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Drewitz C, Arnet J, Waldmann S, Denzler F, Paul J, Centner C. Effects of arthroscopic rotator cuff repair on isokinetic muscle function 6 months following surgery: influence of tear type, tear size, and tendon retraction. J Shoulder Elbow Surg 2024; 33:e585-e595. [PMID: 38599455 DOI: 10.1016/j.jse.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Rotator cuff tears are a common musculoskeletal condition which can lead to functional limitations and impairments in quality of life. The purpose of the present study was to investigate the effects of arthroscopic repair surgery on isokinetic muscle function before and 6-months after surgery. Additionally, the mediating effects of tear type, tear size and tendon retraction were examined. METHODS Data from n = 67 patients (56 ± 9 years) with full-thickness rotator cuff tears were analyzed. Before and 6-months after surgery, isokinetic muscle function in external/internal rotation and abduction/adduction movements was assessed. Further, tear size, tear type (Collin classification) and tendon retraction (Patte classification) were analyzed using magnetic resonance imaging. RESULTS After statistical analysis, a significant increase in limb symmetry index of external (P < .001), internal rotation (P < .01), abduction (P < .001), and adduction (P < .001) were observed from preto postsurgery. The results revealed that tear size and tendon tear type significantly mediated the functional outcome, with no significant effect of tendon retraction. CONCLUSION The present findings point toward the notion that the functional outcome following rotator cuff repair was significantly dependent on tear type and tear size but not tendon retraction. Patients with larger sized tears presented pronounced deficits following 6-months indicating that rehabilitation times need to be adjusted accordingly.
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Chong M, Rojas Gomez MF, Peng P. Axillary nerve: what anesthesiologists and pain physicians should know. Reg Anesth Pain Med 2024:rapm-2024-106010. [PMID: 39461886 DOI: 10.1136/rapm-2024-106010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 10/09/2024] [Indexed: 10/29/2024]
Abstract
Innervation of the shoulder joint is complex and remains poorly understood among regional anesthesiologists and chronic pain specialists. Current literature supports the important contribution of the axillary nerve to the total innervation of the shoulder, as well as its blockade for perioperative pain and denervation for chronic shoulder pain. However, a description of the entire course of the axillary nerve, the corresponding optimal targets, and the sonoanatomy pertinent to pain intervention is lacking. This educational article discusses in detail the functional anatomy and sonographic identification of possible windows for axillary nerve intervention. We discuss the contribution, extent, and type of innervation the axillary nerve provides to the shoulder joint, which is often misunderstood. Ultimately, this article serves to stimulate thoughts and ideas for future research in an area where literature is scarce.
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Affiliation(s)
- Michelle Chong
- Department of Anesthesia and Pain Management, oronto Western Hospital, Univeristy Health Network, Toronto, Ontario, Canada
| | | | - Philip Peng
- Department of Anesthesia and Pain Management, oronto Western Hospital, Univeristy Health Network, Toronto, Ontario, Canada
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Machida T, Hirooka T, Watanabe A, Katayama H, Matsukubo Y. Blood flow velocity in the anterior humeral circumflex artery and tear size can predict synovitis severity in patients with rotator cuff tears. Clin Shoulder Elb 2024; 27:11-17. [PMID: 38268319 PMCID: PMC10938008 DOI: 10.5397/cise.2023.00752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Rotator cuff tears are often associated with synovitis, but the ability of noninvasive ultrasonography to predict the severity of synovitis remains unclear. We investigated whether ultrasound parameters, namely peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, reflect synovitis severity. METHODS A total of 54 patients undergoing arthroscopic rotator cuff repair were selected. Doppler ultrasound was used to measure peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, and these values were compared with the intraoperative synovitis score in univariate and multivariate analyses. RESULTS Univariate analyses revealed that tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the glenohumeral joint were associated with synovitis in the glenohumeral joint (P=0.02, P<0.001, P=0.02, respectively). In the subacromial space, tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the subacromial space were associated with synovitis severity (P=0.02, P<0.001, P=0.02, respectively). Multivariate analyses indicated that tear size and peak systolic velocity in the anterior humeral circumflex artery were independently associated with synovitis scores in both the glenohumeral joint and the subacromial space (all P<0.05). CONCLUSIONS These findings demonstrate that tear size and peak systolic velocity in the anterior humeral circumflex artery, which can both be measured noninvasively, are useful indicators of synovitis severity. Level of evidence: IV.
