Scapular fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
The scapula is part of the shoulder girdle. It is attached to the axial skeleton by the clavicle via the acromioclavicular (AC) and sternoclavicular (SC) joints. This articulation chain maintains a constant distance between the scapula and the sternum. The scapula is located on the posterior chest wall between the second and seventh ribs and is held in this position by the tone of the attached muscles, mainly the upper part of the trapezius and the levator scapulae. The angle between the scapula and the frontal plane is approximately 30 degrees. The scapula is primarily responsible for providing efficient support to the humeral head in all positions of the arm. Smooth motion of the scapula over the chest wall is possible thanks to the gliding fibro-fatty tissue that fills the space between the muscles covering the anterior surface of the scapula and those of the chest wall.
In-Patient Rehabilitation of the Coronary Artery Bypass Surgery Patient and the Heart Transplantation Patient
Mary C. Singleton, Eleanor F. Branch in Advances in Cardiac and Pulmonary Rehabilitation, 2018
Depending on his medical/hemodynamic stability, the patient begins active-assisted exercises, progressing to active arm and leg exercises. The leg exercises have been described previously. The arm exercises include bilateral shoulder flexion and extension, shoulder abduction and shoulder elevation within the patient’s comfort. These range of motion exercises are necessary to avoid muscle shortening in the shoulder girdle musculature, and are done bilaterally to avoid shifting of the sternum and to allow normal healing to occur. Active exercises of neck rotation, flexion, extension and lateral flexion may be started. In the intensive care unit (ICU), care must be taken to avoid shoulder flexion and abduction beyond 90 degrees if the patient has a Swan-Ganz catheter in position, as movement may move the balloon tip out of position.29
Upper limb symptoms and signs
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
This should be assessed in the principal muscles around the shoulder girdle: The deltoid is assessed by abduction against resistance.The serratus anterior is assessed by asking the patient to push against a wall with both hands. The scapula should remain close to the thorax, but if there is weakness it becomes more prominent.Pectoralis major may be assessed by asking the patient to push both hands into their waist.
The Benefits of Preserving the Coracoid Process and Its Attachments
Published in Journal of Investigative Surgery, 2020
The shoulder girdle consists of the scapula, proximal humerus, 1/3 lateral clavicle, and soft tissue attachments. The proximal humerus is the most common site for malignant tumors in the shoulder girdle [1, 2], and chondrosarcoma and osteosarcoma are common types of tumor. The functional components around the proximal humerus are comprised of the deltoid, brachialis, remaining rotator cuff musculature, latissimus dorsi, subscapularis, and parts of the triceps. The characteristics of this area make it very difficult for surgeons to excise the tumors while attempting to maintain the maximum function and appearance of the shoulder joint. For the treatment of malignant tumors in the proximal humerus, upper limb amputation has been replaced with limb sparing surgery at present. Clinicians perform tumor excision surgery prior to performing artificial prosthesis replacement surgery. Hence, patients must undergo a surgery before carrying on with the functional anatomic reconstruction procedures. After going through this process, patients could experience an increase in quality of life with less psychological burden as a result of preserved shoulder joint function and an intact upper limb contour.
The extent of brachial plexus injury: an important factor in spinal accessory nerve to suprascapular nerve transfer outcomes
Published in British Journal of Neurosurgery, 2020
Kevin Rezzadeh, Megan Donnelly, Dorice Vieira, David Daar, Ajul Shah, Jacques Hacquebord
Our study established a statistical association between multiple levels of brachial plexus injury and shoulder strengths postoperatively. The poorer results seen in patients with greater extent of injury could be explained in part by innervation of muscles involved with shoulder abduction or external rotation outside of the upper brachial plexus.3,17–19,23 The shoulder girdle involves numerous muscles. Several of these muscles are innervated by intraplexal nerves. Therefore, while their contribution to shoulder motion is less pronounced than the rotator cuff or deltoids, they nevertheless do play a meaningful role.23 Therefore, the greater extent of the brachial plexus injury, the fewer of these muscles will be present to function on the shoulder girdle. However, we do not believe that the significant decrease in patients that obtain MRC scores greater than or equal to 4 can be largely attributed to muscles such as the rhomboids, upper trapezius, or pectoralis minor that contribute on scapulothoracic motion.3
Trunk Control and Upper Limb Function of Walking and Non-walking Duchenne Muscular Dystrophy Individuals
Published in Developmental Neurorehabilitation, 2021
Ana Lucia Yaeko da Silva Santos, Flaviana Kelly de Lima Maciel, Francis Meire Fávero, Luis Fernando Grossklauss, Cristina dos Santos Cardoso de Sá
Throughout the disease progression, the muscles responsible for shoulder girdle stability have their function compromised,26 which makes it necessary to raise the upper limbs.27 Shoulder girdle stability is assessed from the upper thoracic control, as from this level, the individual needs to maintain the upper limb in abduction in a static, active, and reactive manner. Most non-walking individuals did not have shoulder girdle stability nor difficulty in raising their upper limbs. These results indicate that the decline in muscle function is accompanied by adaptations or functional limitations that DMD individuals present throughout the progression. Therefore, clinical assessments such as PUL can detect muscle weakness early in the disease and allow preventive contracture interventions and minimization of functional decline.28