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The complexity of shoulder mechanics combined with the movement of skin relative to the scapula makes it difficult to measure shoulder kinematics with sufficient accuracy to distinguish between symptomatic and asymptomatic individuals. Multibody skeletal models can improve motion capture accuracy by reducing the space of possible joint movements, and models are used widely to improve measurement of lower limb kinematics. In this study, we developed a rigid-body model of a scapulothoracic joint to describe the kinematics of the scapula relative to the thorax. This model describes scapular kinematics with four degrees of freedom: 1) elevation and 2) abduction of the scapula on an ellipsoidal thoracic surface, 3) upward rotation of the scapula normal to the thoracic surface, and 4) internal rotation of the scapula to lift the medial border of the scapula off the surface of the thorax. The surface dimensions and joint axes can be customized to match an individual's anthropometry. We compared the model to \"gold standard\" bone-pin kinematics collected during three shoulder tasks and found modeled scapular kinematics to be accurate to within 2 mm root-mean-squared error for individual bone-pin markers across all markers and movement tasks. As an additional test, we added random and systematic noise to the bone-pin marker data and found that the model reduced kinematic variability due to noise by 65% compared to Euler angles computed without the model. Our scapulothoracic joint model can be used for inverse and forward dynamics analyses and to compute joint reaction loads. The computational performance of the scapulothoracic joint model is well suited for real-time applications; it is freely available for use with OpenSim 3.2, and is customizable and usable with other OpenSim models.

Background Cases of scapular fractures with fragments displacing into the thoracic cavity via intercostal spaces are exceedingly rare in clinical practice. According to the literature, there have been no prior reports of distal lateral margin fractures of the scapula that displace into the thoracic cavity. Case presentation We reported a case of a patient who presented with right shoulder pain and limited mobility after a fall. Examination revealed fractures of the medial and lateral margins of the right scapula, with the distal end of the lateral margin having detached from the inferior angle of the scapula and penetrating the thoracic cavity through the second intercostal space. Therefore, there existed the possibility of a pleural breach. We opted to perform an operation of open reduction and internal fixation via the Judet approach, during which it was confirmed that the fracture fragments were in contact but didn’t perforate the pleura, thereby avoiding complications such as pneumothorax. The use of plates on both the medial and lateral columns, together with the sturdy scapular spine, formed a triangular structure that stabilized the fracture. At the six-month postoperative follow-up, the patient demonstrated favorable clinical outcomes. Conclusion Surgical approaches are increasingly becoming minimally invasive. In this complex case of scapular fracture, we chose a sufficiently exposed large incision surgical approach to provide a clear view of the fracture fragment that was directed toward the pleura. The non-thoracotomy approach, avoiding the complication of pneumothorax and ensuring rigid fracture fixation, represented an alternative form of “minimally invasive” surgery.

The studies presented in this paper constitute the first scientific attempt to interpret the manner whereby notched implements made of scapulae were made and used. These implements have been found at numerous European and non-European sites, usually dated to the Neolithic-Early Iron Age (predominantly the Early Bronze Age). Research has examined these products since the beginning of the 20th century, resulting in the development of several hypotheses regarding their functions. This paper presents the analysis results of 41 such artefacts from the early Bronze Age defensive settlement in Bruszczewo (central Poland). This is the largest collection of these products from a single site worldwide. The artefacts were subjected to multi-aspect traceological tests (both technological and functional) using optical, metallographic, and scanning electron microscopes. The residues identified on their surfaces were analysed using optical microscopy and scanning electron microscopy and energy dispersive X-rays spectroscopy. Moreover, the studies reported herein involved extensive experimental research. Consequently, the chain of operations followed in producing these tools was reconstructed and the use-wear traces present on their surfaces were classified; it was determined that these tools were most likely used for threshing cereals but might also have been used for threshing legumes. This is the first proof of threshing in central Europe in the Early Bronze Age and the first scientifically substantiated hypothesis regarding the function of these important artefacts.

