- Morphometric Study of Clavicular Facet of Coracoclavicular Joint in Adult Indian Population. [Journal Article]
- JCJ Clin Diagn Res 2016; 10(4):AC08-11
- CONCLUSIONS: The Indian population showed an incidence of 5.6%, which was comparable to other ethnic groups in world population. The morphometric and side differences could be attributed to the occupational factors and range of movements associated with the CCJ. The CCJ should be borne in mind as a differential diagnosis for thoracic outlet syndrome and in general for shoulder pain.
- Acromioclavicular joint reconstruction using the LockDown synthetic implant: a study with cadavers. [Journal Article]
- BJBone Joint J 2015; 97-B(12):1657-61
- Dislocation of the acromioclavicular joint is a relatively common injury and a number of surgical interventions have been described for its treatment. Recently, a synthetic ligament device has become…
Dislocation of the acromioclavicular joint is a relatively common injury and a number of surgical interventions have been described for its treatment. Recently, a synthetic ligament device has become available and been successfully used, however, like other non-native solutions, a compromise must be reached when choosing non-anatomical locations for their placement. This cadaveric study aimed to assess the effect of different clavicular anchorage points for the Lockdown device on the reduction of acromioclavicular joint dislocations, and suggest an optimal location. We also assessed whether further stability is provided using a coracoacromial ligament transfer (a modified Neviaser technique). The acromioclavicular joint was exposed on seven fresh-frozen cadaveric shoulders. The joint was reconstructed using the Lockdown implant using four different clavicular anchorage points and reduction was measured. The coracoacromial ligament was then transferred to the lateral end of the clavicle, and the joint re-assessed. If the Lockdown ligament was secured at the level of the conoid tubercle, the acromioclavicular joint could be reduced anatomically in all cases. If placed medial or 2 cm lateral, the joint was irreducible. If the Lockdown was placed 1 cm lateral to the conoid tubercle, the joint could be reduced with difficulty in four cases. Correct placement of the Lockdown device is crucial to allow anatomical joint reduction. Even when the Lockdown was placed over the conoid tubercle, anterior clavicle displacement remained but this could be controlled using a coracoacromial ligament transfer.
- Structure of Clavicle In Relation to Weight Transmission. [Journal Article]
- JCJ Clin Diagn Res 2015; 9(7):AC01-4
- CONCLUSIONS: The structure of clavicle between conoid tubercle and area for costoclavicular ligament showed thick compact bone and definite pattern of cancellous bone. This structure of clavicle between conoid tubercle and area for attachment of costo-clavicular ligament transmits weight from lateral to medial direction and this knowledge of clavicular structure will also be useful to orthopedic surgeons to deal with clavicular fractures and other abnormalities.
- Surgical excision of a symptomatic congenital coracoclavicular joint. [Case Reports]
- OOrthopedics 2014; 37(9):e836-8
- The coracoclavicular joint is a rare anatomic variant that consists of an articulation between the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula. The…
The coracoclavicular joint is a rare anatomic variant that consists of an articulation between the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula. The coracoclavicular joint is most often asymptomatic and is found incidentally. A symptomatic coracoclavicular joint is exceedingly rare, with only 17 cases reported from 1915 to 2009. Symptoms may include limited range of motion, paresthesia, and brachialgia with radiation to the ipsilateral extremity. In the case of symptomatic coracoclavicular joints for which treatment data are reported, the response to conservative management with rest, analgesics, and physical therapy has been poor. Operative management resulted in complete resolution of symptoms in most patients and symptomatic improvement in the rest. This article reports the case of a 63-year-old man who presented with chronic left anterior shoulder pain exacerbated by forward flexion and overhead activities. Radiographs and computed tomography scan of the affected shoulder showed a bony articulation between the clavicle and the coracoid process of the scapula. The patient did not achieve long-term relief through conservative measures and corticosteroid injections, so the joint was surgically excised by an open procedure. Intraoperative findings were significant for a fully formed synovial joint with a capsule articulating between the clavicle and the coracoid process. After resection, the patient had minimal residual pain, improved range of motion, and symptomatic improvement with activity. The current case provides further data that the coracoclavicular joint can be the cause of significant shoulder pain and can be treated successfully with total resection of the joint if symptoms do not improve with conservative non-operative measures.
- Two large processes at the acromial end of a clavicle: a case report. [Case Reports]
- HHippokratia 2014; 18(2):183-4
- CONCLUSIONS: Although the conoid process of the clavicle may be congenital and usually articulates with the coracoid process of the scapula, in our case the conoid process was acquired and presented a rough and slightly sharp tip, without any joint surface. It was very interesting that the quadrilateral process found at the anterior border of the same clavicle was probably forming an accessory joint between the clavicle and the humeral head.
