Quantification of the deltoid muscle height in the region of the coraco-acromial ligament – An ultraso-nographical study (original) (raw)
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Morphological Variations of the Coraco-Acromial Ligament: A Cadaveric Study
International Journal of Anatomy and Research
The coraco-acromial ligament forms coraco-acromial arch along with acromion and coracoid process of scapula which prevent the superior humeral head displacement. It plays a key role in the pathoetiology of sub-acromial impingement syndrome when there are no significant bony abnormalities. Material and Methods: In the present study we have studied 120 formalin preserved upper limbs (right: 60; left: 60) of unknown age and sex. Each shoulder was dissected carefully to see coraco-acromial ligament. The CAL was identified with careful blunt dissection to prevent overlooking any thinner bands. We observed the number of bands present and shape of the ligament. Photographs were taken. Results: Different morphological subtypes of coraco-acromial ligament were observed and classified according to Kesmezacar et al. Type II (28.33 %) was the most common then type I (25 %), type IV (17.5 %), type V (15 %), type III (11.66%). Anterolateral band of ligament extended antero-laterally to form coracoacromial falx in 51%. Discussion: Coraco-acromial ligament shows different morphological variations in Indian population. Knowledge of morphological variations of coraco-acromial ligament will be helpful for orthopedic surgeon for clinical and intraoperative decision while dealing with sub-acromial impingement syndrome.
Geometric Morphology of the Coracoacromial Ligament: A Cadaveric Study
BioMed Research International, 2019
The coracoacromial ligament (CAL), which restrains superior displacement of humeral head, connects the acromion and coracoid process. Due to the ligament’s variations and its role in shoulder pain, CAL was investigated in this study. Sixty shoulders of 34 cadavers, from persons aged 61-98 (80.95 ± 8.81) years at death time, were dissected. The lengths of lateral (LBL) and medial borders (MBL), widths of acromial (AIW) and coracoid insertions (CIW), and thicknesses of lateral (LSTAI) and medial (MSTAI) sides of acromial insertions were measured by digital caliper. The data were subjected to statistical analysis. 24 (40%) V-shaped, 12 (20%) broad-banded, 9 (15%) quadrangular, 9 (15%) Y-shaped, and 6 (10%) multiple-banded types were identified. The mean total LBL, MBL, AIW, CIW, LSTAI, and MSTAI were 34.94 ± 4.59 mm, 33.58 ± 5.31 mm, 29.82 ± 9.48 mm, 12.62 ± 3.95 mm, 1.29 ± 0.17 mm, and 0.90 ± 0.22 mm, respectively. The mean LBL (39.12 ± 4.29 mm), MBL (36.48 ± 3.9 mm), and CIW (37.01 ±...
Anatomical variations of the acromial and coracoid process: clinical relevance
Surgical and Radiologic Anatomy, 2020
Purpose The acromial and coracoid process morphology is of clinical relevance due to associations with functional limitations and shoulder pathology. Our objective was to describe the anatomical characteristics of the acromial and coracoid process using computed tomography (CT). Methods Descriptive, observational, transversal and retrospective study. A total of 155 CT of patients without shoulder pathology, of both genders, and indistinct age were evaluated and grouped by age: Group 1 < 25 years; group 2 25-40 years; group 3 > 40 years. The following parameters were evaluated: Acromial type (AcT), vertical coracoid distance (VCD), acromial tilt (AT), acromial projection (AP), critical shoulder angle (CSA), type of the subcoracoid outlet (TSO), and the area of the subcoracoid outlet (ASO). Results Statistically significant differences were found between men and women for VCD (14.44 ± 4.79 vs. 11.76 ± 4.00 mm; p < 0.001) and AP (3.66 ± 4.71 vs. 1.62 ± 4.99 mm; p < 0.05) as well as between age groups 1 and 3 for AT (35.08 ± 11.53 vs. 28.41 ± 6.60; p < 0.05) and ASO (398.99 ± 153.91 vs. 255.56 ± 124.58 mm 2 ; p < 0.001). An unexpected high ASO variation was identified with 11% of S-shaped acromion and 1.3% clock-shaped TSO. Conclusion The age group between 25-40 years had the most uniform distribution of data. There is a high morphological variability present in an asymptomatic population, which should be considered in the clinical assessment such as shoulder impingement syndrome.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2018
To perform a quantitative anatomic evaluation of the (1) coracoid process, specifically the attachment sites of the conjoint tendon, the pectoralis minor, the coracoacromial ligament (CAL), and the coracoclavicular (CC) ligaments in relation to pertinent osseous and soft tissue landmarks; (2) CC ligaments' attachments on the clavicle; and (3) CAL attachment on the acromion in relation to surgically relevant anatomic landmarks to assist in planning of the Latarjet procedure, acromioclavicular (AC) joint reconstructions, and CAL resection distances avoiding iatrogenic injury to surrounding structures. Ten nonpaired fresh-frozen human cadaveric shoulders (mean age 52 years, range 33-64 years) were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. The ligament and tendon attachment perimeters and center points on the coracoid, clavicle, and acromion were identified and s...
