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Identifying the glenoid and humeral defect axes: (A) selection of points (blue) on the glenoid rim, (B) adjusting a circle (pink) on the posterior-inferior preserved glenoid rim and tracing the lines (pink) connecting the center of this circle and its intersection with the glenoid rim, (C) identifying the glenoid defect axis (yellow) as the line connecting the ends of the 2 previous lines, (D) defining the mean plane (pink) of the anterior part of the humeral defect, (E) visualization of the posterior part of the humeral defect and identification of the 2 most extreme points (blue) of the V-shaped humeral defect, and (F) identifying the glenoid defect axis (yellow) as the line connecting the ends of the 2 previous points.
Source publication
Background:
Although recurrent anterior shoulder instability (RASI) is a common condition in young patients, no studies to date have measured the 3-dimensional (3D) locked position of the glenohumeral joint during an anterior dislocation. Therefore, our goal was to estimate it with 3D computed tomography (CT) scans.
Methods:
Patients in this pro...
Contexts in source publication
Context 1
... bone defect of the glenoid was identified on the basis of glenoid bone loss quantification methods previously developed. 2,24 The points constituting the glenoid rim were manually selected on the 3D bone model (Fig. 2, A). All of these points were then used to define the mean plane of the glenoid, corresponding to the en face view on which the glenoid bone loss quantification methods were performed. 2,24 On that plane, a circle was manually adjusted on the posterior-inferior preserved glenoid rim (Fig. 2, B), as described in previous studies. 2,24 Two ...
Context 2
... glenoid rim were manually selected on the 3D bone model (Fig. 2, A). All of these points were then used to define the mean plane of the glenoid, corresponding to the en face view on which the glenoid bone loss quantification methods were performed. 2,24 On that plane, a circle was manually adjusted on the posterior-inferior preserved glenoid rim (Fig. 2, B), as described in previous studies. 2,24 Two lines were drawn from the center of this circle to the 2 intersection points between the circle and the glenoid rim ( Fig. 2, B). The line connecting the ends of the 2 previous lines corresponded to the glenoid defect axis (ie, the defect margin of the glenoid eroded area; Fig. 2, C), ...
Context 3
... view on which the glenoid bone loss quantification methods were performed. 2,24 On that plane, a circle was manually adjusted on the posterior-inferior preserved glenoid rim (Fig. 2, B), as described in previous studies. 2,24 Two lines were drawn from the center of this circle to the 2 intersection points between the circle and the glenoid rim ( Fig. 2, B). The line connecting the ends of the 2 previous lines corresponded to the glenoid defect axis (ie, the defect margin of the glenoid eroded area; Fig. 2, C), which was mostly linear in all cases of glenoid bone defects resulting from RASI. 2,24 The glenoid defect axis comes into contact with the bottom of the Hill-Sachs lesion at the ...
Context 4
... glenoid rim (Fig. 2, B), as described in previous studies. 2,24 Two lines were drawn from the center of this circle to the 2 intersection points between the circle and the glenoid rim ( Fig. 2, B). The line connecting the ends of the 2 previous lines corresponded to the glenoid defect axis (ie, the defect margin of the glenoid eroded area; Fig. 2, C), which was mostly linear in all cases of glenoid bone defects resulting from RASI. 2,24 The glenoid defect axis comes into contact with the bottom of the Hill-Sachs lesion at the locked ...
Context 5
... bone defect of the humeral head (ie, the Hill-Sachs lesion) was identified as follows: Points constituting the anterior part of the humeral defect were manually selected on the 3D bone model and used to define a mean plane (Fig. 2, D). The 3D model of the humerus was then cut off from this plane to facilitate the visualization of the posterior part of the humeral defect (Fig. 2, F), which comes into contact with the anterior part of the glenoid at the locked position. From a top-down perspective, the anterior and posterior parts of the humeral defect roughly form a ...
Context 6
... head (ie, the Hill-Sachs lesion) was identified as follows: Points constituting the anterior part of the humeral defect were manually selected on the 3D bone model and used to define a mean plane (Fig. 2, D). The 3D model of the humerus was then cut off from this plane to facilitate the visualization of the posterior part of the humeral defect (Fig. 2, F), which comes into contact with the anterior part of the glenoid at the locked position. From a top-down perspective, the anterior and posterior parts of the humeral defect roughly form a V shape. Finally, the 2 points at the extremities of the posterior part of the humeral defect located at the bottom of this V-shaped defect were ...
