MRI 3D reconstruction model was (3.83±1.36) mm/4.00 (0.58, 6.13) mm for physician 1 and (3.91±1.20) mm/3.86 (1.39, 5.96) mm for physician 2. The length of the glenoid bone defects measured on CT 3D reconstruction model was (3.81±1.38) mm/3.80 (0.60, 6.02) mm for physician 1 and (3.99±1.19) mm/4.00 (1.68, 6.38) mm for physician 2. ICC and Bland-Altman plot analysis showed good consistency. The ICC between the 2 physicians based on MRI and CT 3D reconstruction model measurements were 0.73 [95% CI (0.54, 0.85)] and 0.80 [95% CI (0.65, 0.89)], respectively. The 95% CI of the difference between the two measurements of physicians 1 and 2 were (-0.46, 0.49) and (-0.68, 0.53), respectively.
CONCLUSION
The measurement of glenoid bone defect based on MRI 3D reconstruction model is consistent with that based on CT 3D reconstruction model. MRI can be used instead of CT to measure glenoid bone defects in clinic, and the soft tissue of shoulder joint can be observed comprehensively while reducing radiation.
Male
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Female
;
Humans
;
Young Adult
;
Adult
;
Imaging, Three-Dimensional/methods*
;
Tomography, X-Ray Computed/methods*
;
Joint Instability
;
Shoulder Joint/diagnostic imaging*
;
Shoulder Dislocation
;
Magnetic Resonance Imaging/methods*
5.Clinical symptoms and imaging findings of cervical instability in young adult.
Guang-Qi LU ; Ming-Hui ZHUANG ; Xiao-Juan CHANG ; Li-Guo ZHU ; Jie YU
China Journal of Orthopaedics and Traumatology 2022;35(12):1148-1153
OBJECTIVE:
To explore clinical symptoms and X-ray imaging features of cervical instability in young adult represented by postgraduates with a master's degree in medicine.
METHODS:
Totally 91 postgraduates with a master's degree in medicine were investigated from September to December 2021, including 45 males and 46 females;aged from 22 to 30 years old with an average of (25.30±2.18) years old. The cervical spondylosis-related discomfort symptoms of the subjects were collected and examined by the examiner for neck and shoulder tenderness point examination and cervical vertebra positive and lateral and functional X-ray radiography. According to the results of X-ray examination, the subjects were divided into stable cervical group and unstable cervical group.
RESULTS:
Among 91 subjects, there were 50 patients with cervical instability, accounting for 54.90% of total number of subjects. The cervical curvature was abnormal in 78 patients, accounting for 85.70% of total number of subjects. Among 50 patients with cervical instability, 50 patients were diagnosed as cervical instability on the basis of angular displaxement(AD)≥ 11 °, including 13 cases of C3,4 instability, 30 cases of C4,5 instability and 7 cases of C5,6 instability;and 5 cases were diagnosed as cervical instability based on horizontal displacement(HD)≥ 3.5 mm, including 1 case of C3,4 instability and 4 cases of C4,5 instability. Compared with stable cervical group, the number of discomfort symptoms of neck pain, headache and shoulder pain in instability group was significantly higher than that of in stable cervical group(P<0.05);and the number of tenderness in spinous process space of C4,5 and C5,6, 2 cm adjacent to the spinous process of C2-C5 and the superior angle of the scapula (the stop point of levator scapulae) in the instability group was significantly higher than that in the stable cervical group (P<0.05);and the cervical curvature in the instability group was significantly lower than that in stable cervical group(P<0.05).
CONCLUSION
The incidence of cervical instability in young adult represented by postgraduates with a master's degree in medicine is high, they are mainly diagnosed as cervical instability on the basis of vertebral angular displacement ≥ 11°, and the instability segments are concentrated on C3,4, C4,5 and C5,6 segments, the occurrence of cervical instability is often accompanied by abnormalities of cervical curvature. Most of clinical manifestations are head, neck and shoulder pain, especially neck pain in unstable segment.
Male
;
Female
;
Humans
;
Young Adult
;
Adult
;
Neck Pain/etiology*
;
Shoulder Pain
;
Spinal Diseases
;
Radiography
;
Spondylosis/diagnostic imaging*
;
Joint Instability/diagnostic imaging*
;
Cervical Vertebrae/diagnostic imaging*
6.MR image-guided anterior direct arthrography of the shoulder.
