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Background Previous research has established connections between the acromion index (AI), critical shoulder angle (CSA), acromiohumeral distance (AHD), and lateral acromion angle (LAA) with the incidence of rotator cuff tears (RCTs). Despite numerous international studies exploring the variability of shoulder joint morphology and parameters, research incorporating these parameters has yet to be conducted in Somalia. This study aims to analyze and describe the radiological parameters of acromion morphology in the Somali populations. Furthermore, to investigate the relationship of these parameters with rotator cuff tears within the Somali population. Methods The data and physical examination of 188 patients who had a CT scan of the shoulder from 2018 to 2023 were retrospective analyses, including 107 patients (49 females, 58 males) with RCT and 81 patients (20 females, 61 males) with non-RCT. Using Three-dimensional computed tomography (3D-CT), parameters such as the AI, CSA, AHD, and LAA were compared between the RCT and non-RCT groups. Two independent assessors measured Each parameter from anterior views of the scapula. The inter- and intra-observer reliability was evaluated using the intraclass correlation coefficient (ICC). Additionally, the relationship between these parameters and the presence of rotator cuff tears was explored, and the predictive value of each parameter was assessed through receiver operating characteristic (ROC) analysis. Results The results showed excellent intra- and inter-observer reliability, with all ICC values above 0.75. Among these, the CSA exhibited the greatest measurement stability, with an intra-observer ICC of 0.929 and an inter-observer ICC of 0.911. Significant positive correlations were identified between the AI, CSA, and the presence of RCTs, with CSA exhibiting the strongest correlation ( r  = 0.629; P  < 0.001). Additionally, significant negative correlations were found between the presence of RCTs and both AHD (–0.247) and LAA (–0.338; P  < 0.001 for both). The ROC analysis revealed that the CSA is the most effective parameter for identifying the presence of RCT (area under the ROC curve. 0.857). Conclusion The outcome of this study shows that AI, CSA, AHD, and LAA are independent factors associated with rotator cuff tears in the East African, particularly the Somali population. Specifically, larger AI, CSA, and smaller AHD and LAA are correlated with an increased likelihood of RCTs in this population. In patients with shoulder disease suspected of RCTs, using a 3D-CT scan to measure the CSA may be helpful, as it is the best predictor measurement. Clinical trial number Not Applicable.

Background The aim of this study was to evaluate the interobserver reliability of measurements of the Acromiohumeral Distance (AHD) first described by Golding et al., the Critical Shoulder Angle (CSA), the Acromion Index with Glenoid Humeral (GH) and Glenoid Acromial (GA) distances, following the measuring method by Nyffeler et al., the Lateral Acromion Angle (LAA), as well as the morphology of the acromion according to Bigliani and the humeral head position according to Maloney in X-rays and MRI. Furthermore, the study assessed the correlation of measurement results in X-ray with those in MRI for AHD, CSA, GA, GH, AI, and LAA. Methods A total of 187 patients who underwent shoulder joint X-ray and MRI examinations from 09/2016 to 05/2023 were included in the study. Patients with poor imaging quality, arthrosis or radical prior surgeries, like shoulder prosthetic surgery, status post humerus fractures, that have undergone surgery and therefore changed the anatomical features were excluded, what lead to a total study population of 78. X-ray measurements were performed by two observers in the true anteroposterior view, so that the humeral head and the glenoid are shown without overlap, providing a clear view into the joint space. MRI measurements were performed in oblique coronal MRI slices, using the most accurately depicted glenoid surface as a landmark. Results Interobserver measurement results showed a significance with p  < 0.001 for the assessment of acromion type according to Bigliani, humeral head offset assessment according to Maloney, and AHD. No significance was found for interobserver reliability in measuring LAA. Additionally, there was a high correlation of measurement results in X-ray with measurements in MRI for, CSA, GH/GA, and consequently AI, a good correlation for AHD but no correlation could be shown for LAA. Conclusions These findings provide valuable insights into the robustness of radiological parameters for evaluating shoulder pathology, offering promising prospects for clinical applications and further research. Nevertheless, the specific methodological considerations and patient characteristics should be taken into account when interpreting the results to ensure their accurate application in clinical practice.