Context 7
... 2, F), which comes into contact with the anterior part of the glenoid at the locked position. From a top-down perspective, the anterior and posterior parts of the humeral defect roughly form a V shape. Finally, the 2 points at the extremities of the posterior part of the humeral defect located at the bottom of this V-shaped defect were defined (Fig. 2, E). The line going through these 2 points corresponded to the humeral defect axis (Fig. 2, ...
Context 8
... From a top-down perspective, the anterior and posterior parts of the humeral defect roughly form a V shape. Finally, the 2 points at the extremities of the posterior part of the humeral defect located at the bottom of this V-shaped defect were defined (Fig. 2, E). The line going through these 2 points corresponded to the humeral defect axis (Fig. 2, ...
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Citations
... Both MRI and CT scan have been used to perform these measurements; however, three-dimensional CT scans appear to be the most reliable method by which to assess the on-track versus off-track status of a Hill-Sachs lesion. [89,[103][104][105] Regardless of modality used, many authors advocate using the contralateral glenoid to establish normal width, given that there is minimal side-to-side difference. [94••, 102, 106] The defect size (d) is then calculated as the difference between the contralateral intact glenoid width (D) minus the injured glenoid width [94••]. ...
Purpose
The extent of glenohumeral bone loss seen in anterior shoulder dislocations plays a major role in guiding surgical management of these patients. The need for accurate and reliable preoperative assessment of bone loss on imaging studies is therefore of paramount importance to orthopedic surgeons. This article will focus on the tools that are available to clinicians for quantifying glenoid bone loss with a focus on emerging trends and research in order to describe current practices.
Recent findings
Recent evidence supports the use of 3D CT as the most optimal method for quantifying bone loss on the glenoid and humerus. New trends in the use of 3D and ZTE MRI represent exciting alternatives to CT imaging, although they are not widely used and require further investigation. Contemporary thinking surrounding the glenoid track concept and the symbiotic relationship between glenoid and humeral bone loss on shoulder stability has transformed our understanding of these lesions and has inspired a new focus of study for radiologists and orthopedist alike.
Summary
Although a number of different advanced imaging modalities are utilized to detect and quantify glenohumeral bone loss in practice, the current literature supports 3D CT imaging to provide the most reliable and accurate assessments. The emergence of the glenoid track concept for glenoid and humeral head bone loss has inspired a new area of study for researchers that presents exciting opportunities for the development of a deeper understanding of glenohumeral instability in the future. Ultimately, however, the heterogeneity of literature, which speaks to the diverse practices that exist across the world, limits any firm conclusions from being drawn.
... Ultimately, 13 studies were included in the final qualitative synthesis. A diagram of the study selection process can be seen in Figure 3. Included were 1 study using 2D-CT, 3 6 studies using 3D-CT, 4,5,8,11,20,27 4 studies using MRI, 13,16,18,28 1 study using magnetic resonance arthrography (MRA) and MRI, 21 and 1 study combining CT and MRI. 19 Included in the quantitative analysis were 1 study utilizing 2D-CT, 3 1 using 3D-CT, 11 and 1 MRI study. ...
... Of the 6 3D-CT studies, 5 reported intraobserver and interobserver reliabilities. 4,5,8,20,27 The range of intraobserver reliability within the CT studies was 0.688 to 0.999, with a mean of 0.9046. The range of interobserver reliability within the CT studies was 0.409 to 0.999, with a mean of 0.8164. ...
Background
The glenoid track (GT) concept illustrates how the degree of glenoid bone loss and humeral bone loss in the glenohumeral joint can guide further treatment in a patient with anterior instability. The importance of determining which lesions are at risk for recurrent instability involves imaging of the glenohumeral joint, but no studies have determined which type of imaging is the most appropriate.
Purpose/Hypothesis
The purpose of this study was to determine the validity and accuracy of different imaging modalities for measuring the GT in shoulders with recurrent anterior instability. We hypothesized that 3-dimensional computed tomography (3D-CT) would be the most accurate imaging technique.
Study Design
Systematic review; Level of evidence, 4.
Methods
A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Medline, and Cochrane libraries between database inception and July 2019. We included all clinical trials or cadaveric studies that evaluated imaging modalities for assessing the GT.