Myofascial trigger points (MTrPs) and body postural misalignment, including the position of the scapula, can contribute to the onset and persistence of musculoskeletal pain. However, the relationship in asymptomatic cases remains unclear. Therefore, this study aimed to investigate the relationship between the asymmetry of the resting scapular position and latent MTrPs in the upper trapezius muscle (UTM) in asymptomatic adults. A total of 32 asymptomatic adult men (mean age, 26.28 ± 1.1 years) were included in this study. Full-body photographs were taken from the posterior view, with the participants resting in a standing position. To determine the degree of asymmetry of the resting scapular position, the horizontal scapular alignment angle (HSAA) was analyzed from the photographs. The assessor identified the presence of latent MTrPs in the right and left UTMs. The HSAA was significantly lower in the group with latent MTrPs in the right UTM than in those without latent MTrPs. The results showed that the right scapula was more depressed than the left scapula in the group with latent MTrPs in the right UTM. Furthermore, multiple regression analysis indicated that the dominant arm and presence of latent MTrPs in the right UTM significantly contributed to the prediction of the HSAA. The results of this study demonstrated a close relationship between the asymmetry of the resting scapular position and latent MTrPs in the UTM in asymptomatic adults, which may contribute to the onset and persistence of musculoskeletal pain.

Introduction. Morphometrics can quantify a trait of evolutionary significance and deduce something of their ontogeny or evolutionary relationships. The present study intends to establish the morphometric criterion of scapula in North Indians. This is of definite significance as bone morphology is known to be influenced by cultural, environmental and racial factors. Materials and methods. The present study was carried on 100 adult scapulae of unknown sex obtained from Department of Anatomy, Government Medical College, Amritsar. The parameters studied were length of scapula; maximum breadth of scapula; superoinferior length, transverse breadth and depth of supraspinous fossa; length of infraspinous fossa, maximum breadth of infraspinous fossa, infraspinous fossa breadth, groove for circumflex scapular vessels and its distance from lateral angle and inferior angle, ridge between origin of teres minor and teres major on lateral border of infraspinous fossa, length of attachment of teres minor on infraspinous fossa, length of attachment of teres major on infraspinous fossa; scapular index and infraspinous index. Results. The values of the parameters were found to be more on the right side except superoinferior length of supraspinous fossa, mean distance of the groove from the lateral angle and inferior angle. Mean scapular index and mean infraspinous index were 68.30 and 76.40 respectively. Discussion. The various morphologic parameters studied and morphometric values measured in our study can be used to compare the racial characteristics and study the evolutionary aspects in different populations.

Background Scapular dyskinesis, i.e., the deviant mobility or function of the scapula, hampers upper limb function in daily life. A typical sign of scapular dyskinesis is a scapula alata—a protrusion of the shoulder blade during arm elevation. While some reversible causes of scapula alata can be treated with therapy, other, irreversible causes require invasive surgical interventions. When surgery is not an option, however, severe limitations arise as standard approaches for assisting the scapula in daily life do not exist. The aim of this study was to quantify functional improvements when external, i.e., non-invasive, scapula assistance is provided. Methods The study was designed as a randomized controlled crossover trial. Eight participants with a scapula alata due to muscular dystrophy performed arm elevations in shoulder flexion and abduction while unassisted (baseline), externally assisted by a trained therapist, and externally assisted by a novel, textile-based scapula orthosis. Results With therapist assistance, average arm elevation increased by 17.3 ° in flexion (p < 0.001, 95% confidence interval of the mean C I 95 % = 9 . 8 ∘ , 24 . 9 ∘ ), and by 11.2° in abduction (p < 0.01, C I 95 % = 4 . 7 ∘ , 17 . 7 ∘ ), constituting the potential of external scapula assistance. With orthosis assistance, average arm elevation increased by 6.2° in flexion ( C I 95 % = 0 . 4 ∘ , 11 . 9 ∘ ) and by 5.8° in abduction ( C I 95 % = 3 . 0 ∘ , 8 . 5 ∘ ). Remarkably, in three participants, the orthosis was at least as effective as the therapist. Moreover, orthosis assistance reduced average perceived exertion by 1.25 points (Borg Scale) when elevating a filled bottle during a simulated daily living task. Conclusion These findings indicate a large potential for future advancements in orthotics. Already now, the textile-based scapula orthosis presented here is a feasible tool for leveraging the benefits of external scapula assistance when a therapist is unavailable, as encountered in daily life scenarios. Trial Registration ClincalTrials.gov (ID NCT04154098). Registered: November 6th 2019, https://clinicaltrials.gov/ct2/show/NCT04154098?term=scapula+orthosis&draw=2&rank=1 Graphic abstract