Yu-Lin WANG ; Xing-Gao GUO ; Liu-Quan CHENG ; Min WEI ; Xian XU ; Lin MA
China Journal of Orthopaedics and Traumatology 2009;22(9):665-667
OBJECTIVETo investigate the method of MR guided anterior direct arthrogaphy of shoulder and its clinical applications.
METHODSFrom 2008.4 to 2008.10, 40 patients with rotator-cuff tear (29 males and 11 females, ranging in age from 22 to 70 years, with an average of 35 years) underwent MR guided anterior direct arthrogaphy of shoulder, so as to diagnosis shoulder wound. The results were compared to that of arthroscopy.
RESULTSShoulder arthrography showed lesons in 36 patients, and failure in 2 patients, including contrast media extravasation in 1 patient, and gas entry to joint cavity in 1 patient. Two patients showed no rotator cuff injuries. Twenty-eight patients were confirmed by arthroscopy as rotator-cuff injured in different degree. Twenty-six patients were confirmed injuries by both arthroscopy and MR guided anterior direct arthrogaphy.
CONCLUSIONMR guided anterior direct arthrogaphy of shoulder as a minimally invasive method in displaying the rotator-cuff tear has higher accuracy and wide clinical application prospect.
Adult ; Aged ; Arthrography ; methods ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Shoulder Joint ; diagnostic imaging ; Young Adult
7.Bilateral Scapulohumeral Ankylosis after Prolonged Mechanical Ventilation.
Manon L VAN LOTTEN ; J Rieneke SCHREINEMAKERS ; Arthur VAN NOORT ; Maarten V RADEMAKERS
Clinics in Orthopedic Surgery 2016;8(3):339-344
This case demonstrates a rarely reported bilateral scapulohumeral bony ankylosis. A young woman developed extensive heterotopic ossifications (HOs) in both shoulder joints after being mechanically ventilated for several months at the intensive care unit in a comatose status. She presented with a severe movement restriction of both shoulder joints. Surgical resection of the bony bridges was performed in 2 separate sessions with a significant improvement of shoulder function afterwards. No postoperative complications, pain, or recurrence of HOs were noted at 1-year follow-up. Mechanical ventilation, immobilization, neuromuscular blockage, and prolonged sedation are known risk factors for the development of HOs in the shoulder joints. Relatively early surgical resection of the HOs can be performed safely in contrary to earlier belief. Afterwards, nonsteroidal anti-inflammatory drugs and/or radiation therapy can be possible treatment modalities to prevent recurrence of HOs.
Adult
;
*Ankylosis/diagnosis/diagnostic imaging/etiology/physiopathology
;
Female
;
Humans
;
Magnetic Resonance Imaging
;
Range of Motion, Articular
;
Respiration, Artificial/*adverse effects
;
*Shoulder Joint/diagnostic imaging/physiopathology
;
Tomography, X-Ray Computed
8.Clinics in diagnostic imaging (167). Total shoulder arthroplasty glenoid component loosening with secondary rotator cuff failure.
Tien Jin TAN ; Ahmad Mohammad ALJEFRI ; Marc Bruce ELLIOTT ; Savvas NICOLAOU
Singapore medical journal 2016;57(4):172-quiz 177
A 59-year-old woman who had previously undergone an anatomic left total shoulder arthroplasty presented with increasing left shoulder pain and significant reduction in motion of the left shoulder joint. No evidence of prosthetic loosening or periprosthetic fracture was detected on the radiographs or fluoroscopic arthrogram images. Dual-energy computed tomography (DECT) images revealed evidence of loosening of the glenoid component and secondary rotator cuff failure. This case illustrates how a combination of detailed clinical history, careful physical examination and DECT arthrogram evaluation may be used to identify complications of an anatomic total shoulder arthroplasty.
Arthroplasty, Replacement, Shoulder
;
adverse effects
;
Diagnostic Imaging
;
Female
;
Humans
;
Middle Aged
;
Osteoarthritis
;
diagnosis
;
surgery
;
Prosthesis Design
;
Prosthesis Failure
;
Range of Motion, Articular
;
Reoperation
;
Rotator Cuff
;
diagnostic imaging
;
Shoulder Joint
;
diagnostic imaging
;
physiopathology
;
surgery
9.Adhesive Capsulitis of the Shoulder: MR Arthrography.
