Use of unstable exercises in periscapular muscle activity: A systematic review and meta-analysis of electromyographic studies

BackgroundThe use of unstable surfaces has been proposed to increase the neuromuscular demand. This strategy has been adopted to generate an increase in the activity of periscapular muscles due to its role in the stabilization of the scapula. However, the influence of this instability on the EMG activity remains uncertain. The aim of this study was to analyze the effects of using unstable surfaces on the EMG activity of the periscapular muscles.MethodsA comprehensive search in the PubMed, EMBASE, SCIELO, Web of Science, SCOPUS, Cochrane and LILACS databases was undertaken from their year of inception up to December 2019. Studies which directly investigated the EMG activity of periscapular muscles in healthy individuals while performing exercises for the upper limbs in stable and unstable conditions.ResultsA total of 33 studies which evaluated a total of 678 healthy individuals were found according to the eligibility criteria. A meta-analysis identified that the EMG activity of the upper trapezius showed a trivial increase with the insertion of the unstable surface (P = 0.04; SMD = 0.14 [95%CI 0.00, 0.27]). No significant effects were observed on the middle trapezius (P = 0.10) and lower trapezius (P = 0.25). A decrease of the anterior serratus EMG activity with a small effect size was observed by implementing an unstable surface (P = 0.01; SMD = −0.21 [95%CI -0.36, −0.05]).ConclusionThe use of unstable surfaces generated a trivial increase in the upper trapezius activity, and a slight decrease in the anterior serratus activity. No effect was observed on the middle and lower trapezius.     

Functional Outcome of Open Reduction and Internal Fixation of Displaced Extra-Articular Scapula Fractures

BackgroundScapular fractures are uncommon injuries of upper extremity resulting mostly from high-energy trauma. Extra-articular fractures form the majority of them. Un-displaced fractures can be managed conservatively with good results. But displaced fracture does not yield satisfactory results and needs surgical fixation. In this case series, we report our experience about such fractures.MethodsThis was a retrospective study of 12 patients with displaced scapular body and neck fractures treated between 2015 and 2018. Scapular fractures were exposed by modified Judet approach and fixed with either 3.5 mm T buttress or recon locking plate and screws. One case had associated clavicle fracture which was fixed along with scapula. Patients were put on structured rehabilitation and followed up regularly. Functional outcome and range of motion were analyzed.ResultsThe patients included 10 males and two females. Mean age was 42 years. Average follow-up was 33 months. Average constant and Murley score was 80. Excellent results were seen in four patients, good results in seven patients and one patient has got fair result. The mean post-operative range of motion of the shoulder at the time of final follow-up was 140° of forward flexion, 136° of abduction, and 34° of external rotation.ConclusionDisplaced extra-articular scapular fractures managed by internal fixation using T buttress locking plates and reconstruction plates give good functional outcome.     

Tumors of the scapula: A retrospective analysis identifying predictors of malignancy

BackgroundOsseous tumors of the shoulder girdle occur most frequently in the proximal humerus, scapula and clavicle. Prior studies have determined that tumors occurring in the scapula have a higher risk of malignancy, but few have looked exclusively at tumors of this site to describe incidence, clinical features and potential predictors of malignancy. As imaging technologies for diagnosis have improved, it is important to re-evaluate if patterns of incidence have changed and if new imaging findings could potentially be predictors of malignancy.MethodsThis retrospective analysis identified 173 patients from a pediatric and an adult hospital between 1990 and 2015. All patients with tumors of the scapula either of bony origin or with bony invasion were included. Diagnosis, tumor location, and patient demographics were collected. Bivariate and logistic regression analyses were performed to identify potential predictors of malignancy.ResultsChondrosarcoma and osteochondroma were the most common malignant and benign tumors, respectively. Benign tumors were more prevalent in the pediatric population. Tumors occurred most frequently in the body of the scapula.Risk for malignancy increased with age (OR 1.09, 95% CI 1.05–1.12), tumors invading multiple sites (OR 10.85, 95% CI 2.37–49.72) and tumors that were lucent (OR 7.02, 95% CI 1.14–43.21) or had a mixed radiographic appearance (OR 11.47, 95% CI 1.36–99.65).ConclusionsIncluding neoplasia in the differential diagnosis for shoulder complaints is important because the scapula is a site of increased risk of malignancy. Patterns of incidence and prevalence have not changed in the last years with the use of more advance techniques of imaging studies. Older age, lucent or mixed imaging, and tumors that span multiple sites of the scapula were found to be predictors of malignancy. Additional cross-sectional anatomy studies may be warranted for further evaluation in patients presenting with these characteristics given the higher concern for malignant disease.Level of evidenceLevel IV, Prognostic Study.     