Subacromial spurs are considered the one of the pathology underlying shoulder impingement syndrome. Furthermore, few studies have focused on the morphology of the subacromial spurs in normal Chinese people. This study aimed to study the spur distribution and to illustrate the morphology of spurs, which may help guide the extent of acromioplasty. A total of 93 normal individuals were enrolled, and both shoulders of all enrolled individuals were analyzed. The subjects were divided and classified into three different groups by ages: group I = 18-40 years, group II = 41-60 years, and group III ≥ 61 years. The osteophyte distribution, osteophyte area, subacromial surface area and osteophyte area/subacromial surface area ratio were measured and illustrated using Mimics and 3-matic software. The shape of the acromion was classified according to the Bigliani and Morrison classification system. The acromial angle was also classified. Then, the relationship between osteophytes, acromial classification and acromial angle was analyzed. Type II (curved shape) was the most common type of acromion, and the hooked shape was a rare form. A significant increase in the left subacromial surface area in males was observed in group III compared with group I (P < 0.001) and group II (P = 0.004). The total spur/subacromial area ratio was significantly higher in group II than I. An obvious increase in the right subacromial area was observed in group III compared with group I (P = 0.004). Furthermore, there was a significant increase in the right spur area (P = 0.021) and total spur/subacromial area ratio (P = 0.006) in females in group II compared with group I. Fewer spurs were observed on the left than on the right side (p = 0.0482). One spur was most common among type II acromions (29/36) (80.56%) on the left side and the right side (34/52, 65.38%). Spurs osteophytes are mainly distributed with an irregular shape and mostly run through the medial and lateral sides of the subacromial surface in normal subjects. The characteristics of subacromial spurs are so diverse that a surgeon must conduct subacromial decompression completely based on the morphology of individual spurs.

Anatomy-based guidelines for shoulder surgery have established the routine preoperative evaluation of the humeral head. Despite recognized sex differences in humeral head size, there has been limited investigation into sex-specific variations in acromiohumeral contact surface (AHCS) arc length. This study aims to assess sex differences in the AHCS arc length within a sample of the Chinese population. We retrospectively analyzed 169 normal shoulder CT images from a single medical center, collected between 2011 and 2021. The AHCS arc length was defined as the distance from the superior glenoid tubercle to the lateral edge of the greater tuberosity, measured using a three-dimensional reconstruction algorithm. Physiological reference values for the AHCS arc length were determined at three abduction angle intervals. Linear regression analysis was used to assess the correlation between the AHCS arc length and abduction angle in both sexes. The reference values for AHCS arc length were significantly lower in women across three abduction angle intervals (male 48.07 ± 3.37 mm vs. female 43.54 ± 2.54 mm, (0–10] °, p < 0.001; male 45.07 ± 2.34 mm vs. female 40.78 ± 2.06 mm, (10–20] °, p < 0.001; male 42.08 ± 2.03 mm vs. female 38.09 ± 2.44 mm, > 20 °, p = 0.001, respectively). Additionally, the AHCS arc length was linearly and negatively correlated with the abduction angle (male R2 = 0.436, p < 0.001; female R2 = 0.434, p < 0.001, respectively). The present study identified a significant sex difference in the anatomical AHCS arc length in a sample of the normal Chinese population. Preoperative assessment of the AHCS arc length may be necessary for certain shoulder surgeries in the future.

Shoulder pain is a common clinical problem affecting most individuals in their lifetime. Despite the high prevalence of rotator cuff pathology in these individuals, the pathogenesis of rotator cuff disease remains unclear. Position and motion related mechanisms of rotator cuff disease are often proposed, but poorly understood. The purpose of this study was to determine the impact of systematically altering glenohumeral plane on subacromial proximities across arm elevation as measures of tendon compression risk. Three-dimensional models of the humerus, scapula, coracoacromial ligament, and supraspinatus were reconstructed from MRIs in 20 subjects. Glenohumeral elevation was imposed on the humeral and supraspinatus tendon models for three glenohumeral planes, which were chosen to represent flexion, scapular plane abduction, and abduction based on average values from a previous study of asymptomatic individuals. Subacromial proximity was quantified as the minimum distance between the supraspinatus tendon and coracoacromial arch (acromion and coracoacromial ligament), the surface area of the supraspinatus tendon within 2 mm proximity to the coracoacromial arch, and the volume of intersection between the supraspinatus tendon and coracoacromial arch. The lowest modeled subacromial supraspinatus compression measures occurred during flexion at lower angles of elevation. This finding was consistent across all three measures of subacromial proximity. Knowledge of this range of reduced risk may be useful to inform future studies related to patient education and ergonomic design to prevent the development of shoulder pain and dysfunction.

