The primary objective was to determine the population prevalence of glenohumeral joint imaging abnormalities in asymptomatic adults.
We systematically reviewed studies reporting the prevalence of ...X-ray, ultrasound (US), computed tomography, and magnetic resonance imaging (MRI) abnormalities in adults without shoulder symptoms (PROSPERO registration number CRD42018090041). This report presents the glenohumeral joint imaging findings. We searched Ovid MEDLINE, Embase, CINAHL and Web of Science from inception to June 2023 and assessed risk of bias using a tool designed for prevalence studies. The primary analysis was planned for the general population. The certainty of evidence was assessed using a modified Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) for prognostic studies.
Thirty-five studies (4 X-ray, 10 US, 20 MRI, 1 X-ray and MRI) reported useable prevalence data. Two studies were population-based (846 shoulders), 15 studies included miscellaneous study populations (1715 shoulders) and 18 included athletes (727 shoulders). All were judged to be at high risk of bias. Clinical diversity precluded pooling. Population prevalence of glenohumeral osteoarthritis ranged from 15% to 75% (2 studies, 846 shoulders, 1 X-ray, 1 X-ray and MRI; low certainty evidence). Prevalence of labral abnormalities, humeral head cysts and long head of biceps tendon abnormalities were 20%, 5%, 30% respectively (1 study, 20 shoulders, X-ray and MRI; very low certainty evidence).
The population-based prevalence of glenohumeral joint imaging abnormalities in asymptomatic individuals remains uncertain, but may range between 30% and 75%. Better estimates are needed to inform best evidence-based management of people with shoulder pain.
Abstract Background Calibration of shoulder radiographs is required for accurate preoperative planning. Current practice mostly uses an empirical fixed calibration factor of 5%, and limited ...information is available about how the magnification of the glenohumeral region differs among patients. This retrospective observational study analyzed the patient-specific magnification factor in total shoulder arthroplasty. Methods Radiographs of 94 patients with unilateral total shoulder arthroplasty (SMR Reverse Shoulder System, Lima Ltd., San Daniele del Friuli, Italy) were obtained from archives. The reverse humeral body diameter was used as internal reference. The measured radiographical magnifications were correlated with the patients’ sex, weight, and height. Results The average magnification factor of the glenohumeral region was 11.9% (standard deviation: 3.2%, range: 5.7–20.3%). No statistically significant difference in radiographic magnification was found between the male and the female patients. The magnification factor was higher in patients with higher weight ( p < 0.05), but the explanatory power of the model was weak ( R = 0.09). Conclusions The observed radiographic magnification was considerably higher than a commonly used fixed calibration factor of 5% and exhibited considerable variability among the patients. Therefore, standard radiographs might not be appropriate for accurate preoperative templating, and we recommend using either computer tomography data or calibrating radiographs through external calibration markers for each patient.
Zusammenfassung Hintergrund Für eine genaue präoperative Planung ist die Kalibrierung von Röntgenaufnahmen der Schulter erforderlich. Praktisch wird aktuell zumeist ein empirisch festgelegter Kalibrierungsfaktor von 5 % verwendet, und es gibt nur begrenzt Informationen darüber, wie sich die Vergrößerung der Glenohumeralregion zwischen den Patienten unterscheidet. In der vorliegenden retrospektiven Beobachtungsstudie wurde der patientenspezifische Vergrößerungsfaktor bei totaler Schulterarthroplastik untersucht. Methoden Aus Archiven wurden Röntgenaufnahmen von 94 Patienten mit unilateraler totaler Schulterarthroplastik (SMR Reverse Shoulder System, Fa. Lima Ltd., San Daniele del Friuli, Italien) entnommen. Als interne Referenz wurde der Durchmesser des hinteren Humerusschafts verwendet. Die gemessenen radiographischen Vergrößerungen wurden mit Geschlecht, Gewicht und Körpergröße der Patienten korreliert. Ergebnisse Der durchschnittliche Vergrößerungsfaktor der Glenohumeralregion betrug 11,9 % (Standardabweichung: 3,2 %; Spannbreite: 5,7–20,3 %). Es fand sich kein statistisch signifikanter Unterschied bei der radiographischen Vergrößerung zwischen männlichen und weiblichen Patienten. Ein höherer Vergrößerungsfaktor lag bei Patienten mit höherem Gewicht vor ( p < 0,05), aber die Aussagekraft des Modells war schwach ( R = 0,09). Schlussfolgerung Die ermittelte radiographische Vergrößerung war beträchtlich höher als der gewöhnlich verwendete feste Kalibrierungsfaktor von 5 % und zeigte eine erhebliche Variabilität zwischen den Patienten. Daher sind Standardröntgenaufnahmen möglicherweise nicht als genaue präoperative Schablone geeignet, und die Autoren empfehlen, entweder Computertomographiedaten zu verwenden oder Röntgenaufnahmen mittels externer Kalibrierungsmarker für jeden Patienten zu kalibrieren.