保留上肢的肩胛带切除术治疗肩胛带恶性肿瘤

目的 探讨累及肩关节的肩部恶性肿瘤保肢术式的临床疗效.方法 2001年7月至2008年7月采用保留上肢的肩胛带切除术治疗肩胛带恶性肿瘤16例,男11例,女5例;年龄17～67岁,平均38.4岁.8例起源于肩胛骨,软骨肉瘤4例、Ewing肉瘤1例、转移癌3例;5例起源于肩部软组织,滑膜肉瘤2例、纤维肉瘤1例、血管外皮瘤1例、高分化脂肪肉瘤1例;3例起源于肱骨近端,骨肉瘤1例、转移癌2例.经典Tikhoff-Linberg手术12例,改良Tikhoff-Linberg手术4例.结果 手术时间2.5～4.0 h,平均3 h.术中出血1000～3000 ml,平均1600 ml.全部病例随访6～74个月,中位随访时间40个月.2例术前放疗者伤口延迟愈合,1例尺神经损伤.1例肱骨近端骨肉瘤患者出现局部复发及肺转移,行肩胛带离断术后18个月死亡.1例纤维肉瘤患者出现肺转移,23个月后死亡.1例滑膜肉瘤患者术后3个月出现肺转移,随访9个月带瘤生存.5例转移癌患者中4例于术后11～23个月死亡.至随访期末死亡6例,带瘤生存1例,无瘤生存9例.五年总体生存率34.6%.术后3个月接受经典术式者1993年美国骨肿瘤学会功能评分平均14.7分,接受改良术式者为19.5分.结论 对累及肩关节的肩部恶性肿瘤采用Tikhoff-Linberg手术可达到肿瘤广泛切除,保留上肢肢体及部分功能.经典术式术后肩部功能较差.

Abstract：

Objective To evaluate the functional outcomes of different limb salvage procedures in patients with bone and soft tissue sarcomas of the shoulder girdle.Methods From July 2001 to July 2008,16 patients with limb salvage for sarcomas of shoulder girdle were respectively analyzed,including 11 males and 5 females with an average age of 38.4 years (range,17-67).Localizations of the tumors were 8 in the scapula(including 4 chondrosarcomas,1 Ewing sarcoma,and 3 metastases),5 soft tissues of the shoulder girdie(including 2 synoviosarcomas,1 fibrosarcoma,1 hemangioperieytoma,and 1 well-differentiated liposarcoma),and 3 proximal humerus (including 1 osteosarcoma and 2 metastases).Twelve patients were treated with classical Tikhoff-Linberg procedures,and 4 with improved procedures.Results The mean surgical time duration was 3 hours.The mean blood loss was 1600 ml.The mean follow-up time was 40 months.Major complications included 2 cases of delayed wound healing,and 1 ulnar nerve injury.One patient had local recurrence and died of pulmonary metastases 18 months after second operation of interscapulothoracal amputation.The patient with fibrosarcoma also died of pulmonary metastases 23 months later.One patient with synoviosarcoma was alive with pulmonary metastases in 9 months.Four of 5 patients with carcinoma metastases died during 11 to 23 months later.The 5-year cumulative survival rate was 34.6%.Functions were preserved in the whole hand and elbow.The MSTS functional score of the patients receiving classical Tikhoff-Linberg procedures was 14.7,while improved Tikhoff-Linberg procedures was 19.5.Conclusion The Tikhoff-Linberg procedure not only provides a wide resection of tumors in the shoulder girdle but also preserve the whole hand and elbow functions.The shoulder function was poor in patients receiving classical Tikhoff-Linberg procedures.     

