Osteotomy of the Margo Medialis Scapulae to Approach Subscapular and Subrhomboid Tumors. A Technical Note

Purpose: The approach to resect subscapular and subrhomboid tumors needs elevation of the scapula. This is usually performed by detaching the muscles from the margo medialis of the scapula. We wish to communicate our technique of a longitudinal osteotomy of the margo medialis for improved refixation of the muscles. Patients and Methods: 5 patients with subscapular and one patient with a subrhomboid benign tumor were operated on using this technique. Results: All patients achieved stable healing and full functional recovery;only in one patient there was slightly reduced elevation of the arm. Conclusion: Elevation of the muscles inserting into the medial scapular margo with a small rim of bone facilitates refixation and allows for excellent restitution of function.

Scapula Fracture in a Child: Report of a Rare Injury

Scapular fracture is exceptional in children, mainly occurring after high-energy trauma. Radiologic investigations help its diagnosis and classification, which determines its management. We report the case of a 14-year-old patient admitted for blunt trauma of the left shoulder after falling from a speeding car. The diagnosis of a displaced fracture of the body of the scapula was made, and non-operative treatment was indicated and carried out for four weeks, followed by physiotherapy for another four weeks. Nine weeks after the trauma, the mobility of the affected shoulder was equivalent to that of the contralateral shoulder.

Biomechanics of posterior shoulder instability-current knowledge and literature review

Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year,even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare,biomechanical knowledge is limited. The purpose of our study was to perform an extensive literature search,including PubMed and Medline,and to give an overview of the current knowledge on the biomechanics of posterior shoulder instability. The Pub Med/Medline databases were utilized,and all articles related to posterior shoulder instability and biomechanics were included to form a comprehensive compilation of current knowledge. A total of 93 articles were deemed relevant according to our inclusion and exclusion criteria. As expected with any newly acknowledged pathology,biomechanical studies on posterior shoulder instability remain limited in the literature. Current biomechanical models are performed in a static manner,which limits their translation for explaining a dynamic pathology. Newer models should incorporate dynamic stabiliza-tion of both the rotator cuff and scapulothoracic joint. There is a current lack of knowledge with regards to the pathomechanism of posterior shoulder instability,with no consensus on appropriate treatment regimens. Further investigation is therefore required at both basic science and clinical levels.

Assessment of scapulohumeral rhythm for scapular plane shoulder elevation using a modified digital inclinometer

AIM: To develop a better understanding of scapulohumeral rhythm during scapular plane shoulder elevation.METHODS: Thirteen healthy, college-aged subjects participated in this study. Subjects were free from any upper extremity, neck or back pathology. A modified digital inclinometer was utilized to measure scapular upward rotation of the subject's dominant shoulder. Upward rotation was measured statically as subjects performed clinically relevant amounts of shoulder elevation in the scapular plane. Testing order was randomized by arm position. Scapular upward rotation was assessed over the entire arc of motion and over a series of increments. The percent contributions to shoulder elevation for the scapula and glenohumeral joint were calculated. Scapulohumeral rhythm was assessed and represented the ratio of glenohumeral motion to scapulothoracic motion(glenohumeral elevation: scapular upward rotation). A one-way ANOVA wasused to compare scapular upward rotation between elevation increments.RESULTS: Scapulohumeral rhythm for the entire arc of shoulder elevation was equal to a ratio of 2.34 :1 and ranged from 40.01:1 to 0.90:1 when assessed across the different increments of humeral elevation. Total scapular motion increased over the arc of shoulder elevation. The scapula contributed 2.53% of total motion for the first 30 degrees of shoulder elevation, between 20.87% and 37.53% for 30o-90 o of shoulder elevation, and 52.73% for 90o-120 o of shoulder elevation. Statistically significant differences in scapular upward rotation were identified across the shoulder elevation increments [F(3,48) = 12.63, P = 0.0001].CONCLUSION: Clinically, we must recognize the usefulness of the inclinometer in documenting the variable nature of scapulohumeral rhythm in healthy and injured shoulders.

A complicated case of lung cancer and pulmonary tuberculosis initially presented with painful scapular metastasis in other side

We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor.Same side lung biopsy and histopathological study characterized tuberculosis but biopsy of the left lung lesion identified adenocarcinoma of the lung.The final diagnosis was right scapular metastatic lesion from left lung adenocarcinoma.Musculoskeletal symptoms are commonly encountered in lung malignancies due to paraneoplastic syndrome or hematogenous metastasis but scapular metastasis on the other side as the presentation of lung cancer is extremely rare.