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Affiliation(s)
- Takahiro Machida
- Department of Rehabilitation, Machida Orthopedics, Kochi, Japan
- Department of Orthopedic Surgery, Machida Orthopedics, Kochi, Japan
| | - Takahiko Hirooka
- Department of Orthopedic Surgery, Onomichi Municipal Hospital, Hiroshima, Japan
| | | | - Hinako Katayama
- Department of Rehabilitation, Machida Orthopedics, Kochi, Japan
| | - Yuki Matsukubo
- Department of Rehabilitation, Machida Orthopedics, Kochi, Japan
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Siriwanarangsun P, Pakdee W, Pisanuwongse A, Keyurapan E, Lektrakul N. Subscapularis tendon tear detection using axial internal rotation MRI: semiquantitative and quantitative analysis. Quant Imaging Med Surg 2023; 13:8274-8289. [PMID: 38106250 PMCID: PMC10721994 DOI: 10.21037/qims-23-273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Background Magnetic resonance image (MRI) of the subscapularis tendon plays an important role in preoperative planning. This retrospective study aimed to evaluate the diagnostic value and quantitative measurement of an additional internal rotation sequence in the detection of partial subscapularis tendon tears. Methods The study included 76 patients who underwent arthroscopy and magnetic resonance (MR) shoulder between January 2018 to December 2019. Three different sets of images were evaluated in each case to determine the diagnostic value in the detection of partial subscapularis tendon tears including Set 1: standard axial fat-suppressed proton density (PD/FS) image and sagittal fat-suppressed T2 weight image (T2W/FS) images, Set 2: standard axial PD/FS and internal rotation PD/FS images, and Set 3: standard axial PD/FS, sagittal T2W/FS and axial internal rotation PD/FS images. Subscapularis tendon tear was diagnosed by arthroscopy and patients with or without tears were grouped. The coracohumoral distance (CHD), coracoglenoid angle (CGA), coracohumeral angle (CHA), CHD difference and CHD ratio were evaluated and compared between groups using univariate and multivariate analysis. The interreader agreement was assessed. The cut-off point for the prediction of subscapularis tears was calculated. Results Twenty-nine shoulders revealed partial subscapularis tendon tears (29/76, 38.2%). Imaging Set 3 provided the highest sensitivity and accuracy {79-83% [confidence interval (CI): 0.60-0.95], 75-76% (CI: 0.63-0.85)}, compared to image Set 2 [31-58% (CI: 0.15-0.76), 67-68% (CI: 0.55-0.79)] and Set 1 [17-21% (CI: 0.06-0.40], 61-66% (CI: 0.54-0.76)], and a moderate level of interobserver agreement (Kappa =0.55). Axial CHD [odd ratio (OR) =1.48, P=0.044], internal rotate CHD (OR =0.68, P=0.02), CHD difference (OR =2.58, P<0.001), and CHD ratio (OR =1.34, P<0.001) were associated with subscapularis tears. A CHD difference and CHD ratio of more than 0.04 mm and 1.01 achieved a 90% sensitivity and 72% specificity, both. Conclusions Internal rotation during MRI can increase diagnostic accuracy for subscapularis tendon partial tears. The CHD differences and CHD ratio are useful parameters to indicate subscapularis tears. This technique may improve preoperative management and reduce the consequences of delayed diagnosis and treatment.