Results
A total of 13 studies were included in this review: 1 study using 2-dimensional CT, 6 studies using 3D-CT, 4 studies using magnetic resonance imaging (MRI), 1 study using magnetic resonance arthrography (MRA)/MRI, and 1 study combining CT and MRI. The mean sensitivity, specificity, and accuracy for 2D-CT was 92%, 100%, and 96%, respectively. For MRI, the means were 72.2%, 87.9%, and 84.2%, respectively. No papers included 3D-CT metrics. The mean intraclass correlation coefficients (ICCs) for intraobserver reliability were 0.9046 for 3D-CT and 0.867 for MRI. ICCs for interobserver reliability were 0.8164, 0.8845, and 0.43 for 3D-CT, MRI, and MRA/MRI, respectively.
Conclusion
There is evidence to support the use of both CT and MRI imaging modalities in assessing the GT. In addition, few studies have compared radiographic measurements with a gold standard, and even fewer have looked at the GT concept as a predictor of outcomes. Thus, future studies are needed to further evaluate which imaging modality is the most accurate to assess the GT.
The objective of this structured review was to review how computed tomography (CT) scanning has been used to measure the kinematics of the shoulder. A literature search was conducted using Evidence-based Medicine Reviews (Embase) and PubMed. In total, 29 articles were included in the data extraction process. Forty percent of the studies evaluated healthy participants’ shoulder kinematics. The glenohumeral joint was the most studied, followed by the scapulothoracic, acromioclavicular, and sternoclavicular joints. Three-dimensional computed tomography (3DCT) and 3DCT with biplane fluoroscopy are the two primary imaging techniques that have been used to measure shoulder joints’ motion under different conditions. Finally, many discrepancies in the reporting of the examined motions were found. Different authors used different perspectives and planes to report similar motions, which results in confusion and misunderstanding of the actual examined motion. The use of 3DCT has been widely used in the examination of shoulder kinematics in a variety of populations with varying methods employed. Future work is needed to extend these methodologies to include more diverse populations, to examine the shoulder complex as a whole, and to standardize their reporting of motion examined to make study to study comparisons possible.Graphical Abstract
Objectif : Proposer une alternative fiable, et plus proche de la réalité fonctionnelle, en utilisant une approche isocinétique sectorielle représentée par le calcul de ratios agonistes/antagonistes par plage angulaire de 10°. Matériel et Méthode : Trois études ont été menées, chaque étude portant sur des sites articulaires particulièrement impliqués dans la motricité humaine, et également très concernés par la survenue de blessure en lien avec la balance musculaire des principaux groupes stabilisateurs. Il s'agit respectivement de l'articulation scapulo-humérale (muscles rotateurs interne/externe), de l'articulation fémoro-tibiale (muscles fléchisseurs/extenseurs), et du rachis lombaire (muscles fléchisseurs/extenseurs). Les sujets étaient des volontaires sains, non spécialistes d'une pratique sportive. Les ratios par plage angulaire de 10° étaient comparés entre les plages angulaires et également par rapport aux ratios classiques associés aux valeurs "pic". La reproductibilité était évaluée pour l'ensemble des ratios. Résultats : Nos études ont montré que les ratios par plage angulaire étaient évolutifs au cours du mouvement et significativement différents des ratios classiques. De plus, nos résultats ont mis en exergue une bonne reproductibilité absolue des ratios associés aux plages angulaires de 10°. Conclusion : La méthode sectorielle associée aux plages angulaires de 10° permet une évaluation fiable et pertinente de la balance musculaire
Objectives
Physiological and functional ratios of internal and external rotators are used to assess the muscle balance of shoulder joint. Ratios are usually calculated from the peak torque value (PT) of each muscle group, without taking into account the angular positions at which PT are reached. The aim of our study was to propose an alternative and reliable method based on sectorial analysis for isokinetic assessment of the shoulder muscle balance.
Method
22 men (23.0±2.7y) participated in isokinetic tests of the muscle rotators in a seated position in scapular plane, at 60°.s⁻¹, in concentric (CON) and eccentric (ECC) modes for both shoulders. Peak torque (PT) and torque averaged per range of 10° (T) were calculated for internal and external rotators. Physiological and functional ratios were calculated with classic peak approach (PT-ratios) and new sectorial approach (T-ratios).
Results
PT-ratios and T-ratios were different (P<0.05). T-ratios were different between the angular ranges (P<0.05). The reliability was variable as function of angular ranges. The majority of the T-ratios calculated over non-extreme angular ranges were more reliable than PT-ratios (intraclass correlation coefficient=0.14-0.75; coefficient of variation=7.0-28.5%).
Conclusions
The angular range method showed a better reliability than the peak torque method. Angular range method better reflects the functional reality because it takes into account the muscular potential in its entirety of the range of movement.
