scholarly journals Displacement of the Greater Tuberosity in Humeral Head Fractures Does Not only Depend on Rotator Cuff Status

2021 ◽  
Vol 10 (18) ◽  
pp. 4136
Author(s):  
Lisa Klute ◽  
Christian Pfeifer ◽  
Isabella Weiss ◽  
Agnes Mayr ◽  
Volker Alt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Rotator Cuff ◽  
Humeral Head ◽  
Fatty Infiltration ◽  
Greater Tuberosity ◽  
Position Determination ◽  
Computed Tomography Scans ◽  
Fracture Types

It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction. The purpose of this study was to investigate the association between rotator cuff status and displacement characteristics of the greater tuberosity in four-part humeral head fractures. Computed tomography scans of 121 patients with Neer type 4 fractures were analyzed. Fatty infiltration of the supra- and infraspinatus muscles was classified according to Goutallier. Position determination of the greater tuberosity fragment was performed in both coronary and axial planes to assess the extent of dorsocranial displacement. Considering non-varus displaced fractures, the extent of the dorsocranial displacement was significantly higher in patients with mostly inconspicuous posterosuperior rotator cuff status compared to advanced fatty degenerated cuffs (cranial displacement: Goutallier 0–1: 6.4 mm ± 4.6 mm vs. Goutallier 2–4: 4.2 mm ± 3.5 mm, p = 0.020; dorsal displacement: Goutallier 0–1: 28.4° ± 32.3° vs. Goutallier 2–4: 13.1° ± 16.1°, p = 0.010). In varus displaced humeral head fractures, no correlation between the displacement of the greater tuberosity and the condition of the posterosuperior rotator cuff could be detected (p ≥ 0.05). The commonly accepted theory of greater tuberosity displacement in humeral head fractures by rotator cuff traction cannot be applied to all fracture types.

The greater tuberosity radius ratio: maybe a new predictor in diagnosis of rotator cuff tear

2020 ◽  
Author(s):  
Qi Ma ◽  
Changjiao Sun ◽  
Pu Liu ◽  
Sha Wu ◽  
Xu Cai
Keyword(s):  
Computed Tomography ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Roc Curve ◽  
Radius Ratio ◽  
Rotator Cuff Tears ◽  
Cutoff Value ◽  
Greater Tuberosity ◽  
Cuff Tear ◽  
Computed Tomography Images

Abstract Background The role of the greater tuberosity of humerus in subacromial impingement should be of equal important as the acromion. In this study we concerned on the morphological characteristics of the greater tuberosity of humerus and proposed the greater tuberosity radius ratio (GTRR) as a new predictor for the diagnosis of rotator cuff tear. We hypothesized that a larger value of the GTRR could increase the risk of developing rotator cuff tear. Methods This was a retrospective study and clinical data and preoperative computed tomography images of the patients with rotator cuff tears (defined as the RCT group, simple size: 61) or without rotator cuff tears (defined as the control group, simple size: 56) were collected. Three-dimensional models of shoulders were established by multiplanar reconstruction of computed tomography scans. In a standard anteroposterior view, the radius of the best-fit circle of the humeral head (the r) and the radius of the concentric circle passing through the most superolateral edge of the greater tuberosity (the R) were measured for each shoulder. The ratio of R and r (R/r) was defined as the greater tuberosity radius ratio (GTRR). Independent samples t tests were used to find significant differences within the r, the R and the GTRR between groups. Receiver operating characteristic (ROC) curve based on the values of GTRR was performed to determine an applied cutoff value which may be useful in clinical practice. Results There was no significant difference in the values of r or R. However, the mean values of GTRR were 1.339 ± 0.143 (range, 1.087–1.684) and 1.244 ± 0.172 (range, 1.040–1.706) in the two groups respectively (p = 0.002). According to the ROC curve, an optimized cutoff value of GTRR was determined as 1.262, whose sensitivity was 72% and specificity was 65% for diagnosis of rotator cuff tear. Conclusion The greater tuberosity of humerus contributes to the mechanisms of rotator cuff tear. The greater tuberosity radius ratio is recommended as a new predictor for diagnosis of rotator cuff tear, with an optimized cutoff value set as 1.262.

scholarly journals Anatomy and Biomechanic of the Shoulder

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0046
Author(s):  
Troydimas Panjaitan
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Central Component ◽  
Subscapularis Tendon ◽  
Glenoid Fossa ◽  
Greater Tuberosity ◽  
Glenohumeral Ligaments ◽  
Shoulder Complex

