Assessment of Thoracic Abnormalities in Premature Infants

Background: There is a large incidence of congenital thoracic abnormalities that manifest as deformities and or defects of anterior chest walls. Thoracic abnormalities in preterm infants may also be associated with malpositioning in the incubator in the presence of respiratory disease and prolonged mechanical ventilation. Immaturity of respiratory and musculoskeletal system need to compromise biomechanical function of thorax. Thus, the purpose of the study is to access the thoracic alteration and the factors associated with its abnormalities in the infants born prematurely. Objective: Assess thoracic alteration in premature infants. Methods: This was an observational study with infants in first year of age, born prematurely with birth weight < 2000g. Exclusion criteria were: major congenital malformations as defined by the centers for disease contol and prevention, grade III/IV intraventricular hemorrhage or preventricular leucomalacia. Physical examinations were performed independently to assess shoulder elevation and thoracic alterations. Results: 34 infants born prematurely were included for the study according to the inclusion criteria from which 20 infants (58.8%) showed thoracic abnormalities and remaining 14 infants (41.1%) were without abnormalities. Conclusion: The prevalence of thoracic abnormalities was high in infants born prematurely, and was associated with pulmonary disease, and may also have compromised the growth rate of these infants during the first year of life.

Association of Shoulder Dysfunction with Mobility Limitation in Older Adults of the BLSA

Mobility limitation affects one-third of older adults; yet, the impact of shoulder dysfunction which effects roughly 20%, is inadequately documented. As arm swing is a fundamental component of ambulation, we investigated the cross-sectional association between shoulder range of motion (ROM) and walking endurance using time to walk 400m as quickly as possible and lower extremity performance using the expanded Short Physical Performance Battery (e-SPPB). Data are from 614 men (50.5%) and women aged ≥ 60 years (mean 71.8 ±8 years) in the Baltimore Longitudinal Study of Aging (BLSA) who performed bilateral shoulder elevation and/or bilateral shoulder external rotation (ER) during nurse-administered physical examination. We examined odds of poor 400m-walk and e-SPPB performance defined as the worst quartile associated with abnormal shoulder elevation (≤9%) relative to bilateral normal shoulder elevation and abnormal shoulder external rotation (≤5%) relative to bilateral normal shoulder external rotation (ER) in separate analyses. Analyses were adjusted for age, sex, weight and height. Adjusted odds (95% confidence interval) of poor 400m-walk performance associated with abnormal shoulder elevation (N=254) were 4.7 (1.1-19.5;p=0.035) and with abnormal shoulder ER (n=401) were 4.8 (1.4-16.7;p=0.010). Adjusted odds of poor e-SPPB performance associated with abnormal shoulder elevation (N=462) were 3.5 (1.6-7.7;p=0.002) and with abnormal shoulder ER (n=457) were 2.9 (1.1-7.4;p=0.030). Results suggest abnormal shoulder ROM is associated with poorer walking endurance capacity and lower-extremity functional performance in the relatively healthy older adults. Future research is warranted to develop novel screening paradigms that mitigate mobility limitation and functional decline in older adults with shoulder dysfunction.

Anteroinferior Bundle of The Acromioclavicular Ligament Plays a Substantial Role in The Joint Function During Shoulder Elevation and Horizontal Adduction: A Dynamic Finite Element Model.

Background: Postoperative acromioclavicular (AC) ligament deficiency has been identified as a common cause of failure after isolated coracoclavicular reconstruction. The two-bundle arrangement of the acromioclavicular ligament has recently been reported in histological and anatomical research. In addition, a clear structural advantage of the superoposterior bundle (SPB) over the less consistent anteroinferior bundle (AIB) was also found. However, the current understanding of the function of the acromioclavicular ligament in joint stability is based on uniaxial bone loading experiments and sequential ligament sectioning. Consequently, these rigid biomechanics models do not reproduce the coupled physiological kinematics, neither in the normal joint nor in the postoperative condition. Therefore, our goal was to build a dynamic finite element model to study the function of the acromioclavicular ligament based on its biomechanical performance patterns using the benefits of computational models.Methods: A three-dimensional bone model is reconstructed using images from a healthy shoulder. The ligament structures were modeled according to the architecture and dimensions of the bone. The kinematics conditions for the shoulder girdle were determined after the osseous axes aligned to simulate the shoulder elevation in the coronal plane and horizontal adduction. Three patterns evaluated ligament function. The peak von Mises stress values were recorded using a clock model that identified the stress distribution. In addition, the variation in length and displacement of the ligament during shoulder motion were compared using a two-tailed hypotheses test. P values < 0.01 were considered statistically significant.Results: The peak von Mises stress was consistently observed in the AIB at 2:30 in coronal elevation (4.058 MPa) and horizontal adduction (2.323 MPa). Except in the position 2:00, statistically significant higher deformations were identified in the two bundles during shoulder elevation. The highest ligament displacement was observed on the Y- and Z- axes. Conclusions: The AIB has the primary role in restricting the acromioclavicular joint during shoulder motion, even though the two bundles of the AC ligament have a complementary mode of action. During horizontal adduction, the SPB appears to prevent anterior and superior translation.