Hyun Jeong KIM ; Tae Il HAN ; Kwang Won LEE ; Soon Tae KWON ; Youn Seon CHOI ; Dae Hong KIM ; Hyun Young HAN ; Mun Kab SONG
Journal of the Korean Radiological Society 2001;45(1):55-59
PURPOSE: Adhesive capsulitis is a clinical syndrome involving pain and decreased joint motion caused by thickening and contraction of the joint capsule. The purpose of this study is to describe the MR arthrographic findings of this syndrome. MATERIALS AND METHODS: Twenty-nine sets of MR arthrographic images were included in the study. Fourteen patients had adhesive capsulitis diagnosed by physical examination and arthrography, and their MR arthrographic findings were compared with those of 15 subjects in the control group. The images were retrospectively reviewed with specific attention to the thickness of the joint capsule, volume of the axillary pouch (length, width, height(depth)), thickness of the coracohumeral ligament, presence of extra-articular contrast extravasation, and contrast filling of the subcoracoid bursa. RESULTS: Mean capsular thickness measured at the inferior portion of the axillary pouch was 4.1 mm in patients with adhesive capsulitis and 1.5 mm in the control group. The mean width of the axillary pouch was 2.5 mm in patients and 9.5 mm in controls. In patients, the capsule was significantly thicker and the axillary pouch significantly narrower than in controls (p<0.05). Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch (sensitivity 93%, specificity 80%) and a pouch narrower than 3.5 mm (sensitivity 93%, specificity 100%) were useful criteria for the diagnosis of adhesive capsulitis. In patients with this condition, extra-articular contrast extravasation was noted in six patients (43%) and contrast filling of the subcoracoid bursa in three (21%). CONCLUSION: The MR arthrographic findings of adhesive capsulitis are capsular thickening, a low-volume axillary pouch, extra-articular contrast extravasation, and contrast filling of the subcoracoid bursa. Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch and a pouch width of less than 3.5 mm are useful diagnostic imaging characteristics.
Adhesives*
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Arthrography*
;
Bursitis*
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Diagnosis
;
Diagnostic Imaging
;
Humans
;
Joint Capsule
;
Joints
;
Ligaments
;
Physical Examination
;
Retrospective Studies
;
Sensitivity and Specificity
;
Shoulder*
10.Bilateral ultrasound-guided supraclavicular brachial plexus block in shoulder joint release surgery for shoulder periarthritis.
Gaoming SHE ; Cai NIE ; Yuyong LIU ; Xuemei PENG ; Qingde ZHANG ; Yalan LI
Journal of Southern Medical University 2015;35(8):1193-1196
OBJECTIVETo observe the anesthetic efficacy and safety of bilateral ultrasound-guided supraclavicular brachial plexus block in patients undergoing arthrolysis for shoulder periarthritis.
METHODSTwenty-seven patients (ASA class I-II) undergoing bilateral shoulder joint release surgery and 24 ml received bilateral ultrasound-guided supraclavicular brachial plexus block anesthesia with 0.4% ropivacaine and 0.8% lidocaine. The visual analogue scale (VAS) scores for shoulder joint pain were recorded before and after anesthesia. The efficacy of axillary nerve, dorsal scapular nerve and suprascapular nerve block was evaluated, and the anesthetic effect and complications was assessed during surgery. Before and after anesthesia, the range of left and right diaphragmatic muscle movement was measured when the patient took a quiet breath and a deep breath.
RESULTSThe patients showed no significant variations in MAP, HR, or SpO₂after anesthesia. The VAS scores of shoulder joint pain during anteflexion, abduction, posterior extension, rotation, posterior extension and medial rotation were significantly lowered after anesthesia (P<0.05), but the left and the right diaphragm movement range showed no significant difference between quiet breath and deep breath (P>0.05). The rates of complete block of the axillary nerve and dorsal scapular nerve was 100%, and that of suprascapular nerve was 92.6%. Partial phrenic nerve block occurred in 1 case with mild local anesthetic toxicity in another.
CONCLUSIONSBilateral ultrasound-guided supraclavicular brachial plexus block in patients has excellent analgesic effect in should joint release surgery with good safely.
Amides ; Anesthetics, Local ; Brachial Plexus Block ; Diaphragm ; Humans ; Lidocaine ; Orthopedic Procedures ; Pain Measurement ; Periarthritis ; diagnostic imaging ; surgery ; Shoulder Joint ; diagnostic imaging ; physiopathology ; Ultrasonography