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Affiliation(s)
- Palanan Siriwanarangsun
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Wisitsak Pakdee
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Arin Pisanuwongse
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Ekavit Keyurapan
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Nittaya Lektrakul
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
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Homma H, Aoki M, Okino K, Hayashi T, Yamane M, Sasaki Y. Reproducibility of subscapularis muscle thickness measurement using ultrasound imaging. -Relationship between subscapularis muscle thickness and internal rotation torque of the shoulder joint. J Bodyw Mov Ther 2023; 36:349-356. [PMID: 37949583 DOI: 10.1016/j.jbmt.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/06/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Few studies have reported on the morphometry of the subscapularis muscle using ultrasound imaging (USI); and their reproducibility has not been verified. OBJECTIVES This study aimed to clarify the relative and absolute reproducibility of USI measurements of subscapularis muscle thickness at rest and during isometric contraction as well as the degree of change in muscle thickness caused by the amount of internal rotational torque in the shoulder joint. DESIGN Two-group repeated-measures study. METHODS The subjects were the inferior fibers of the subscapularis muscle of 40 healthy adult males. Muscle thickness was measured at rest and at 10%-30% of the maximum isometric internal rotation torque. Intraclass correlation coefficients (ICC) and Brand Altman analysis were used for reproducibility measurement. The degree of change in muscle thickness at each torque was also calculated. RESULTS Intra- and inter-rater ICCs (ranged from 0.69 to 0.91) were good. A proportional error was observed in intra-rater measurements. Both minimal detectable change 95 (ranged from 2.33 to 6.47) were high. The subscapularis muscle thickness was significantly increased at 10% torque (25.49 ± 3.80 mm), 20% torque (26.07 ± 3.90 mm), and 30% torque (25.96 ± 3.82 mm) as compared to that in resting conditions (24.53 ± 4.46 mm) (p < 0.05). CONCLUSION The reproducibility and error of the subscapularis muscle thickness measurement using USI used in this study were clarified when repeated measurements were made in the same limb position and under the same probe installation conditions, suggesting that the contraction of the subscapularis muscle can be estimated by muscle thickness measurement.
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Affiliation(s)
- Hisashi Homma
- Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, 061-0293, Hokkaido, Japan; Department of Rehabilitation, Sapporo Hachiken Orthopedic Clinic, Hokkaido, Japan.
| | - Mitsuhiro Aoki
- Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, 061-0293, Hokkaido, Japan.
| | - Kumiko Okino
- Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, 061-0293, Hokkaido, Japan.
| | - Tomoya Hayashi
- Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, 061-0293, Hokkaido, Japan.
| | - Masahiro Yamane
- Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, 061-0293, Hokkaido, Japan.
| | - Yuji Sasaki
- Graduate School of Rehabilitation Sciences, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, 061-0293, Hokkaido, Japan.
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Cho TH, Hong JE, Yang HM. Neuromuscular compartmentation of the subscapularis muscle and its clinical implication for botulinum neurotoxin injection. Sci Rep 2023; 13:11167. [PMID: 37430018 DOI: 10.1038/s41598-023-38406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023] Open
Abstract
In this study, using immunohistochemistry with fresh cadavers, deliberate histological profiling was performed to determine which fibers are predominant within each compartment. To verify the fascial compartmentation of the SSC and elucidate its histological components of type I and II fibers using macroscopic, histological observation and cadaveric simulation for providing an anatomical reference of efficient injection of the BoNT into the SSC. Seven fixed and three fresh cadavers (six males and four females; mean age, 82.5 years) were used in this study. The dissected specimens revealed a distinct fascia demarcating the SSC into the superior and inferior compartments. The Sihler's staining revealed that the upper and lower subscapular nerves (USN and LSN) innervated the SSC, with two territories distributed by each nerve, mostly corresponding to the superior and inferior compartments of the muscle, although there were some tiny communicating twigs between the USN and LSN. The immunohistochemical stain revealed the density of each type of fiber. Compared with the whole muscle area, the densities of the slow-twitch type I fibers were 22.26 ± 3.11% (mean ± SD) in the superior and 81.15 ± 0.76% in the inferior compartments, and the densities of the fast-twitch type II fiber were 77.74% ± 3.11% in the superior and 18.85 ± 0.76% in the inferior compartments. The compartments had different proportions of slow-fast muscle fibers, corresponding to the functional differences between the superior compartment as an early-onset internal rotator and the inferior compartment as a durable stabilizer of the glenohumeral joint.
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Affiliation(s)
- Tae-Hyeon Cho
- Department of Anatomy, College of Korean Medicine, Semyung University, Jecheon, Republic of Korea
- Translational Research Unit for Anatomy and Analgesia, Seoul, Republic of Korea
| | - Ju-Eun Hong
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare Convergence, Yonsei University MIRAE Campus, Wonju, Republic of Korea
| | - Hun-Mu Yang
- Translational Research Unit for Anatomy and Analgesia, Seoul, Republic of Korea.