- Quantification of perspective-induced shape change of clavicles at radiography and 3D scanning to assist human identification. [Journal Article]
- JFJ Forensic Sci 2014; 59(2):447-53
- Change in perspective between antemortem and postmortem imaging sessions (radiograph to radiograph and surface scan to radiograph) may cause different 2D renderings of the same osseous element compli…
Change in perspective between antemortem and postmortem imaging sessions (radiograph to radiograph and surface scan to radiograph) may cause different 2D renderings of the same osseous element complicating comparisons for identification. In this study, clavicle shape changes due to radiographic positioning and 3D laser scanning were examined in 20 right-side specimens, as pertinent to chest radiograph comparisons. Results indicate substantial changes in clavicle form with short source-to-image receptor distance, elevation of the element from the image receptor, and movement of the element away from the center beam (10% mean square for shape). Although quantitative shape differences were small when the clavicle was in close opposition to the image receptor (3% mean square), important qualitative differences remained with large distances from the center beam (e.g., conoid tubercle presence/absence). The significance of these results for image superimposition and computer-automated-shape-based searches of radiographic libraries to find matching candidates is discussed.
- Symptomatic coracoclavicular joint: incidence, clinical significance and available management options. [Review]
- IOInt Orthop 2011; 35(12):1821-6
- CONCLUSIONS: Symptomatic CCJ is rare, and its rarity leads to lack of awareness in the general orthopaedic community. When symptomatic, CCJ may lead to delayed diagnosis or inappropriate management due to lack of evidence and poor description in most orthopaedic textbooks. Despite its low success rate, conservative treatment is advocated before embarking upon surgical intervention.
- The coracoclavicular ligaments: an anatomic study. [Journal Article]
- SRSurg Radiol Anat 2010; 32(7):683-8
- CONCLUSIONS: The findings are important indices for the accurate reconstruction of the coracoclavicular ligaments in acromioclavicular joint dislocations.
- Posterior approach technique for accessory-suprascapular nerve transfer: a cadaveric study of the anatomical landmarks and number of myelinated axons. [Journal Article]
- CAClin Anat 2007; 20(2):140-3
- Accessory-suprascapular nerve transfer by the anterior supraclavicular approach technique was suggested to ensure transferrance of the spinal accessory nerve to healthy recipients. However, a double …
Accessory-suprascapular nerve transfer by the anterior supraclavicular approach technique was suggested to ensure transferrance of the spinal accessory nerve to healthy recipients. However, a double crush lesion of the suprascapular nerve might not be sufficiently demonstrated. In that case, accessory-suprascapular nerve transfer by the posterior approach would probably solve the problem. The aim of this study was to evaluate the anatomical landmarks and histomorphometry of the spinal accessory and suprascapular nerve in the posterior approach. Dissection of fresh cadaveric shoulder in a prone position identified the spinal accessory and suprascapular nerve by the trapezius muscle splitting technique. After that, nerves were taken for histomorphometric evaluation. The spinal accessory nerve was located approximately halfway between the spinous process and conoid tubercle. The average distance from the conoid tubercle to the suprascapular nerve (medial edge of the suprascapular notch) is 3.3 cm. The mean number of myelinated axons of the spinal accessory and suprascapular nerve was 1,603 and 6,004 axons, respectively. The results of this study supported the brachial plexus reconstructive surgeons, who carry out accessory-suprascapular nerve transfer by using the posterior approach technique. This technique is an alternative for patients who have severe crushed injury of the shoulder or suspected double crush lesion of the suprascapular nerve.
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- Anatomic safe zone of pin insertion point for distal clavicle fixation. [Journal Article]
- JMJ Med Assoc Thai 2005; 88(11):1551-6
- Clavicle fracture is the most common childhood fracture and one of the most common fractures in adults. Only some types of distal clavicular fractures, and dislocation of the acromioclavicular joint,…
Clavicle fracture is the most common childhood fracture and one of the most common fractures in adults. Only some types of distal clavicular fractures, and dislocation of the acromioclavicular joint, require internal fixation. Many surgeons prefer closed pinning; however, the difficulty inserting many of the various kinds of pins from acromion into the medullary canal, of the distal clavicle, means the likelihood of iatrogenic complications from repeated drilling is heightened. The purpose of the present study was to establish what would be the optimum insertion point and direction for safe intramedullary pinning of the distal clavicle. Embalmed cadaveric shoulders (32) were studied. A bone window was created at the distal one-thirds of the clavicle, approximately 1.5 cm medial from the conoid tuberosity - as wide as could be freely, retrogradely drilled into the medullary canal of the distal clavicle. A 2.0-mm Kirschner wire was inserted until it penetrated the acromion. The point of emergence was recorded as ratio compared with the acromial width and length in coronal and sagittal planes, respectively. K-wire directions were measured as the angle between the K-wire and the reference line from the anterosuperior tubercle of the clavicle to the anterior angle of the acromion. The process was repeated until the acromion fractured 304 drillings were performed on 32 specimens. The length of the sagittal vs.coronal pin insertion point from the anterior vs. lateral borders of the acromion divided by its length vs. width averaged 0.325 +/- 0.04 and 0.397 +/- 0.09, respectively. The angle of the K-wire and the reference was 7.69 +/- 3.04 and 14.59 +/- 4.34 degrees in the coronal and horizontal planes, respectively. At 8 and 10 drillings survival was 0.72 (95%CI: 0.53-0.84) and 0.41 (95%CI: 0.24-0.57), respectively. The optimum pin inserting point for fixation of distal clavicle fracture and acromioclavicular joint dislocation is 32.5% and 39.7% of acromial length and width, respectively. If a 2.0-mm K-wire is used for fixation, drilling should not be repeated drilled more than 8 times to avoid sudden, high risk iatrogenic acromial fracture.