Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study

Gomide, Leandro Cardoso; Carmo, Thiago Côrrea do; Bergo, Guilherme Henrique Moreira; Oliveira, Glauber Araújo; Macedo, Igor Severino

doi:10.1016/j.rboe.2017.06.002

Cited by 27 publications

(44 citation statements)

References 16 publications

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“…This angular evaluation, however, does not take into account the forces of other muscles such as the pectoralis major, the latissimus dorsi and the biceps, which may also contribute to a more accurate predictability of mechanical shoulder overloads, 4 5 6 11 12 since muscle recruitment simplifications are used even in its theorizing. 11 12 13 Passive structures are also not taken into account this evaluation, as in the current models only at the extremes of movement they would have some influence on the forces acting on the shoulder.…”

Section: Discussionmentioning

confidence: 99%

“…Essa avaliação angular, entretanto, não leva em conta as forças de outros músculos como o peitoral maior, o grande dorsal e o bíceps, que também podem contribuir para uma previsibilidade mais precisa das sobrecargas mecânicas do ombro, 4 5 6 11 12 visto que simplificações do recrutamento muscular são utilizadas inclusive na sua teorização. 11 12 13 Estruturas passivas também não são levadas em conta nessa avaliação; pelos modelos atuais, apenas nos extremos de movimento elas teriam alguma influência nas forças atuantes no ombro.…”

Section: Discussionunclassified

“… 1 2 3 O ângulo crítico do ombro (ACO), obtido por meio de avaliações radiográficas, tem sido considerado um importante fator preditivo para essa sobrecarga mecânica. 4 5 Uma análise em ensaio biomecânico também corroborou o estabelecimento dessa correlação. 6 …”

Section: Introductionunclassified

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Estudo duplo-cego randomizado da correlação entre radiografia simples e ressonância magnética na avaliação do ângulo crítico do ombro: Reprodutibilidade e curva de aprendizado

Garcia¹,

Altoe²,

Amaral³

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar a confiabilidade da obtenção do ângulo crítico do ombro (ACO) na ressonância magnética (RM) comparada com esse mesmo ângulo obtido por meio de radiografias, e avaliar a curva de aprendizado do método. Métodos As imagens de radiografias e RMs de 15 pacientes foram avaliadas prospectivamente de forma cega e randômica. O ACO foi medido e comparado entre os grupos e subgrupos. Resultados A média dos ACOs nas imagens de radiografia foi de 34,61° ± 0,67, e, na RM, 33,85° ± 0,53 (p = 0,29). Não houve diferença estatisticamente significativa. Houve curva de aprendizado progressiva na regressão linear entre os subgrupos, de especializando em ombro a especialista e radiologista. Conclusão Não houve diferença estatisticamente significativa entre o ACO por imagens de radiografia e RM. O método da RM parece ter sua eficiência associada a avaliadores mais experientes. Independente da experiência do avaliador, a variabilidade dos dados foi menor nas avaliações por RM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

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Estudo duplo-cego randomizado da correlação entre radiografia simples e ressonância magnética na avaliação do ângulo crítico do ombro: Reprodutibilidade e curva de aprendizado

Garcia¹,

Altoe²,

Amaral³

et al. 2020

Rev Bras Ortop (Sao Paulo)

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“…Rotator cuff retraction can increase the tension of the repair, resulting in poor footprint coverage, and the more severe the rotator cuff retraction is, the longer the patient's disease course and the worse the tendon quality. 35,50,53 Studies have shown that the compression force and shear force of the shoulder joint depend on the CSA, 23,57 and the shear force of the joint increases as the CSA increases, which will cause the shoulder joint to become unstable. Thus, the supraspinatus muscle needs additional force to maintain the stability of the joint.…”

Section: Anatomic Factorsmentioning

confidence: 99%

Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review

Zhao

Luo

Pan

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Retear after arthroscopic rotator cuff repair (ARCR) consistently challenges medical staff and patients, and the incidence of retear after surgery is 10%-94%. The purpose of this study was to identify the risk factors that cause retear after ARCR and provide theoretical guidance for clinical intervention to reduce the occurrence of postoperative rotator cuff retear. Methods: The protocol for this meta-analysis was registered with PROSPERO (CRD42021225088). PubMed, Web of Science, and Embase were searched for observational studies on risk factors for rotator cuff retear after arthroscopic repair. Meta-analytical methods were used to determine the odds ratio or weighted mean difference of potential risk factors related to postoperative rotator cuff retear. Stata 15.1 was used to quantitatively evaluate the publication bias of the statistical results. Results: Fourteen studies from 6 countries with a total of 5693 patients were included. The meta-analysis revealed that the risk factors for retear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score. Conclusion: These findings can help clinical medical staff identify patients who are prone to retear early after arthroscopic repair and develop targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR.

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“…CSAs above 35° (normal range 30°-35°) are associated with an increased risk of RC tear, which is thought to occur through altered deltoid biomechanics. 4 , 5 , 6 , 7 , 8 , 9 , 10 A high CSA results in a more vertical deltoid force vector through 2 mechanisms: (1) the longer acromion increases the lever arm of the deltoid, increasing its mechanical pull; (2) a larger glenoid inclination reduces the vertical deltoid force required to cause proximal migration of the humerus. 11 , 12 , 13 In the face of an increased vertical force vector, a larger compressive force is required by the RC to restore shoulder stability and prevent proximal humeral migration.…”

mentioning

confidence: 99%

The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty

Smith

Liu

Bonar

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The aim of this study was to assess the nature of the middle deltoid muscle insertion onto the lateral acromion by macroscopic, MRI and histologic examination and to, therefore, assess the potential impact of a vertical lateral acromioplasty on the deltoid origin. Methods We assessed the acromial origin of the deltoid in 6 cadaver shoulders by macroscopic, MRI and histologic examination. The cadavers were scanned with T1 and proton density-weighted sequences. H&E- and Masson trichrome-stained histologic sections through the acromion were taken and visualized under polarized microscopy. Results The enthesis of the deltoid muscle consisted of dense birefringent bundles of collagen that blended with the bony endplate of the acromion at all points on its lateral wall. A prominent band of collagen was seen on both MRI and histologic slices, traversing the superior surface of the acromion. It was continuous with the deltoid origin and blended with the superficial fascia of the deltoid laterally. Conclusions The middle deltoid muscle occupies the entire lateral acromion. Clinical Relevance A high critical shoulder angle is associated with rotator cuff tears. A lateral acromioplasty resects the lateral acromion and aims to normalize the critical shoulder angle. However, a vertical lateral acromioplasty may release the middle deltoid origin from the lateral acromion. The superior band of collagen may anchor the middle deltoid to the superior acromion and prevent retraction.

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Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study

Cited by 27 publications

References 16 publications

Estudo duplo-cego randomizado da correlação entre radiografia simples e ressonância magnética na avaliação do ângulo crítico do ombro: Reprodutibilidade e curva de aprendizado

Estudo duplo-cego randomizado da correlação entre radiografia simples e ressonância magnética na avaliação do ângulo crítico do ombro: Reprodutibilidade e curva de aprendizado

Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review

The Lateral Deltoid Originates From the Entire Lateral Wall of the Acromion: MRI and Histologic Cadaveric Analysis Regarding Vertical Lateral Acromioplasty

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