The shoulder is one of the most complex joints of the human body. Consequently, they are susceptible to injury and degeneration. Mechanical shoulder pathology typically results when overuse, extremes of motion, or excessive forces overwhelm intrinsic material properties of the shoulder complex resulting in tears of the rotator cuff, capsule, and labrum. The fundamental central component of the shoulder complex is the glenohumeral joint. It has a ball-and-socket configuration with a surface area ratio of the humeral head to glenoid fossa of about 3:1 with an appearance similar to a golf ball on a tee. Overall, there is minimal bony covering and limited contact areas that allow extensive translational and rotational ability in all three planes. The glenohumeral joint has 2 groups of stabilizers, which are static (passive) and dynamic (active) restrains. Static stabilizers include the concavity of the glenoid fossa, glenoid fossa retroversion and superior angulation, glenoid labrum, the joint capsule, and glenohumeral ligaments, and a vacuum effect from negative intra-articular pressure. Dynamic stabilization is merely the coordinated contraction of the rotator cuff muscles that create forces that compress the articular surfaces of the humeral head into the concave surface of the glenoid fossa. During upper extremity movement, the effects of static stabilizers are minimized and dynamic or active stabilizers become the dominant forces responsible for glenohumeral stability The simple act of arm elevation is a complex task that occurs via the combination of glenohumeral and scapulothoracic motion, together known as scapulohumeral rhythm. In the first 1200, glenohumeral arm abduction, the supraspinatus and deltoid work together and create a force couple that promotes stability, while raising the arm (deltoid contraction). In addition, the humerus must undergo 450 external rotation to not only clear the greater tuberosity posteriorly but also loosen the inferior glenohumeral ligament (IGHL) to allow maximum elevation. There are several anatomical updates regarding the rotator cuff and capsular footprint. The footprint of the supraspinatus on the greater tuberosity is much smaller than previously believed, and this area of the greater tuberosity is actually occupied by a substantial amount of the infraspinatus. The superior-most insertion of the subscapularis tendon extends a thin tendinous slip, which attaches to the fovea capitis of the humerus. The teres minor muscle inserts to the lowest impression of the greater tuberosity of the humerus and additionally inserts to the posterior side of the surgical neck of the humerus.

scholarly journals A Study for Determination of Sex by Multidetector Computed Tomography of Sternum using Discriminant Function and Logistic Regression

2019 ◽  
Vol 1 (10) ◽  
pp. 1444-1453
Author(s):  
Soumeek Chowdhuri ◽  
Priyam Roy ◽  
Arkadeep Dey ◽  
Saikat Das ◽  
Ritwik Ghosh
Keyword(s):  
Computed Tomography ◽  
Discriminant Function ◽  
Forensic Anthropology ◽  
Skeletal Remains ◽  
Post Mortem ◽  
Cadaver Dissection ◽  
Exclusion Criteria ◽  
Computed Tomography Scans ◽  
Gender Based

Post-mortem investigations of skeletal remains as well as radiographs from living individuals provide useful information for the discrimination of sex. Our study aimed to find out a mathematical model to differentiate gender based on greater degree of accuracy than the anthropological measures taken from the sternum obtained from cadaver dissection. The study was performed on 108 adults who were brought for examination of chest due to various medical reasons. Their age ranged between 18 and 80 years. The cases were selected randomly after considering the inclusion and exclusion criteria. Sternal measurements were taken by studying CT (Computed Tomography) scans. Of these cases, 73 were males and 35 were females. The discriminant function equation (Df) = 0.071 Manubrial Length +0.075 Manubrio-Sternal Length +0.036 Width at S1 +0.037 Width at S3 -11.367 (Constant). Overall 80.6% of the sample was correctly classified into their group. This study revealed that measurements from CT scan of sternum can be used to differentiate between sex of individuals which adds to a great advantage in forensic anthropology.

scholarly journals Is the Walch B3 glenoid significantly worse than the B2?