Ultrasound-guided injections are used to treat common shoulder pathologies and have been shown to be more accurate and effective than traditional landmark-guided procedures. Currently, there exists ...no inexpensive shoulder model that accurately simulates the anatomical structures of the shoulder while also facilitating glenohumeral joint (GHJ) injection. Our model is an alternative to the traditional bedside training and provides a low-risk training environment.
We created this model from easily accessible materials. Polyvinyl chloride pipe was used to create the skeletal infrastructure pectoral girdle. A detergent pod was used to represent the GHJ space. Steaks were used to simulate the infraspinatus and deltoid muscles, with meat glue as a fascial layer between the two simulated muscles. Total cost of materials for the model was $19.71.
Our model successfully replicates known anatomical features of the GHJ. Additionally, the model facilitates injection into a GHJ space, representing a GHJ injection. Our model was replicated to train medical student practitioners during five different educational sessions. The model was validated through comparison to standardized educational ultrasound training videos. It was further validated by ultrasound experts.
The shoulder model we created is effective in simulating GHJ injections under ultrasound guidance. It simulates realistic muscle and bony landmarks both for ultrasound imaging and injection feel. Importantly, it is inexpensive and easy to replicate allowing more access to medical practitioners and students to be educated on the procedure.
Image-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided ...glenohumeral injections do not require additional subspecialist referrals or equipment. An optimal technique would be safe and accurate and have few barriers to implementation. The purpose of this study was to define the accuracy of glenohumeral needle placement via an anterior landmark-guided approach as assessed by direct arthroscopic visualization.
A consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. The time required to perform the injection, the precise location of the needle tip, and factors that affected the accuracy of the injection were also assessed.
A standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery, and the location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by sports medicine and shoulder/elbow fellowship-trained orthopedic surgeons was confirmed in 93.8% (76/81) of patients. The average time to complete the procedure was 24.8 s. There were no patient-related variables associated with nonintra-articular injections in the cohort.
This study demonstrated that the technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 s to perform. This method is safe, yields similar accuracy to image-guided procedures, has improved cost and time efficiency, and requires less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting.
Level 5.
IRB: Approved under Stanford IRB-56323.
Glenohumeral posterior external rotation contractures and scapular winging are frequently overlooked problems in residual neonatal brachial plexus injury (NBPI). Recent attention has emphasized their ...impact on vital functions such as feeding and hygiene. This study aims to present the epidemiology of posterior glenohumeral (GH) contractures in a significant pediatric NBPI population and explore contributing factors.
We conducted a retrospective analysis of data collected from January 2019 to November 2022, involving a case series of 262 children with residual NBPI. The data included demographics, palsy level, prior surgical history, and the modified Mallet scale. Glenohumeral passive internal rotation in abduction (IRABD) and cross-body adduction (CBADD) angles were measured bilaterally. Subjects were categorized into 'Belly-' (Mallet Hand-to-Belly <3) and 'Belly+' (Mallet Hand-to-Belly ≥3) groups.
Median participant age was 7.9 years (range: 3.5 – 21 years). Extension injury patterns included Erb's palsy (56.5%), extended Erb's palsy (28.6%), and global palsy (14.9%). Contractures exceeding 10, 20, and 30 degrees were prevalent in both IRABD and CBADD angles. The 'Belly-' group (9.5%) demonstrated a significant reduction in both angles compared to the 'Belly+' group. Weak correlations were found between IRABD (r=0.390, p<0.0001) or CBADD (r=0.163, p=0.0083) angles and Mallet hand-to-abdomen item. Glenohumeral reduction and Hoffer procedures led to a notable decrease in CBADD angle, without affecting 'Belly-' prevalence. Global injuries exhibited decreased angles compared to Erb's group.
External rotation glenohumeral contractures are prevalent in residual NBPI, impacting midline access. Surprisingly, history of glenohumeral procedures or extensive injuries did not increase the likelihood of losing the ability to reach the belly. ROC analysis suggests specific thresholds for maintaining this ability.
