Medium to long-term outcome of thoracoscapular arthrodesis with screw fixation for facioscapulohumeral muscular dystrophy

Background: Shoulder girdle muscle weakness is the most constant feature of facioscapulohumeral muscular dystrophy and leads to scapular winging. Mechanical fixation of the scapula to the thoracic wall provides a stable fulcrum on which the deltoid muscle can exert its action on the humerus. The aim of this study was to evaluate the medium to long-term outcome of thoracoscapular arthrodesis with screw fixation (the modified Howard-Copeland technique). Methods: All patients with facioscapulohumeral dystrophy who underwent thoracoscapular arthrodesis with screw fixation and bone-grafting from July 1997 to July 2010 were retrospectively reviewed. Preoperative and postoperative clinical assessment included active shoulder elevation, the Constant score, a patient satisfaction score, and cosmetic satisfaction. Union was determined both clinically and radiographically. Results: Thoracoscapular arthrodesis was performed in thirty-five shoulders in twenty-four patients; eleven patients underwent bilateral procedures. The principal study group consisted of thirty-two shoulders in twenty-one patients with a minimum follow-up of twenty-four months (Mean, eighty-eight months; range, twenty-four to 174 months). The mean Constant score increased from 30 (range, 17 to 41) preoperatively to 61 (range, 30 to 90) postoperatively. The mean satisfaction score increased from 1 (range, 0 to 4) to 8.4 (range, 4 to 10). Early complications consisted of one pneumothorax, one superficial wound infection, and four early failures, two of which were associated with noncompliance with the postoperative regimen. Late complications consisted of one posttraumatic fracture resulting in loosening and one painful nonunion; both were treated successfully with revision. Conclusions: Thoracoscapular arthrodesis with screw fixation prevented scapular winging and improved short-term and long-term shoulder function in patients with facioscapulohumeral dystrophy. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Real-time simulation of three-dimensional shoulder girdle and arm dynamics

Electrical stimulation is a promising technology for the restoration of arm function in paralyzed individuals. Control of the paralyzed arm under electrical stimulation, however, is a challenging problem that requires advanced controllers and command interfaces for the user. A real-time model describing the complex dynamics of the arm would allow user-in-the-loop type experiments where the command interface and controller could be assessed. Real-time models of the arm previously described have not included the ability to model the independently controlled scapula and clavicle, limiting their utility for clinical applications of this nature. The goal of this study therefore was to evaluate the performance and mechanical behavior of a real-time, dynamic model of the arm and shoulder girdle. The model comprises seven segments linked by eleven degrees of freedom and actuated by 138 muscle elements. Polynomials were generated to describe the muscle lines of action to reduce computation time, and an implicit, first-order Rosenbrock formulation of the equations of motion was used to increase simulation step-size. The model simulated flexion of the arm faster than real time, simulation time being 92% of actual movement time on standard desktop hardware. Modeled maximum isometric torque values agreed well with values from the literature, showing that the model simulates the moment-generating behavior of a real human arm. The speed of the model enables experiments where the user controls the virtual arm and receives visual feedback in real time. The ability to optimize potential solutions in simulation greatly reduces the burden on the user during development

Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review

Rehabilitation of the patient with glenohumeral impingement requires a complete understanding of the structures involved and the underlying mechanism creating the impingement response. A detailed clinical examination and comprehensive treatment programme including specific interventions to address pain, scapular dysfunction and rotator cuff weakness are recommended. The inclusion of objective testing to quantify range of motion and both muscular strength and balance in addition to the manual orthopaedic clinical tests allows clinicians to design evidence-based rehabilitation programmes as well as measure progression and patient improvement

Upper Extremity Biomechanical Model for Evaluation of Pediatric Joint Demands during Wheelchair Mobility

Current methods for evaluating upper extremity (UE) dynamics during pediatric wheelchair use are limited. We propose a new model to characterize UE joint kinematics and kinetics during pediatric wheelchair mobility. The bilateral model is comprised of the thorax, clavicle, scapula, upper arm, forearm, and hand segments. The modeled joints include: sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist. The model is complete and is currently undergoing pilot studies for clinical application. Results may provide considerable quantitative insight into pediatric UE joint dynamics to improve wheelchair prescription, training and long term care of children with orthopaedic disabilities

Tracking scapular movement

Measuring the three-dimensional movement of the scapula provides vital information in the analysis and treatment of shoulder clinical disorders and contributes to our understanding of its complex kinematics. However, the thick layer of skin overlying the scapular region means that all skin-based techniques inaccurately determine the scapular kinematics. The scapula locator makes use of a palpation technique in order to reduce the problem of skin deformation. At present, the scapula locator is the most accurate noninvasive method of measuring scapular movements, but to date the method has only been used to measure the scapula position statically. Here, a new method was developed to measure the scapula movements dynamically; the method makes use of the scapula locator and feedback from pressure-sensors attached to the locator probes to track the scapula during movement. The reliability of the method after short-term practise as well as the intra-observer and inter-observer variations and the inter-session repeatability were tested and quantified in a series of studies. The method was found to be able to measure dynamic scapular movements in slow to medium paced arm movements to a good degree of accuracy as well as provide scapulothoracic measurements of high reliability compared to using the scapula locator on its own and to previously reported results in the literature. Finally, the new locator method was used to calibrate the acromial tracker in order to improve the accuracy of the device and facilitate its use as an alternative to the scapula locator in clinical studies involving fast (higher than functional velocities) dynamic activities. The new scapula locator method and the calibrated acromial tracker method present significant improvements on the available scapular measurement techniques particularly in measuring subtle scapular rotations of clinical importance, such as the scapular tilt. The methods described will be used in future clinical and sport-related studies