2017 ◽  
Vol 10 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Kevin Chan ◽  
Nikolas K. Knowles ◽  
Jean Chaoui ◽  
Louis M. Ferreira ◽  
Gilles Walch ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Humeral Head ◽  
Three Dimensional ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Scapular Plane ◽  
Glenoid Plane

Background The Walch B3 glenoid is theorized to be a progression of the B2 biconcave pattern. The present study aimed to compare glenoid indices between B2 and B3 patterns. We hypothesized that the B3 pattern would have significantly worse retroversion, inclination and medialization. Methods Computed tomography scans of 50 patients with B2 erosions [mean (SD) age 68 (9) years; 25 male] and 50 patients with B3 erosions [mean (SD) age 72 (8) years; 22 males] were converted into three-dimensional reconstructions. Retroversion, inclination, medialization and humeral head subluxation were compared. Results The data demonstrated no statistically significant differences [mean (SD)] between groups when assessing retroversion: B2 = 21 (8)°, B3 = 24 (7)° ( p = 0.602); glenoid inclination: B2 = 9 (6)°, B3 = 8 (6)° ( p = 0.967); or medialization: B2 = 12 (4) mm, B3 = 14 (4) mm ( p = 0.384). In the B2 group, the mean (SD) humeral head subluxation was 80% (10%) according to the scapular plane and 55% (9%) according to the glenoid plane, which was not statistically different from the B3 group with a mean (SD) humeral head subluxation of 81% (7%) according to the scapular plane ( p = 0.680) and 54% (7%) according to the glenoid plane ( p = 0.292). Conclusions These results demonstrated no significant differences between the B2 and B3 erosion patterns, with respect to the glenoid indicies measured. The aetiology of the B3 glenoid cannot be completely explained by progression of wear in a B2 glenoid.

Accuracy in Identifying the Source of Subarachnoid Hemorrhage in the Setting of Multiple Intracranial Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Jennifer L Orning ◽  
Sophia F Shakur ◽  
Ali Alaraj ◽  
Mandana Behbahani ◽  
Fady T Charbel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Ruptured Aneurysm ◽  
Multiple Aneurysms ◽  
Microsurgical Clipping ◽  
Computed Tomography Scans ◽  
Rupture Site

Abstract BACKGROUND Subarachnoid hemorrhage cases with multiple cerebral aneurysms frequently demonstrate a hemorrhage pattern that does not definitively delineate the source aneurysm. In these cases, rupture site is ascertained from angiographic features of the aneurysm such as size, morphology, and location. OBJECTIVE To examine the frequency with which such features lead to misidentification of the ruptured aneurysm. METHODS : Records of patients who underwent surgical clipping of a ruptured aneurysm at our institution between 2004 and 2014 and had multiple aneurysms were retrospectively reviewed. A blinded neuroendovascular surgeon provided the rupture source based on the initial head computed tomography scans and digital subtraction angiography images. Operative reports were then assessed to confirm or refute the imaging-based determination of the rupture source. RESULTS One hundred fifty-one patients had multiple aneurysms. Seventy-one patients had definitive hemorrhage patterns on initial computed tomography scans and 80 patients had nondefinitive hemorrhage patterns. Thirteen (16.2%) of the cases with nondefinitive hemorrhage patterns had discordance between the imaging-based determination of the rupture source and intraoperative findings of the true ruptured aneurysm, yielding an imperfect positive predictive value of 83.8%. Of all multiple aneurysm cases with subarachnoid hemorrhage treated by surgical or endovascular means at our institution, 4.3% (13 of 303) were misidentified. CONCLUSION Morphological features cannot reliably be used to determine rupture site in cases with nondefinitive subarachnoid hemorrhage patterns. Microsurgical clipping, confirming obliteration of the ruptured lesion, may be preferentially indicated in these patients unless, alternatively, all lesions can be contemporaneously and safely treated with endovascular embolization.

Determination of the appropriate catheter length for needle thoracostomy by using computed tomography scans of trauma patients in Japan

Injury ◽  
2012 ◽  
Vol 43 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Takeshi Yamagiwa ◽  
Seiji Morita ◽  
Rie Yamamoto ◽  
Tomoko Seki ◽  
Katsuhiko Sugimoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Trauma Patients ◽  
Computed Tomography Scans

scholarly journals The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Omer Ozel ◽  
Robert Hudek ◽  
Mohamed S. Abdrabou ◽  
Birgit S. Werner ◽  
Frank Gohlke
Keyword(s):  
Computed Tomography ◽  
Rotator Cuff ◽  
Inclination Angle ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Fatty Infiltration ◽  
Critical Shoulder Angle ◽  
Software Program ◽  
3D Software ◽  
Shoulder Angle

Abstract Background The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°. Methods A total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group. Results The median (min/max) values for the 231 shoulders were 8° (− 23°/56°) for the inclination angle, − 11°(− 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders. Conclusion Our findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact. Level of evidence Level III.

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