太行山地区猕猴肩胛骨变量主成分分析

对４４例成年太行山地区弥猴肩胛骨有关变量进行主成分分析。通过与溪南猴猕猴、川西猕猴入湘鄂猕猴的肩胛骨有关变量进行比较,结果表明,太行山猕猴的肩胛骨变量有较明显的自身特征,与其它猕猴种群之间比较有一定的差异,提示可能与猴猴的种下分类及运动类型的划分有关。     

肩胛骨嗜酸性肉芽肿1例报告并文献复习

目的:探讨肩胛骨嗜酸性肉芽肿临床特点及治疗。方法:报告我院1例肩胛骨嗜酸性肉芽肿病例,结合国内外文献资料,对肩胛骨嗜酸性肉芽肿的临床特点、诊断、鉴别诊断及治疗进行总结。结果:肩胛骨嗜酸性肉芽肿的临床表现无特异性;影像学上表现为溶骨性破坏;须与单纯性骨囊肿、囊状骨结核、骨髓炎等相鉴别;单发的主要治疗方法是手术治疗。结论:影像学检查和病理活检是确诊的关键,单发的肩胛骨嗜酸性肉芽肿以手术治疗为主,多发的考虑放疗。     

Displaced acromion fracture: A rare injury,case report

IntroductionAcromion fractures are extremely rare. There are no common accepted treatment schemes and fixation methods We aimed to present a case which may contribute to the diagnosis and treatment of acromion fracture in a patient with polytrauma.Presentation of caseAcromion fracture associated with scapula and clavicle fractures was diagnosed in 40 years old patient and treated with open reduction and cannulated screw fixation. The fracture healing was completed without causing subacromial impingement.DiscussionIn patients with polytrauma, diagnosis and treatment of acromion fractures can be delayed or overlooked. In improperly treated acromion fractures; pain, movement restriction, subacromial impingement, rotator cuff injury and symptomatic nonunion can occur.ConclusionWe recommend early surgical treatment for displaced acromion fractures, reduction of subacromial space and disruption of the superior shoulder suspensory complex.     

肩胛骨恶性骨肿瘤微波灭活的临床研究

目的 探讨采用微波对肩胛骨原发恶性肿瘤及转移瘤进行原位灭活,保持肩胛骨完整性的可行性和疗效.方法 1998年6月至2008年2月对累及肩胛骨的17例原发恶性骨肿瘤及转移瘤患者采用微波原位灭活进行治疗.男12例,女5例;年龄13～59岁,平均48岁.肿瘤类型:原发恶性骨肿瘤12例,转移瘤5例.肿瘤部位:14例累及S1区,3例转移瘤同时累及S1和S2区.17例全部采用肩胛骨背侧人路,根据肿瘤累及区域采用弧形或"口"形切口暴露肿瘤,周围软组织在铜网保护下,用2450MHz微波将肿瘤局部温度加热到50℃,持续20 min,然后全部或部分剥离坏死肿瘤组织,保留肩胛骨的支架作用.1例肩胛骨转移性腺癌患者术中切断进入肿瘤的部分腋神经,切除肿瘤后适当游离远、近端直接吻合.结果 手术时间60～180min,平均120min;手术失血量300～100ml,平均460ml.所有患者无严重的术中及术后并发症.随访3个月～10年,平均4.2年.3例肩胛骨Ewing肉瘤患者术后8～24个月出现肺、脑和全身多发性转移而死亡.3例恶性纤维组织细胞瘤患者分别于术后10～22个月因肺转移及全身多发转移而死亡;1例术后6个月复发,带瘤生存.5例肩胛骨转移瘤患者分别于术后6～14个月出现非肩胛骨转移而死亡.其余5例原发恶性骨肿瘤患者随访期间未出现复发或转移.3例患者术后肩关节外展功能受限,前伸、后屈无受限.结论 微波原位灭活手术具有操作简便、疗效可靠、易于推广等优点,是一种理想的治疗肩胛骨恶性肿瘤的手术方法 .     