Purpose Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark–specific nerve position data. The purpose of this study is to address this gap by investigating such relationships. Method This cadaveric study examines axillary, radial and suprascapular nerves’ relation with acromion, coracoid and greater tuberosity of the humerus (GT). It also correlates this data with humeral lengths and explores nerve dynamics in relation to arm positions. Results The mean distance from the axillary nerve to (i) GT was 4.38 cm (range 3.32–5.44, SD 0.53), (ii) acromion was 6.42 cm (range 5.03–7.8, SD 0.694) and (iii) coracoid process was 4.3 cm (range 2.76–5.84, SD 0.769). Abduction brought the nerve closer by 0.36 cm, 0.35 cm and 0.53 cm, respectively. The mean distance from radial nerve to (i) GT was 5.46 cm (range 3.78–7.14, SD 0.839), (ii) acromion was 7.82 cm (range 5.4–10.24, SD 1.21) and (iii) tip of the coracoid process was 6.09 cm (range 4.07–8.11 cm, SD 1.01). The mean distance from the suprascapular nerve to the acromion was 4.2 cm (range 3.1–5.4, SD 0.575). The mean humeral length was noted to be 27.83 cm (range 25.3–30.7, SD 1.13). There was no significant correlation between these distances and humeral lengths. Conclusion It is essential to exercise caution to avoid axillary nerve damage during the abduction manoeuvre, as its distance from the greater tuberosity and tip of the coracoid process has shown a significant reduction. The safe margins, in relation to the length of the humerus and consequently the patient’s stature, exhibit no significant variation. In situations where the greater tuberosity (GT) and the border of the acromion are inaccessible due to reasons such as trauma, the tip of the coracoid process can serve as a dependable bone landmark for establishing a secure surgical margin.

To establish the test–retest reliability of ultrasound measurements on acromio-humeral distance (AHD) and supraspinatus tendon thickness; and to explore their relationships with shoulder rotational strengths. Test–retest observational study. Thirty-seven individuals (age: 21.5±1.4 years) participated in this study. Twenty-four were University volleyball players with 15 healthy and 9 players with shoulder impingement syndrome (SIS). Thirteen participants were healthy untrained individuals. Ultrasound measurements of AHD and supraspinatus tendon thickness were taken, and isokinetic testing of concentric shoulder internal rotation (IR) and external rotation (ER) at a speed of 90°/s was performed. The measurement of the AHD and the supraspinatus tendon thickness indicated excellent reliability (ICC=0.922, and ICC=0.933 respectively), and the minimum detectable difference (MDD) were 2.10mm and 0.64mm respectively. A cut-off AHD distance of 23.9mm had a sensitivity of 0.67 and specificity of 0.71 (area under curve (AUC): 0.70; p=0.05) in identifying individuals with and without SIS. Hence, individuals with AHD larger than 23.9mm had greater possibility of having SIS. Positive correlations were found in AHD with supraspinatus tendon thickness (r=0.36, p<0.05) and shoulder external rotational strengths (r=0.47–0.62, all p<0.05) and ER/IR ratios (r=0.56–0.58, all p<0.05). Ultrasound measurements of AHD and tendon thickness have excellent reliability. The reported cut-off AHD highlighted the potential role of ultrasound measurements in volleyball players for early identification of SIS. The AHD was related to the supraspinatus tendon thickness and shoulder external rotation strengths. Our findings provide a scientific basis for muscle training in overhead athletes such as volleyball players.