2014
The coracoacromial ligament represents a strong triangular band, which extends between the coracoid process and the acromion. Its function is related to the formation of vault for the protection of the humeral head together with the acromion and the coracoid process. During routine dissection in the section hall of the Department of Anatomy and Histology in Medical University-Sofia we came across a very interesting variation of the coracoacromial ligament. It consists of two parts joining together to the acromion. These bands attached respectively to the apex and the base of the coracoid process. There is a fibrous connective tissue and a gap between two bands of the coracoacromial ligament. Two bands combined in a common portion joining together to the acromion. We observed the presence of a deformation of the humeral head and the osteoarthritis in the shoulder joint. The severe osteoarthritis changes were accompanied with the absence of cartilage on the humeral head in the investigated shoulder joint. In our case the question arises whether the ligament is adherent intimately to the undersurface of the overlying anterior deltoid muscle especially the deltoid fascia. It may be the main reason for the impingement syndrome during lifetime. The impingement syndrome very often is a cause for the pain in shoulder and may lead to operative treatment, which in turn leads to a period of temporary disability. It is clear that the variations of the acromion and the coracoacromial ligament are important since, in turn, they can lead to the impingement syndrome. .
Aspects of coracoacromial ligament anatomy of interest ot the arthroscopic surgeon
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1995
Examination was performed on 100 cadaveric specimens to demonstrate the anatomy of the coracoacromial (C-A) ligament. In a substantial number (34 specimens), the bipartite nature of the ligament and the breadth of its insertions were considerably more pronounced than usually perceived through the arthroscope. Supplementing the cadaveric material, 300 dry bone scapulae were examined from museum specimens of older persons. These demonstrated various degrees of transformation of the C-A ligament into bone (enthesopathy) at its acromial insertion. Variations in the patterns of these enthesopathic transformations corresponded to variations in the patterns seen in the cadaver-k material. This variability is of practical importance in a variety of operative procedures. Additionally, the relationship between the acromial insertion of the C-A ligament and the overlying deltoid muscle was examined. An understanding of this relationship is crucial in avoiding complications when operating in this area.
Knee Surgery, Sports Traumatology, Arthroscopy, 2020
Purpose To investigate whether arthroscopic lateral acromion resection can sufficiently reduce the critical shoulder angle (CSA) without damaging deltoid muscle insertion. Methods Ninety patients who underwent arthroscopic rotator cuff (RC) repair were retrospectively analysed. According to the preoperative CSA, patients were categorized as Group I (CSA < 35°) and Group II (CSA ≥ 35°). Additional arthroscopic lateral acromion resection was performed in Group II. The CSA was measured 1 week postoperatively, while RC integrity and the deltoid attachment were assessed at 3, 6 and 12 months via ultrasound. Deltoid function was evaluated using the Akimbo test, in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm. Results Large and massive RC tears were more prevalent in Group II (p = 0.017). In both groups, the CSA reduction was statistically significant (Group I = 1°: range 0°-3°, Group II = 3.7°: range 1°-8°; p < 0.001). When the preoperative CSA was > 40°, the respective postoperative CSA remained > 35° in 83.3% of cases (p < 0.001). Final shoulder strength was correlated with the amount of CSA reduction (rho = 0.41, p = 0.002). The postoperative CSA was higher, but not significantly different (n.s.), in patients with re-torn (36°, range 32°-40°) than with healed RC (33°, range 26°-38°). No clinical detachment or hypotrophy of the deltoid was observed with the Akimbo test and ultrasound evaluation. Conclusions Arthroscopic lateral acromion resection is a safe procedure without affecting deltoid muscle origin or function, and it is effective in significantly reducing the CSA. However, the CSA cannot always be reduced to < 35°, especially in patients with preoperative CSA values > 40°. Level of evidence III.