Outcomes following endoscopic-assisted Woodward procedure for Sprengel deformity

Purpose An endoscopic-assisted approach for Sprengel deformity has been previously reported. Our objective was to assess outcomes of the endoscopic Woodward procedure in a series of patients. Methods Retrospective analysis was performed of children with a Sprengel deformity treated between November 2014 and February 2018. Recorded data were demographic, pre- and postoperative active shoulder elevation and deformity severity according to Cavendish. Results A total of 12 children (four girls and eight boys, ten right-sided/two left-sided) with a mean age of nine years two months (3 years 5 months to 16 years 1 month) and mean follow-up 19.8 months (10 to 48) were assessed. Nine children were classified as Cavendish Grade III and three as grade IV, respectively. Mean preoperative active shoulder forward elevation was 100.8° (70° to 120°), while postoperatively it increased to 149.2° (100° to 170°). Mean preoperative scapular high difference was 4.5 cm (2.8 to 5.2), while postoperatively it was 1.33 cm (0 to 2.8). Conclusion The endoscopic assisted Woodward procedure is an effective technique. Further comparative studies will ascertain advantages in functional and cosmetic results compared to the standard Woodward procedure. Level of Evidence Therapeutic study, Level IV

Biomechanical analysis of the right elevated glenohumeral joint in violinists during legato-playing

BACKGROUND: Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements. OBJECTIVE: For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture. METHODS: Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position. RESULTS: The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture. CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.

Pseudoparalysis and pseudoparesis of the shoulder

Background Clinical presentation of massive rotator cuff tears range from pain to loss of active range of motion. Pseudoparalysis and pseudoparesis are defined inconsistently in the literature, but both include limited active with maintained passive range of motion. Objective This article aims to provide a consistent definition of pseudoparalysis and pseudoparesis of the shoulder and show structural and biomechanical differences between these two types of rotator cuff tear with their implications for treatment. Methods A literature review including key and basic papers discussing clinical symptoms, biomechanical differences, and their impact on therapeutic options for pseudoparalysis and pseudoparesis was performed. Results Biomechanically, structural differences between pseudoparalysis (active scapular plane abduction <45°) and pseudoparesis (active scapular plane abduction 45–90°) exist. For massive posterosuperior rotator cuff tears, the integrity of the inferior subscapularis tendon is the most predictive factor for active humeral elevation. Patients with pseudoparalysis have a higher grade of subscapularis tendon involvement (>50%) and fatty infiltration of the subscapularis muscle. Treatment options depend on the acuteness and repairability of the tear. Rotator cuff repair can reliably reverse the active loss of active range of motion in acute and reparable rotator cuff tears. In chronic and irreparable cases reverse total shoulder arthroplasty is the most reliable treatment option in elderly patients. Conclusion The most concise definition of pseudoparalysis is a massive rotator cuff tear that leads to limited active (<45° shoulder elevation) with free passive range of motion in the absence of neurologic deficits as the reason for loss of active elevation. The integrity of the subscapularis tendon is the most important difference between a pseudoparalytic and pseudoparetic (active shoulder elevation 45–90°) shoulder. Decision-making for surgical options depends more on reparability of the tendon tear and patient age than on differentiation between pseudoparalysis and pseudoparesis.

Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair

Background: Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR). Purpose: To investigate scapular dyskinesis, proprioception, and functional level after ABR. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living. Results: The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group ( P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls ( P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation ( r = –0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score ( r = 0.58; P = .03). Conclusion: Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.