Coracoid Process Fracture: A Report of Two Cases and Brief Review of Literature

Coracoid process of Scapula fracture is not a common entity. Because of its deep anatomic location, they hardly sustain any direct traumatic force. Most of the time, they get fractured by indirect force by the muscles and ligaments attached to them. They are usually associated with fracture of the acromion process of Scapula, acromio-clavicular dislocation and proximal humerus fracture or dislocation of the shoulder joint. They may be missed because more attention is drawn by the obvious injuries. We report two cases of coracoid process fracture, one is associated with fracture dislocation of the shoulder and the other with acromion process fracture.

Shoulder Reconstruction with Massive Scapular-Proximal Humerus Osteoarticular Allograft after Total Scapulectomy for Proximal Humerus Osteosarcoma Recurrence

Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.

Primary Alveolar Soft Part Sarcoma of the Scapula

Alveolar soft-part sarcoma (ASPS) is an uncommon, aggressive soft-tissue neoplasm, occurring in less than 1% of sarcomas. It is typically found in the head and neck tissues in children or in the deep soft tissues of the lower extremities in young adults. This tumor arises primarily within the skeletal muscles or musculofascial planes. Primary involvement of bone is extremely rare. ASPS has poor prognosis with a propensity for recurrence as well as distant metastasis. In this report, we present a 25-year-old male with primary ASPS in the left scapular bone and discuss the histopathological and immunohistochemical features of this sarcoma.

Fire-Needle Acupuncture Treatment in Scapular Muscle Fasciitis

The scapula (shoulder blade) is a large triangular-shaped bone located in the upper back and includes two muscles on each side. The scapula is surrounded and supported by a complex system of muscles that work together to help in the arm movement. If some condition or injury causes these muscles to become imbalanced or weak, the position of the scapula can be altered at rest or in motion. A change in the scapular positioning or motion can make difficulties in the arm movement, especially when performing overhead activities and may cause shoulder weakness. Acupuncture treatment as part of the Traditional Chinese Medicine is most commonly used treatment for treating musculoskeletal disorders. In the treatment of scapular muscle fasciitis the fire-needle acupuncture gave the fastest and best results in our practice. The aim of the treatment is to break up the scar tissue and the adhesions which commonly form at the site, to relax the levator scapula muscle and restore local normal blood and energy flow. In the research are included 13 patients, 6 male and 7 female, on age from 24 to 70. All patients had scapular pain and on all was performed fire-needle acupuncture. Most common age groups are 50 - 60, most patients have pain on the right scapula and most of them—9 have done only one treatment. A long-term problem with the scapula muscle can be resolved with only one fire-needle acupuncture treatment.

Innovations with the scapula and subscapular system for head and neck microvascular reconstruction

Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.

Scapular dislocation from trivial trauma： a rare case

Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event.Scapulothoracic dissociation though has been reported,usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury,etc.Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition.Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature.It is a distinct clinical entity and needs to be differentiated from other similar conditions.Here,we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a l0 years old girl.The patient had a recurrence of the dislocation before presenting to us.But she did not have any pre-existing condition for scapular dislocation.

A new cause of snapping scapula and its arthroscopic treatment

Snapping scapula is an uncommon condition described as palpable, audible, or painful crepitus of the scapula that causes diminished quality of life.l Until now it is still a largely under-recognized problem because of its diverse causes. The etiology of the problem is mainly divided into three major categories： bursitis, muscle abnormality, and bony or soft-tissue abnormality.

Cutaneous bronchogenic cyst in the left scapular region of a boy

Background:Scapular bronchogenic cyst(SBC)is rare.Methods:A sinus on a boy's left scapula was excised.Results:Histopathological analysis showed the epithelium with scattered PAS-positive goblet cells was positive for CEA and CK7.Conclusion:SBC should be suspected of a superfi cial scapular skin lesion in children.

Winging of scapula due to serratus anterior tear

Winging of scapula occurs most commonly due to injury to long thoracic nerve supplying serratus anterior muscle.Traumatic injury to serratus anterior muscle itself is very rare.We reported a case of traumatic winging of scapula due to tear of serratus anterior muscle in a 19-year-old male.Winging was present in neutral position and in extension of right shoulder joint but not on ＂push on wall＂ test.Patient was managed conservatively and achieved satisfactory result.

Unilateral rupture of the serratus ventralis muscle in a foal

A 3-year-old Arabian filly with a history of abnormal instability of the scapula of the left foreleg following an accident during training.Unilateral partial rupture of serratus ventralis was diagnosed after ultrasonographic examination of the affected leg in comparison with the other sound leg.