Stretching positions for the coracohumeral ligament: Strain measurement during passive motion using fresh/frozen cadaver shoulders

<p>Abstract</p> <p>Background</p> <p>Contracture of the coracohumeral ligament is reported to restrict external rotation of the shoulder with arm at the side and restrict posterior-inferior shift of the humeral head. The contracture is supposed to restrict range of motion of the glenohumeral joint.</p> <p>Methods</p> <p>To obtain stretching position of the coracohumeral ligament, strain on the ligament was measured at the superficial fibers of the ligament using 9 fresh/frozen cadaver shoulders. By sequential measurement using a strain gauge, the ligament strain was measured from reference length (L0). Shoulder positions were determined using a 3 Space Tracker System. Through a combination of previously reported coracohumeral stretching positions and those observed in preliminary measurement, ligament strain were measured by passive external rotation from 10° internal rotation, by adding each 10° external rotation, to maximal external rotation.</p> <p>Results</p> <p>Stretching positions in which significantly larger strain were obtained compared to the L0 values were 0° elevation in scapula plane with 40°, 50° and maximum external rotation (5.68%, 7.2%, 7.87%), 30° extension with 50°, maximum external rotation (4.20%, 4.79%), and 30° extension + adduction with 30°, 40°, 50° and maximum external rotation (4.09%, 4.67%, 4.78%, 5.05%)(P < 0.05). No positive strain on the coracohumeral ligament was observed for the previously reported stretching positions; ie, 90° abduction with external rotation or flexion with external rotation.</p> <p>Conclusions</p> <p>Significant strain of the coracohumeral ligament will be achieved by passive external rotation at lower shoulder elevations, extension, and extension with adduction.</p

Breast MRI: guidelines from the European Society of Breast Imaging

The aim of breast MRI is to obtain a reliable evaluation of any lesion within the breast. It is currently always used as an adjunct to the standard diagnostic procedures of the breast, i.e., clinical examination, mammography and ultrasound. Whereas the sensitivity of breast MRI is usually very high, specificity—as in all breast imaging modalities—depends on many factors such as reader expertise, use of adequate techniques and composition of the patient cohorts. Since breast MRI will always yield MR-only visible questionable lesions that require an MR-guided intervention for clarification, MRI should only be offered by institutions that can also offer a MRI-guided breast biopsy or that are in close contact with a site that can perform this type of biopsy for them. Radiologists involved in breast imaging should ensure that they have a thorough knowledge of the MRI techniques that are necessary for breast imaging, that they know how to evaluate a breast MRI using the ACR BI-RADS MRI lexicon, and most important, when to perform breast MRI. This manuscript provides guidelines on the current best practice for the use of breast MRI, and the methods to be used, from the European Society of Breast Imaging (EUSOBI)

Comparison of the sonographic features of the abdominal wall muscles and connective tissues in individuals with and without lumbopelvic pain.

Study Design: Cross sectional, case-control study.Objectives: Measure and compare the resting thickness of the four abdominal wall muscles, their associated perimuscular connective tissue (PMCT), and inter-recti distance (IRD) in persons with and without lumbopelvic pain (LPP), using ultrasound imaging (USI).Background: The muscles and PMCT of the abdominal wall assist in controlling the spine and functional deficits have been detected in LPP populations. Investigations of the abdominal wall in LPP are primarily concerned with muscle, most commonly the transversus abdominis (TrA) and internal oblique (IO). As the abdominal wall functions as a unit, it seems prudent that all 4 abdominal muscles and their associated connective tissues are considered concurrently.Methods: B-mode USI was used to measure the resting thickness of the rectus abdominis (RA), external oblique (EO), IO, and TrA muscles, the PMCT planes, and IRD in 50 male and female subjects (25 with and 25 without LPP; mean +/- SD age 36.3 +/- 9.4 and 46.6 +/- 8.0 years, respectively). Univariate correlation analysis was used to identify covariates. Analyses of covariance and Kruskal-Wallis test (IRD) were used to compare cohorts (alpha=0.05).Results: The LPP cohort had less total abdominal muscle thickness (LPP 18.9 +/- 3.0 mm, Control 20.3 +/- 3.0 mm; ANCOVA adjusted for body mass index [BMI], P=.03), thicker PMCT (LPP 5.5 +/- 0.2 mm, Control 4.3 +/- 0.2 mm; ANCOVA adjusted for BMI, P=.007), and wider IRD (LPP 11.5 +/- 2.0 mm, Control 8.4 +/- 1.8 mm; Kruskal-Wallis, P=.005). Analysis of individual muscle thickness revealed no difference in the EO, IO, and TrA, but a thinner RA (LPP 7.8 +/- 1.5 mm, Control 9.1 +/- 1.2 mm; 56 ANCOVA adjusted for BMI, P&lt;.001) in the LPP cohort.Conclusions: To our knowledge this is the first study to investigate the morphological characteristics of all 4 abdominal muscles and PMCT in individuals with LPP. The results suggest altered loading of the PMCT and linea alba, which may be secondary to an altered motor control strategy that involves a reduced contribution of the RA. Further, the change in RA and connective tissue morphology may be more evident than changes in EO, IO, and TrA thickness in persons with LPP. The causes and functional implications of these changes warrant further investigation, as does the role of the RA muscle in the development and persistence of LPP.<br/