腋窝入路肩胛盂前缘骨折复位固定的应用解剖学及临床研究

目的探讨腋窝入路肩胛盂前缘骨折复位固定的可行性及临床疗效。方法取两具新鲜成人大体标本(4侧肩关节), 模拟经腋窝入路行肩胛盂前缘骨折切开复位内固定手术。标本置于侧卧位, 于腋后线切开, 经背阔肌前侧肌肉间隙显露肩胛骨侧方, 分离并保护腋神经、旋肱后动脉、胸背神经及旋肩胛动脉等周围重要组织。腋窝入路下术野分为上侧四边区及下侧三边区, 可显露肩胛盂前下侧、肩胛颈及肩胛骨外侧缘全长。2018年4月至2020年12月采用腋窝入路肩胛盂切开复位内固定术治疗肩胛盂前缘骨折13例, 男7例、女6例;年龄(50.38±13.74)岁(范围24～67岁);右肩12例、左肩1例, 均为IdebergⅠa型骨折。采用解剖型支撑钢板固定5例、空心螺钉联合掌骨钢板固定7例、桡骨远端钢板固定1例。术后采用Constant-Murley评分、上肢功能评分(disabilities of the arm, shoulder and hand, DASH)评价临床疗效。结果全部病例均获得随访, 随访时间(13.00±5.97)个月(范围6～26个月)。骨折均在6个月内愈合, 无延迟愈合及畸形愈合。术后3个月Co...     

剪切波弹性成像技术评估肩胛动力障碍患者和健康成人肩胛带肌厚度与弹性模量的对比研究

目的 探讨剪切波弹性成像(SWE)技术定量评估肩胛动力障碍(SD)患者与健康成人肩胛带肌厚度与弹性模量的应用价值。方法 前瞻性病例对照研究。纳入2019年3-9月中国康复研究中心北京博爱医院骨科33例(33肩)SD患者为SD组,其中男10例、女23例,年龄35~71岁;另招募同期健康志愿者32例(61肩)为对照组,其中男10例、女22例,年龄22~74岁。采用二维灰阶超声和SWE测量两组受试者的上斜方肌(UT)、肩胛提肌(LS)、中斜方肌(MT)、菱形肌(RM)、下斜方肌(LT)、前锯肌(SA)的厚度、剪切波速度,并计算弹性模量值。比较SD患者与健康成人的肩胛带肌厚度与弹性模量变化,分析年龄、性别对肩胛带肌厚度与弹性模量的影响。结果 SD患者的LS厚度、UT弹性模量、UT与MT弹性模量比和UT与LT弹性模量比分别为(0.40±0.11)cm、(44.42±29.17)kPa(1 mmHg= 0.133 kPa)、1.59±0.56、1.56±0.63,健康成人分别为(0.47±0.17)cm、(31.00±12.68)kPa、1.30±0.30、1.30±0.30,SD患者LS厚度小于健康成人,UT弹性模量、UT与MT弹性模量比、UT与LT弹性模量比均大于健康成人,差异均具有统计学意义(P值均＜0.05)。同年龄段的SD患者与健康成人比较:青年(18~40岁)SD患者的RM弹性模量为(31.14±3.93)kPa大于健康青年人(23.30±8.24)kPa,中年(41~60岁)SD患者的UT与SA弹性模量比为1.57±0.38大于健康中年人1.30±0.33,老年(61~80岁)SD患者的UT与MT弹性模量比、UT、LS和SA弹性模量分别为1.81±0.68、(53.59±36.99)kPa、(36.54±11.41)kPa、(18.51±8.05)kPa,健康老年人分别为1.40±0.39、(32.01±11.93)kPa、(28.82±9.42)kPa、(13.04±7.23)kPa,老年SD患者均大于健康老年人,差异均有统计学意义(P值均＜0.05)。在SD患者和健康成人中,男性的SA厚度分别为(0.82±0.24) cm和(0.80±0.17)cm,女性分别为(0.63±0.15)cm和(0.69±0.17)cm,男性SA厚度均大于女性;而且在健康成人中,女性的UT弹性模量为(32.91±13.87)kPa,大于男性的(26.77±8.37)kPa:差异均有统计学意义(P值均＜0.05)。在健康成人中,SA厚度、LT弹性模量、SA弹性模量均与年龄增长呈负相关(r= -0.334、-0.416、-0.431),而UT与LT弹性模量比、UT与SA弹性模量比均与年龄增长呈正相关(r=0.317、0.300);在SD患者中,UT与MT弹性模量比、LS弹性模量均与年龄增长呈正相关(r= 0.410 、0.399),而RM弹性模量与年龄增长呈负相关(r=-0.402):差异均具有统计学意义(P值均＜0.05)。结论 SWE可用于定量评估肩胛带肌弹性模量,可反映SD患者肩胛带肌力偶失衡的特点,对SD的预防、早期诊断与精准化康复治疗具有一定的指导意义。