- Translational Laboratory for Clinical Anatomy, Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Mann MR, Plutecki D, Janda P, Pękala J, Malinowski K, Walocha J, Ghosh SK, Balawender K, Pękala P. The subscapularis muscle: A meta-analysis of its variations, prevalence, and anatomy. Clin Anat 2023; 36:527-541. [PMID: 36597929 DOI: 10.1002/ca.24008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The subscapularis (SSC) is the largest rotator cuff muscle and is involved in the medial rotation, abduction, adduction, and anterior stabilization of the shoulder. It is anatomically variable, as is the morphology and prevalence of the accessory SSC (aSSC), a rare muscle slip attached to the SSC. There is no current review investigating the prevalence and morphometrics of the SSC and aSSC. PURPOSE To investigate the prevalence of the morphological variants of the SSC and aSSC via meta-analysis and review the relevant literature involving cadaveric, magnetic resonance imaging, and ultrasonographic studies. STUDY DESIGN Meta-analysis. MATERIALS AND METHODS Literature data reporting the prevalence rates and morphometrics of the SSC and aSSC and their variants were pooled. Literature searches and data analyses were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Anatomical Quality Assurance guidelines. RESULTS Forty-six studies, totaling 2166 shoulders, were assessed. The SSC showed an overall length, thickness, cross-sectional area, and volume of 152.2 mm (95% confidence interval, CI, 103.8-200.5 mm), 5.6 mm (95% CI, 4.6-6.6 mm), 18.1 cm2 (95% CI, 14.2-22.0 cm2 ), and 126.9 cm3 (95% CI, 87.2-166.5 cm3 ), respectively. The SSC displayed substantial variations in its origin and insertion points and in the composition of its tendon. The aSSC had an overall pooled prevalence of 24.6% (95% CI, 0.0%-76.9%). CONCLUSIONS The SSC and aSSC have been implicated in multiple shoulder pathologies, including muscle and tendon ruptures and neurovascular compromise. A better understanding of SSC and aSSC variants when diagnosing and treating their related pathologies will reduce patient morbidity and improve treatment regimens.
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Affiliation(s)
- Mitchell R Mann
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Dawid Plutecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Patryk Janda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Konrad Malinowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Sanjib Kumar Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Krzysztof Balawender
- Department of Morphological Sciences, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Goldberg DB, Tamate TM, Hasegawa M, Kane TJ, You JS, Crawford SN. Literature Review of Subscapularis Tear, Associated injuries, and the Available Treatment Options. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:2-7. [PMID: 35340936 PMCID: PMC8941617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The population of Hawai'i is uniquely connected to the Ocean and to open water sports. Shoulder injuries, particularly those to the rotator cuff, are among the most common injuries sustained to athletes participating in ocean sports such as surfing, paddling, and swimming. In addition, rotator cuff injuries increase in prevalence with advanced age. As a consequence, the number of patients in Hawai'i who present with an injury to the subscapularis tendon will continue to rise. However, limited research has been done to delineate the involvement of subscapularis injuries in this population. This article covers the anatomy and function of the subscapularis, the epidemiology and classification of tears in this tendon, and the management of tears. The anatomy section will cover innervation, vascular supply and insertional anatomy of the subscapularis tendon. The function of the subscapularis in regards to both stability and motion of the glenohumeral joint will be examined. The focus of the article will then shift to the tears of the subscapularis, starting with an in depth look at the epidemiology and classification of these tears. The article will then cover the different imaging modalities and their utility in regards to subscapularis tears. Finally, the operative and non-operative management and indications for each modality will be discussed in detail.
