A radiographic review of the subacromial architecture : a South African study

The subacromial space, which is occupied by the subacromial bursa, rotator cuff complex and the long head of the biceps brachii tendon, is a wellknown area of study due to its association with subacromial disease. Although it is demarcated by the coraco-acromial arch and the supraglenoid tubercle, degenerative changes in these osteological components often lead to mechanical narrowing and subsequent tendon abrasion. In addition to the morphological characteristics, the morphometry of the subacromial architecture is considered to play an important role in maintaining glenohumeral stability. Accordingly, the present study outlined the morphometry of the subacromial architecture and the acromial morphology from a radiological perspective. A total of 120 true lateral-outlet view radiographs (n = 120), representative of 58 males and 62 females of the Black (12), Coloured (10), Indian (27) and White (71) race groups, were analysed. In addition to calculation of the standard and populationspecific means, the acromial classification scheme of Bigliani et al. (1986) was adopted. A trend of ascending values from Type III (16.7%) to Type II (37.5%) to Type I (45.8%) acromia was noted. Various shapes of the subacromial space were observed, viz. rhomboidal (20.0%), trapezoidal (65.8%) and triangular (14.1%). Since a statistically significant P value of 0.030 was recorded for the comparison of acromial type with the shape of the subacromial space, the shape of the subacromial space appeared to be dependent on the acromial type. While the parameters were determined with regard to the demographic representation of South Africa, this study also provided standard mean values which were not previously reported. Furthermore, the correlation of the acromio-glenoidal length with side, gender and shape of the subacromial space reflected levels of significance and highlighted this parameter as a diagnostic determinant of subacromial disease due to its tendency to change in accordance with the demographic and morphological factors

Fracture of the posterior medial tubercle of the talus: a case report and review of the literature

Isolated fracture of the posterior medial tubercle of the talus is a rare injury. To our knowledge the fracture has only been described by five different authors. We diagnosed lately a fracture after a direct trauma. Non-operative treatment with custom made insoles and counselling lead to a acceptable outcome

Introduction of the angle of shoulder slope in a South African population

BACKGROUND: The angle of shoulder slope has been reported in accordance with the specific occupational activities of the aviation and textile industries. However, as no accurate definition nor standardised anatomical landmarks exist within the medical field, this study aimed to devise an appropriate definition with preplaced reference landmarks. In addition, the vertebral level of the acromial tip was also determined. METHODS: The sample series comprised 260 posterior radiographs of the shoulder, of which 127 were males and 133 females. The ethnic distribution included ten black, 13 coloured, 49 Indian and 188 white individuals. In accordance with the trapezial line, the angle of shoulder slope was defined and measured as the angle between the line from the spinous process of C7 to the acromial tip and the line from the acromial tip directly across to the median plane of the vertebral column. RESULTS: The standard mean angle of shoulder slope was approximately 13.56±3.70°. Left and right sides appeared to have mean angles of 13.81±3.41° and 13.33±3.95°, respectively. Mean angular values were also calculated in accordance with the demographic representation - sex: male 13.64±3.71°, female 13.48±3.71°; ethnic groups: black: 13.81±3.81°, coloured: 12.18±3.82°, Indian: 12.97±3.09°, white: 13.64±3.96°. Although the acromial tip was commonly aligned to the level of the spinous process of T3, the incidence of the vertebral level of the acromion was categorised into seven groups, viz. i) intervertebral disc between T1 and T2; ii) intervertebral disc between T2 and T3; iii) intervertebral disc between T3 and T4; iv) spinous process of T1; v) spinous process of T2; vi) spinous process of T3; vii) spinous process of T4. CONCLUSION: Since a statistically significant P value was recorded for the comparison between the angle of shoulder slope and the acromial vertebral level, it was postulated that the magnitude of the angle may determine the acromial vertebral level. As the present study incorporated standard osteological landmarks into the definition and calculation of the angle of shoulder slope, it may provide reference data regarding the position of the acromion which may be indicative of shoulder asymmetry and distorted shoulder setting. Level of evidence: Level 3

The 'anchor shape' technique for long head of the biceps tenotomy to avoid the popeye deformity

Surgical options for symptomatic pathologies of the long head of the biceps (LHB) include tenotomy and tenodesis. Tenotomy is surgically simple and quick, does not require immobilization, and avoids implant complications. However, it is associated with residual “Popeye” muscle deformity and biceps muscle cramps. Tenodesis avoids Popeye deformity, but it is technically a more difficult operation with a longer rehabilitation period and possible implant complications. The purpose of this report is to describe a novel technique for LHB tenotomy that avoids the Popeye muscle deformity. Before releasing the LHB from its anchor over the superior labrum, this technique consists of making an oblique incision, involving 50% of the tendon, distal to its attachment at the superior labrum. A second standard complete tenotomy incision is made about 1.5 cm medial to the oblique incision. The remaining stump of the LHB at the tendon-labrum junction is resected. The first incision, an oblique incomplete incision, allows the remnant of the LHB to open up and form an “anchor shape” that anchors the LHB at the articular entrance of the bicipital groove, thus decreasing the risk of Popeye deformity

Radial head fractures

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason-Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2mm and <5mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure

Een casus van n. ulnaris-compressie ter hoogte van de elleboog door de m. anconeus epitrochlearis

Een rechtshandige, 48-jarige dame komt op consultatie met sinds meerdere maanden pijnklachten in de ulnaire zijde van de rechteronderarm, uitstralend tot aan straal 4 en 5 van de rechterhand. Op echografisch onderzoek wordt een aanwezige m. anconeus epitrochlearis (MAE) gezien met tekenen van een compressieneuropathie van de n. ulnaris. Wanneer deze spier aanwezig is, kan deze een statische druk geven op de n. ulnaris waar de zenuw de cubitale tunnel binnengaat, met een compressieneuropathie als gevolg. Gezien de toename van de klachten en de ontwikkeling van krachtsverlies wordt er beslist om over te gaan tot een operatieve ingreep met resectie van de MAE en release van de n. ulnaris, zonder anteriorisatie.A right-handed, 48-year-old female patient consults with complaints of pain at the right forearm, radiating to the fourth and fifth digit. An ultrasound identifies the presence of the anconeus epitrochlearis muscle and signs of a compression neuropathy of the ulnar nerve. When this muscle is present, it can cause static pressure on the nerve when entering the cubi-tal tunnel, which can lead to a compression neuropathy. Because of deterioration and loss of strength, an operation is performed with resection of the anconeus epitrochlearis muscle and release of the ulnar nerve, without anterior transposition

The “Anchor Shape” Technique for Long Head of the Biceps Tenotomy to Avoid the Popeye Deformity

Surgical options for symptomatic pathologies of the long head of the biceps (LHB) include tenotomy and tenodesis. Tenotomy is surgically simple and quick, does not require immobilization, and avoids implant complications. However, it is associated with residual “Popeye” muscle deformity and biceps muscle cramps. Tenodesis avoids Popeye deformity, but it is technically a more difficult operation with a longer rehabilitation period and possible implant complications. The purpose of this report is to describe a novel technique for LHB tenotomy that avoids the Popeye muscle deformity. Before releasing the LHB from its anchor over the superior labrum, this technique consists of making an oblique incision, involving 50% of the tendon, distal to its attachment at the superior labrum. A second standard complete tenotomy incision is made about 1.5 cm medial to the oblique incision. The remaining stump of the LHB at the tendon-labrum junction is resected. The first incision, an oblique incomplete incision, allows the remnant of the LHB to open up and form an “anchor shape” that anchors the LHB at the articular entrance of the bicipital groove, thus decreasing the risk of Popeye deformity