Purpose Recent techniques for acromioclavicular (AC) joint reconstruction focus on additional AC cerclage to coracoclavicular (CC)-reconstructions. Due to the specific slim bone morphology at the acromion, there are concerns regarding these additional bone tunnels, as they may predispose to fracture and break out. The purpose of this study was to investigate anatomic properties of the acromion which may help improve surgical techniques directed at injuries to the AC joint. It was hypothesized that via measurements of thickness and density points of increased strength and support could be identified on the acromion. Methods Eighty-five fresh frozen cadaveric shoulders were used for this study. A standardized 3D-net was developed and thicknesses of the acromion were taken from defined points using a certified caliper. To define the acromial arch, the angle and radius of curvature between the antero-lateral, the highest point of the acromial arch and the postero-lateral aspect of the acromion were measured. Additional bone mineral density (BMD) evaluation was performed on 43 specimens in an anterio-posterior and latero-medial direction using 5-mm slices with a maximum of 10 and 6 slices, respectively. Results Median specimen age was 63.0 (range 36) years (55 female, and 30 male). There was no statistical significance between male (62.0, range: 35 years) and female (64.5, range 32 years) regarding age (n.s.). Thickness of acromion points of interest were ranging from 3.5 to 24.3 mm. Median radius of curvature of acromial arch for female was 48.2 (range 92.7) mm and 66.2 (range 85.6) for male ( p  = 0.019). The median angle for female specimens was 21.4° (range: 44.6°) and 23.3° (range 51.7°) for male ( p  = 0.047). The latero-medial measurements showed significant difference between the region of interest (ROI): 1 and 4, 5, 6 ( p  = 0.001, p  = 0.001, p  = 0.001), 2 and 4, 5, 6 ( p  = 0.007, p  = 0.001, p  = 0.001), 3 and 5, 6 ( p  = 0.001, p  = 0.001), 4 and 5, 6 ( p  = 0.010, p  = 0.001). Antero-posterior measurements showed significant difference between the ROI: 1 and 8 ( p  = 0.031). Conclusion The posterior–medial acromion close to the AC joint revealed the highest BMD with an increasing density from lateral to medial. In combination with thickness measurements this region would support additional anatomical fixation of the AC joint using bone tunnels if necessary. Clinical relevance To anatomically reproduce the insertions of the AC ligaments at the acromion, either bone tunnels or anchors are needed. Therefore, several techniques have been developed. This study provides the anatomical data for these techniques and confirms the reconstructive approach of techniques using anatomical points of fixation and orientation.

IntroductionAnatomical variations of the lateral offset of the acromion (LOA) are supposed to be a factor favoring of the development of rotator cuff tears. The primary objective of this study is to quantify the inter-individual variations of the lateral offset of the acromion.MethodsThe morphology of 103 dried scapula was studied. Scapula with an os-acromiale, fractures and osteoarthritic changes of the glenoid cavity were excluded. We measured the distance between the medial edge of the spine and the supra-glenoidal tubercle of the glenoid fossa (L0), as well as the distance between this medial point and the most lateral point of the acromion (Lmax). Then, the acromial offset = (Lmax − L0), in absolute value (mm) and in relative value (% of Lmax) were calculated.ResultsThe absolute average offset is 3.2 cm (SD = 0.4040 cm), the relative average offset is 23.07% (SD = 2.195%). We observed a non-Gaussian distribution of the LOA, with two peaks of distribution of which average and the median offset measurements are situated between these two distributions.ConclusionThis study shows that there are two different morphologies for the scapula, characterized by the lateral offset of their acromion: small or large lateral offset. Clinical implications in shoulder pathology seem important because the resultant of the constraints applied by the deltoid to the joint would favor either rotator cuff tears, or scapulohumeral arthrosis.

Accurate arm circumference (AC) measurement is required for accurate blood pressure (BP) readings. Standards stipulate measuring arm circumference at the midpoint between the acromion process (AP) and the olecranon process. However, which part of the AP to use is not stipulated. Furthermore, BP is measured sitting but arm circumference is measured standing. We sought to understand how landmarking during AC measurement and body position affect cuff size selection. Two variations in measurement procedure were studied. First, AC was measured at the top of the acromion (TOA) and compared to the spine of the acromion (SOA). Second, standing versus seated measurements using each landmark were compared. AC was measured to the nearest 0.1 cm at the mid‐point of the upper arm by two independent observers, blinded from each other's measurements. In 51 participants, the mean (±SD) mid‐AC measurement using the anchoring landmarks TOA and SOA in the standing position were 32.4 cm (±6.18) and 32.1 cm (±6.07), respectively (mean difference of 0.3 cm). In the seated position, mean arm circumference was 32.2 (±6.10) using TOA and 31.1 (±6.03) using SOA (mean difference 1.1 cm). Kappa agreement for cuff selection in the standing position between TOA and SOA was 0.94 ( p  < 0.001). The landmark on the acromion process can change the cuff selection in a small percentage of cases. The overall impact of this landmark selection is small. However, standardizing landmark selection and body position for AC measurement could further reduce variability in cuff size selection during BP measurement and validation studies.