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Affiliation(s)
- Daniel B. Goldberg
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DBG, TMT, MH, TJKK, SNC)
| | - Trent M. Tamate
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DBG, TMT, MH, TJKK, SNC)
| | - Morgan Hasegawa
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DBG, TMT, MH, TJKK, SNC)
| | - Thomas J.K. Kane
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DBG, TMT, MH, TJKK, SNC)
| | - Jae S. You
- Department of Orthopedics, Straub Clinic & Hospital, Honolulu, HI (JSY, SNC)
| | - Scott N. Crawford
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DBG, TMT, MH, TJKK, SNC)
- Department of Orthopedics, Straub Clinic & Hospital, Honolulu, HI (JSY, SNC)
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Imaging Review of Subscapularis Tendon and Rotator Interval Pathology. Radiol Res Pract 2022; 2022:4009829. [PMID: 35070451 PMCID: PMC8767392 DOI: 10.1155/2022/4009829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/10/2021] [Indexed: 01/05/2023] Open
Abstract
As the largest rotator cuff muscle, the subscapularis plays a major role in stabilizing the glenohumeral joint, in conjunction with surrounding rotator cuff structures. Injury to the subscapularis tendon can be isolated, but more commonly is seen in conjunction with supraspinatus tendon pathology. Injury can be associated with biceps pulley instability, superior labral anterior-posterior (SLAP) tears, humeral head subluxation, and anterosuperior and coracoid impingements. The involvement of the rotator interval can lead to what is called “the hidden lesion,” due to its difficulty to diagnose during arthroscopy. Understanding the anatomical relations of the subscapularis tendon with the rest of the rotator cuff and rotator interval, as well as common patterns of injury that involve the subscapularis tendon, can aid in proper diagnosis of these injuries leading to prompt surgical repair. This review describes the anatomy of the subscapularis muscle and tendon, and the magnetic resonance imaging (MRI) patterns of subscapularis tendon injury.
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Gnyawali SC, Sinha M, El Masry MS, Wulff B, Ghatak S, Soto-Gonzalez F, Wilgus TA, Roy S, Sen CK. High resolution ultrasound imaging for repeated measure of wound tissue morphometry, biomechanics and hemodynamics under fetal, adult and diabetic conditions. PLoS One 2020; 15:e0241831. [PMID: 33227015 PMCID: PMC7682876 DOI: 10.1371/journal.pone.0241831] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Non-invasive, repeated interrogation of the same wound is necessary to understand the tissue repair continuum. In this work, we sought to test the significance of non-invasive high-frequency high-resolution ultrasound technology for such interrogation. High-frequency high-resolution ultrasound imaging was employed to investigate wound healing under fetal and adult conditions. Quantitative tissue cellularity and elastic strain was obtained for visualization of unresolved inflammation using Vevo strain software. Hemodynamic properties of the blood flow in the artery supplying the wound-site were studied using color Doppler flow imaging. Non-invasive monitoring of fetal and adult wound healing provided unprecedented biomechanical and functional insight. Fetal wounds showed highly accelerated closure with transient perturbation of wound tissue cellularity. Fetal hemodynamics was unique in that sharp fall in arterial pulse pressure (APP) which was rapidly restored within 48h post-wounding. In adults, APP transiently increased post-wounding before returning to the pre-wounding levels by d10 post-wounding. The pattern of change in the elasticity of wound-edge tissue of diabetics was strikingly different. Severe strain acquired during the early inflammatory phase persisted with a slower recovery of elasticity compared to that of the non-diabetic group. Wound bed of adult diabetic mice (db/db) showed persistent hypercellularity compared to littermate controls (db/+) indicative of prolonged inflammation. Normal skin strain of db/+ and db/db were asynchronous. In db/db, severe strain acquired during the early inflammatory phase persisted with a slower recovery of elasticity compared to that of non-diabetics. This study showcases a versatile clinically relevant imaging platform suitable for real-time analyses of functional wound healing.
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Affiliation(s)
- Surya C. Gnyawali
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Mithun Sinha
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Mohamed S. El Masry
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Department of Plastic and Reconstructive Surgery, Zagazig University, Zagazig, Egypt
| | - Brian Wulff
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Subhadip Ghatak
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Fidel Soto-Gonzalez
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Traci A. Wilgus
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Sashwati Roy
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Chandan K. Sen
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
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11