Morphometry of Glenoid Cavity

Objectives: Knowledge of the shape and dimensions of the glenoid are important in the design and fitting of glenoid components for total shoulder arthroplasty. An understanding of variations in normal anatomy of the glenoid is essential while evaluating pathological conditions like osseous Bankart lesions and osteochondral defects. Methods: This study was done on 202 dry, unpaired adult human scapulae of unknown sex belonging to the south Indian population. Three glenoid diameters were measured, the superior-inferior diameter, anterior-posterior diameter of the lower half and the anterior-posterior diameter of the upper half of the glenoid. Based on a notch present on the anterior glenoid rim, variations in the shape of the glenoid cavity were classified as inverted comma shaped, pear shaped and oval. Results: The average superior-inferior diameter on right and the left sides were 33.67±2.82mm and 33.92±2.87mm respectively. The average anterior-posterior diameter of the lower half of the right glenoid was 23.35±2.04mm and that of the left was 23.02±2.30mm. The mean diameter of the upper half of the right glenoid was 16.27±2.01mm and that of the left was 15.77±1.96mm. Conclusion: The dimensions of the glenoid observed in the present study were lesser than those recorded in the studies done on other populations. This fact may be taken into consideration while designing glenoid prostheses for the south Indian population. The current study recorded a higher percentage of glenoid cavities having the glenoid notch as compared to earlier studies. While evaluating defects/lesions of the glenoid, this fact could be useful

Biomechanical evaluation of the push-up exercise of the upper extremities from various starting points

The purpose of the present research was to evaluate the push-up exercise of the upper extremities in respect of biomechanics, to compare the muscle function, while changing the position of performance and to examine the torso's inclination during the exercise. The result is that the activation of the muscles, apart from the triceps brachii muscle, does not differentiate significantly in any of the positions. Moreover, the elevating the hands above the feet position is not recommended in protocols where the aim is to improve the muscle force because it displays the lowest mean value of vertical force and a low RFD. On the other hand, the standard push-up position is considered to be the most appropriate when the aim is to improve the triceps brachii muscle's force because it displays the highest RFD and the highest activation of this muscle. Finally, the correct body position during this exercise prevents from incorrect and damaging inclinations of the torso. © JPES

Wing myology of Caracaras (Aves, Falconiformes): muscular features associated with flight behavior

Caracaras (Aves, Falconiformes, Falconidae) are Neotropical diurnal raptors that belong to the subfamily Polyborinae. The forelimb myology of this group has not been comprehensively studied or compared with that of other Falconidae. Thus, the aims of this study were i) to describe the forelimb muscles of two species of Polyborinae (Caracara plancus and Milvago chimango), ii) to explore the possible relationship between muscular features and their function in flight behavior and iii) to compare the muscular features of these species with those of species of the subfamily Falconinae. To this end, the forelimb muscles of C. plancus (n=4) and M. chimango (n=4) were dissected. Additonally, to complement this data set, two specimens of M. chimachima were dissected. The mass of each muscle of one wing and its percentage with respect to the body mass were obtained. A total of 45 muscles were identified, and differences with respect to Falconinae were related to the presence of single or additional bellies. The total forelimb muscle mass represented between 7.68 and 10.26 % of the body mass. The muscle pectoralis represented ̴ 5% of the body mass, followed by the muscles scapulohumeralis caudalis (0.64–0.79%), deltoideus major (0.43 –0.53%), supracoracoideus (0.34– 0.38%) and biceps brachii (0.26 –0.39%). The high values of these muscles are in agreement with their important function: they are involved in the downstroke and upstroke phases of the flapping flight. On the other hand, the muscles that seemed to contribute little to the mechanical power for flight presented low values that ranged between 0.01 and 0.25%. Comparison of the forelimb muscles of caracaras with published data on Falconinae species suggests that their muscular features might be associated with their type of flight, which is more erratic and less powerful than that of Falconinae.Fil: Picasso, Mariana Beatriz Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Paleontología Vertebrados; ArgentinaFil: Mosto, María Clelia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Paleontología Vertebrados; Argentin

The occipital lateral plate mesoderm is a novel source for vertebrate neck musculature

In vertebrates, body musculature originates from somites, whereas head muscles originate from the cranial mesoderm. Neck muscles are located in the transition between these regions. We show that the chick occipital lateral plate mesoderm has myogenic capacity and gives rise to large muscles located in the neck and thorax. We present molecular and genetic evidence to show that these muscles not only have a unique origin, but additionally display a distinct temporal development, forming later than any other muscle group described to date. We further report that these muscles, found in the body of the animal, develop like head musculature rather than deploying the programme used by the trunk muscles. Using mouse genetics we reveal that these muscles are formed in trunk muscle mutants but are absent in head muscle mutants. In concordance with this conclusion, their connective tissue is neural crest in origin. Finally, we provide evidence that the mechanism by which these neck muscles develop is conserved in vertebrates