The coracoacromial ligament: Morphology and study of acromial enthesopathy
Journal of Shoulder and Elbow Surgery, 2005
The coracoacromial ligament (CAL), normally a superior restraint against humeral translation, is frequently involved in rotator cuff impingement pathology. However, surgical excision of the CAL is not always clinically successful. Little anatomic information exists about the morphology and function of this ligament. The CAL and glenohumeral joint in 56 cadaveric shoulders were examined in 31 cadavers. Nineteen dimensional parameters were obtained by direct measurement. In 16 shoulders, specific attention was directed at the anterior band of the CAL. Variation exists in the morphology of the CAL. The most common configuration of the CAL was two distinct ligamentous bands that could be classified anatomically as an anterolateral band (ALB) and posteromedial band (PMB). The ALB commonly extended to the posterolateral aspect of the acromion. Furthermore, it frequently extended anterolaterally to the acromion, ending in a coracoacromial falx. Spur formation had occurred in 10 of 16 shoulders evaluated and always appeared in the ALB. Spur formation in the ALB correlated with a focal CAL that was narrower, less divergent, shorter, and thicker than a diffuse CAL that did not have a spur. The mean angle of diversion between the ALB and PMB, when a spur was present, was 31°compared with 45°when no spur was present. CAL band thickness varied, with the ALB being thicker at the acromion than at the coracoid and the PMB being thicker at the coracoid than at the acromion. During arthroscopic subacromial decompression, failure to visualize the anterolateral corner of the acromion adequately may result in incomplete resection of the CAL, especially if the PMB is mistaken to be the entire liga-ment. Incomplete removal of the CAL may be a factor in clinical failures of arthroscopic subacromial decompression. The preferential location of spurs in the ALB suggests that it is a major load-bearing structure. Furthermore, the ALB is thicker at the acromion, suggesting increased strain. Our data suggest that a possible function of the CAL is to dampen stress on the acromion from muscle activity. (J Shoulder Elbow Surg 2005;14:542-548.)
Shoulder Impingement and its Association with Acromial Morphology- A Review
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Shoulder with its chronic disability recognized by impingement of the rotator cuff beneath the coracoacromial arch. Varying acromial morphology revealed alterations attributable to mechanical impingement. The undersurface of the anterior part of the acromion and the front lip were always implicated. Extrinsic factors caused impingement and tendonopathy, with the antero-lateral acromion 'impinging' on the superior surface of the rotator cuff. The present review clearly describes the acromial morphology and its role as extrinsic causative factor in shoulder impingement. Treatment options for confirmed impingement range from analgesics and physiotherapy to injectable therapy and, open and arthroscopic surgery. In most studies, the results of arthroscopic subacromial decompression are positive, and data suggest that, the operation minimises the occurrence of rotator cuff injuries when compared to a control group. Complete acromionectomy and lateral acromionectomy yielded dismal ...
Reverse shoulder arthroplasty in patients with pre-operative impairment of the deltoid muscle
The indications for reverse shoulder arthroplasty (RSA) continue to be expanded. Associated impairment of the deltoid muscle has been considered a contraindication to its use, as function of the RSA depends on the deltoid and impairment of the deltoid may increase the risk of dislocation. The aim of this retrospective study was to determine the functional outcome and risk of dislocation following the use of an RSA in patients with impaired deltoid function. Between 1999 and 2010, 49 patients (49 shoulders) with impairment of the deltoid underwent RSA and were reviewed at a mean of 38 months (12 to 142) post-operatively. There were nine post-operative complications (18%), including two dislocations. The mean forward elevation improved from 50° (SD 38; 0° to 150°) pre-operatively to 121° (SD 40; 0° to 170°) at final follow-up (p < 0.001). The mean Constant score improved from 24 (SD 12; 2 to 51) to 58 (SD 17; 16 to 83) (p < 0.001). The mean Single Assessment Numeric Evaluation score was 71 (SD 17; 10 to 95) and the rate of patient satisfaction was 98% (48 of 49) at final follow-up. These results suggest that pre-operative deltoid impairment, in certain circumstances, is not an absolute contraindication to RSA. This form of treatment can yield reliable improvement in function without excessive risk of post-operative dislocation. Cite this article: Bone Joint J 2013;95-B:1106-13.