Patients with shoulder joint dysfunction may perform compensatory motion using the glenohumeral joint,scapula, or trunk to accomplish the intended movement. It is necessary to consider which ...treatment strategyto pursue, improvement of normal movement or acquisition of compensatory function, depending on theintended goal. In this paper, compensatory movement caused by functional impairment of the glenohumeraljoint and scapula are used as examples. In addition, electromyographic data are presented and details of thekind of compensatory movement occurring are explained.
Patients with shoulder joint dysfunction may perform compensatory motion using the glenohumeral joint,scapula, or trunk to accomplish the intended movement. It is necessary to consider which ...treatment strategyto pursue, improvement of normal movement or acquisition of compensatory function, depending on theintended goal. In this paper, compensatory movement caused by functional impairment of the glenohumeraljoint and scapula are used as examples. In addition, electromyographic data are presented and details of thekind of compensatory movement occurring are explained.
Background:
The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. However, meaningful clinical outcomes after this surgery have not been ...defined.
Purpose:
This study aimed to establish the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for commonly used outcome measures in patients undergoing the Latarjet procedure and determine correlations between preoperative patient characteristics and achievement of MCID or PASS.
Study Design:
Case series; Level of evidence, 4.
Methods:
A multicenter retrospective review at 4 institutions was performed to identify patients undergoing primary open Latarjet procedure with minimum 2-year follow-up. Data collected included patient characteristics (age, sex, sports participation), radiological parameters (glenoid bone loss, off-track Hill-Sachs lesion), and 4 patient-reported outcome measures (collected preoperatively and 2 years postoperatively): the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), the visual analog scale (VAS) for pain, and the Western Ontario Shoulder Instability Index (WOSI). The MCID and PASS for each outcome measure were calculated, and Pearson and Spearman coefficient analyses were used to identify correlations between MCID or PASS and preoperative variables (age, sex, sports participation, glenoid bone loss, off-track Hill-Sachs lesion).
Results:
A total of 156 patients were included in the study. The MCID values for ASES, SANE, VAS pain, and WOSI were calculated to be 9.6, 12.4, 1.7, and 254.9, respectively. The PASS values for ASES, SANE, VAS pain, and WOSI were 86.0, 82.5, 2.5, and 571.0, respectively. The rates of patients achieving MCID were 61.1% for VAS pain, 71.6% for ASES, 74.1% for SANE, and 84.2% for WOSI. The rates of achieving PASS ranged from 78.4% for WOSI to 84.0% for VAS pain. There was no correlation between any of the studied preoperative variables and the likelihood of achieving MCID or PASS.
Conclusion:
This study defined MCID and PASS values for 4 commonly used outcome measures in patients undergoing the Latarjet procedure. These findings are essential for incorporating patient perspectives into the clinical effectiveness of the Latarjet procedure and provide valuable parameters for the design and interpretation of future clinical trials.
While shoulder injuries resulting from the bench press exercise are commonly reported, no biomechanical evidence for lowering injury risk is currently available. Therefore, the aim of the present ...study was to compare musculoskeletal shoulder loads and potential injury risk during several bench press variations. Ten experienced strength athletes performed 21 technical variations of the barbell bench press, including variations in grip width of 1,1.5 and 2 bi-acromial widths (BAW), shoulder abduction angles of 45°, 70° and 90°, and scapula poses including neutral, retracted, and released conditions. Motions and forces were recorded by an opto-electronic measurement system and an instrumented barbell. An OpenSim musculoskeletal shoulder model was employed to estimate joint reaction forces in the glenohumeral and acromioclavicular joints. Time-series of joint reaction forces were compared between techniques by statistical non-parametric mapping. Results showed that narrower grip widths of < 1.5 BAW decreased acromioclavicular compression ( p < 0.05), which may decrease the risk for distal clavicular osteolysis. Moreover, scapula retraction, as well as a grip width of < 1.5 BAW ( p < 0.05), decreased glenohumeral posterior shear force components and rotator cuff activity and may decrease the risk for glenohumeral instability and rotator cuff injuries. Furthermore, results showed that mediolaterally exerted barbell force components varied considerably between athletes and largely affected shoulder reaction forces. It can be concluded that the grip width, scapula pose and mediolateral exerted barbell forces during the bench press influence musculoskeletal shoulder loads and the potential injury risk. Results of this study can contribute to safer bench press training guidelines.