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Toprak U, Türkoğlu S, Aydoğan Ç, Kovalak E, Saylısoy S, Sıddıkoğlu D, Mahmud A. Diagnostic accuracy of ultrasound in subscapularis tendon abnormalities and the importance of operator experience. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:423-429. [PMID: 32609088 DOI: 10.5152/j.aott.2020.20146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the reasons behind the compliance, diagnostic success, and failure of ultrasound (US) examinations of two radiologists with reference to magnetic resonance imaging (MRI) in the abnormalities of subscapularis (SSC) tendon, including tendinosis. METHODS One less experienced radiologist (operator-1) and one senior radiologist, experienced in the musculoskeletal US (operator-2), performed the shoulder US on 78 patients (mean age: 53.18 ± 10.89 [22-73] years), who had undergone MRI for routine reasons except malignancy, within 1-4 weeks of MRI. Tendinopathy, partial (PT), or full-thickness (FT) tears were recorded in the subscapularis. The thickness of the anterior and lateral soft tissues in the shoulder girdle was measured by MRI. The inter-operator agreement on the US results, the US-MRI compliance for each operator, and the relationship between the US-MRI compliance and tissue thickness were investigated. RESULTS The inter-operator agreement on the US findings was moderate. The US-MRI compliance was fair for operator-1, but substantial for operator-2. The circumferential soft tissue thickness and US-MRI compliance were not correlated (p>0.05). The interobserver agreement in US was moderate (K: 0.415). The US-MRI compliance was fair for operator-1 (K: 0.344) and substantial for operator-2 (K: 0.616). The accuracy rates for the differentiation of normal tendon, tendinosis, PT, and FT were 59%, 75%, 72%, and 100%, respectively, for operator-1 and 87%, 83%, 85%, and 100%, respectively, for operator-2. However, the respective sensitivity of operator-1 was 46%, 19%, 44%, and 100%; and operator-2 was 91%, 67%, 82%, and 100%. The diagnostic performance of operator-1 was lower, except for FT. CONCLUSION The thickness of the surrounding tissue does not affect the US results. The differentiation between tendinosis and PT tear is difficult (more prominent in less experienced user); however, because this would not change the treatment choice, shoulder US is recommended after basic training in subscapularis pathologies. LEVEL OF EVIDENCE Level II, Diagnostic.
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Affiliation(s)
- Uğur Toprak
- Department of Radiology, Eskişehir Osmangazi University, School of Medicine, Eskişehir, Turkey
| | - Sefa Türkoğlu
- Clinic of Radiology, Denizli State Hospital, Denizli, Turkey
| | - Çiğdem Aydoğan
- Clinic of Physical treatment and Rehabilitation, Artvin State Hospital, Artvin, Turkey
| | - Emrah Kovalak
- Department of Orthopaedics, Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Suzan Saylısoy
- Department of Radiology, Eskişehir Osmangazi University, School of Medicine, Eskişehir, Turkey
| | - Duygu Sıddıkoğlu
- Department of Biostatistics, Ankara University, School of Medicine, Ankara, Turkey
| | - Akkan Mahmud
- Clinic of Pediatric Hematology, Lösante Hospital, Ankara, Turkey
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Youn KH, Cho TH, Kwon HJ, Yang HM, Won SY. A Detailed Analysis of the Blood Supply to the Subscapularis Muscle. Clin Anat 2019; 32:642-647. [PMID: 30829418 DOI: 10.1002/ca.23362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/08/2019] [Accepted: 02/25/2019] [Indexed: 12/29/2022]
Abstract
This study aimed to provide a comprehensive description of the arterial supply to the subscapularis (SSC) muscle. This will provide critical information for various surgical procedures. Ten specimens of embalmed Korean cadavers were dissected and subjected to modified Sihler's method to reveal the branching pattern of the arteries surrounding the subscapularis, and its intramuscular blood supply. The SSC muscle was generally supplied by branches from the subclavian artery (suprascapular artery, supraSA; circumflex scapular artery, CxSA; and dorsal scapular artery, dSA) and the axillary artery (subscapular artery, subSA; lateral thoracic artery, LTA; posterior circumflex humeral artery, PCxHA; and a branch of the axillary artery, AAbr). The anterior aspect of the muscle was supplied by the subSA, LTA, CxSA, supraSA, and AAbr. The posterior aspect of the muscle was supplied by the supraSA, PCxHA, and subSA. The dSA was more scarcely distributed than the other arteries. In two cases, the dSA supplied the portion of the muscle near the medial border of the scapular. The anterior side of the muscle tendon was supplied by the CxSA, and its posterior side was supplied by the PCxHA. The subSA can be considered to be the main branch supplying the SSA based on its distribution area of arteries. It was mostly situated within the lower region of the SSC. After distributing to the anterior surface of the SSC, some branches of the subSA reached the posterior surface as perforating branches. Clin. Anat. 32:642-647, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Kwan-Hyun Youn
- Division in Biomedical Art, Incheon Catholic University Graduate School, Incheon, South Korea
| | - Tae-Hyeon Cho
- Department of Anatomy, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, South Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Yoon Won
- Department of Occupational Therapy, Semyung University, Jecheon, South Korea
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