While several biomechanical investigations have measured acromion and scapular spine strains for various pathological conditions to better understand the risk factors for fracture, no study has measured strains in the native shoulder. The objective of this study was to use an ex-vivo shoulder motion simulator to measure principal strain during continuous, unconstrained, muscle-driven motion of the native shoulder. Eight cadaveric specimens (57 ± 6 years) were used to simulate scapular plane abduction (27.5 to 80° of humerothoracic elevation), forward flexion (27.5 to 72.5° of humerothoracic elevation), external rotation (0 to 40° of external rotation), and circumduction (elliptical path) with glenohumeral rotation speeds of 10°/s. Principal strain was measured throughout motion in four clinically relevant regions of the scapular spine and acromion according to the Levy classification using tri-axial strain gauge rosettes. Increases in humeral elevation during scapular plane abduction and forward flexion were associated with increases in deltoid force and scapula strain. However, above approximately 60° of humerothoracic elevation, strains plateaued while deltoid forces continued to increase indicating that scapula strain patterns are influenced by deltoid force magnitude and direction. Scapula strain was higher during scapular plane abduction than forward flexion in all regions but was only significantly higher in Levy 3B (p = 0.038). The highest strains were observed in Levy regions 2 and 3A (p ≤ 0.01) which correspond to regions with the highest clinically observed fracture rates demonstrating that the shape of the acromion and scapular spine may influence strain distribution irrespective of the joint condition.

The shoulder is a closed-chain mechanism that balances the mobility required by the ranges of motion in normal activities with the stability required to act as a stable ball and socket base for those activities. The scapula plays key roles in the closed-chain mechanism by being mobile enough to place the glenoid in optimal relation to the humerus to facilitate concavity/compression and by being a stable base for coordinated muscle activation to compress the humerus into the glenoid. Scapular dyskinesis alters these roles and is frequently present in many types of glenohumeral instability. It may create or exacerbate the abnormal glenohumeral kinematics in instability. Clinical evaluation methods can demonstrate scapular dyskinesis, and if dyskinesis is present, rehabilitation for the dyskinesis should be included in the non-operative, preoperative, or post-operative treatment. Rehabilitation for scapular dyskinesis can be performed by specific protocols and is more successful in muscle-predominant instabilities such as multidirectional instability and repetitive microtrauma instability. Level of evidence V.

The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. The areas covered included the scapula and shoulder injury, the scapula and sports participation, clinical evaluation and interventions and known outcomes. Major conclusions were (1) scapular dyskinesis is present in a high percentage of most shoulder injuries; (2) the exact role of the dyskinesis in creating or exacerbating shoulder dysfunction is not clearly defined; (3) shoulder impingement symptoms are particularly affected by scapular dyskinesis; (4) scapular dyskinesis is most aptly viewed as a potential impairment to shoulder function; (5) treatment strategies for shoulder injury can be more effectively implemented by evaluation of the dyskinesis; (6) a reliable observational clinical evaluation method for dyskinesis is available and (7) rehabilitation programmes to restore scapular position and motion can be effective within a more comprehensive shoulder rehabilitation programme.

An evidence regarding which bony flap for reconstruction of mandibular defects following tumour resection is associated with the highest survival rate is still lacking. This network meta-analysis (NMA) aimed to guide surgeons selecting which vascularized osseous flap is associated with the highest survival rate for mandibular reconstruction. From inception to March 2021, PubMed, Embase, Scopus, and Cochrane library were searched to identify the eligible studies. The outcome variable was the flap survival rate. The Bayesian NMA accompanied by a random effect model and 95% credible intervals (CrI) was calculated. Twenty-two studies with a total of 1513 patients, comparing four osseous flaps namely fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were included. The respective survival rates of FFF, DCIA, Scapula, and ORFF were 94.50%, 93.12%, 97%, and 95.95%. The NMA failed to show a statistically significant difference between all comparators (FFF versus DCIA (Odd ratio, 1.8; CrI, 0.58,5.0); FFF versus ORFF (Odd ratio, 0.57; CrI, 0.077; 2.9); FFF versus scapula flap (Odd ratio, 0.25; CrI, 0.026; 1.5); DCIA versus ORFF (Odd ratio, 0.32; CrI, 0.037; 2.1); DCIA versus scapula flap (Odd ratio, 0.14; CrI, 0.015; 1.1) and ORFF versus scapula flap (Odd ratio, 2.3; CrI, 0.16; 34)). Within the limitations of the current NMA, FFF, DCIA, Scapula, and ORFF showed a comparable survival rate for mandibular reconstruction. Although the scapula flap reported the highest survival rate compared to other osseous flaps for mandibular reconstruction; however, the decision making when choosing an osseous flap should be based on many factors rather than simply flap survival rate.