of the glenohumeral ligaments to the synovial recesses types of arrangement of
On the basis of a cadaver study of 108 shoulders, the variable topographical relationship of the glenohumeral ligaments to the synovial recesses Fig. 23 a gave rise to six distinct variations designs as Types I to VI. There are developmental types for they were present also in infant shoulders. However, because of progressive soft-tissue changes the different types may lose their distinguishing features. The size of both the superior and inferior subscapularis recess, regardless of the type in...
Classification of hidden rotator interval lesions according to Bennett [8
Various lesions of the rotator interval are illustrated in Fig. 20. These include subscapularis tear or intraarticular subscapularis IASS without involvement of the SGHL MCHL complex, Fig. 20 a tears of the SGHL MCHL complex without subscapularis IASS involvement, Fig. 20b and subscapularis IASS tears with involvement of the SGHL MCHL com- Fig. 20. Arthroscopic classification of hidden rotator interval lesions. The various lesions found in rotator interval. Arrows indicate potential direction...
Classification of the extent of rotator cuff tears according to Patte [107
The extent of the lesion is measured in centimetres at the level of the bony insertion. The tears are divided into three groups small, intermediate, and large. A fourth group, characterized by secondary osteoar-thritic OA changes in the humeral head which is usually subluxed , deserves a separate analysis of results. Group I partial tears or full-substance tears measuring less than 1 cm in sagittal diameter at bony detachment Group II full-substance tears of entire supraspinatus Group III...
Classification of fractures of the clavicle according to Allman [1
Fractures of the clavicle may be divided into three groups Group I fractures of the middle third, the most frequent site Group II fractures distal to the coracoclavicular ligament, where nonunion is frequent Group III fractures of the proximal end of the clavicle, where displacement and nonunion are rare Group I fractures of the middle third of the clavicle The mechanism of injury generally is a fall onto the outstretched hand or a fall on the point of the shoulder. When there is displacement,...
according to Kibler and McMullen [68
Scapular dyskinesis is defined as observable alterations in the position of the scapula and the patterns of scapular motion in relation to the thoracic cage. Several factors may create these abnormal patterns and positions. Three-dimensional biomechanical analysis of possible scapular motions shows that the scapula moves around three axes of motion simultaneously. Patterns of abnormal motion in scapular dyskinesis are best observed by first determining the position of the scapula with the...
Classifications of Osteoarthritis of the shoulder
Outerbridge described in 1961 the macroscopic aspect of changes of the articular cartilage for the articular surface of the patella. Meanwhile this classification is generally used for the description of articular cartilage lesions. The macroscopic changes of chondromalacia can be classified into four grades In grade 1 there are softening and swelling of the cartilage. In grade 2 there are fragmentation and fissuring in an area half an inch or less in diameter. Grade 3 is the same as grade 2...
Site T
The local extent of the neoplasm is determined by the staging studies. A T0 lesion is confined within its capsule and remains within its compartment of origin. A T lesion does not have a true limiting capsule, but has compressed the surrounding tissue into a pseudocapsule. Fingerlike projections or isolated nodules of tumour called satellite lesions are found in the reactive zone. Both the lesion and the reactive zone must be contained within the compartment of origin to be designated T A...
Classifications for rheumatoid arthritis
Low-grade, intermediate, and severe involvement. There is a great deal about rheumatoid arthritis that is poorly understood. We do not know its cause or have a specific diagnostic test. In our present state of ignorance, it is helpful in making clinical decisions to classify the disease as low-grade, intermediate, or severe. Post-operative rehabilitation is much easier in those with mild disease. Bone loss is apt to occur more slowly, and they may develop marginal osteophytes similar to those...
Arthroscopic classification of labroligamentous lesions associated with
The aim of the prospective arthroscopic study of 100 patients was to list and classify the capsuloligamentous lesions associated with traumatic anterior chronic instability at three levels the glenoid, the humeral and the mid substance of the IGHL. According to the location Fig. 32 a and according to the importance of the detachment of the labrum around the glenoid, the authors distinguished A classic Bankart lesion was present in half of cases 52 the detachment of the labrum could be located...
Classifications of rotator cuff tears according to Patte [107
1 Extent of the tear see Sect. 5.6 2 Topography of the tear in the sagittal plane 3 Topography of the tear in the frontal plane 4 Trophic quality of the muscle of the torn tendon 5 State of the long head of the biceps Topography of rotator cuff tear in sagittal plane according to Patte 107 Fig. 7 Segment 1 subscapularis tear Segment 2 coracohumeral ligament tear Segment 3 isolated supraspinatus tear Segment 4 tear of entire supraspinatus and one-half of infraspinatus Segment 5 tear of...
State of ACjoint space and SCjoint space according to De Palma [31 28
Of significance was the observation that the lateral one third of the clavicles exhibits varying degrees of anterior torsion. This is readily noted if the clavicle is observed with the sternoclavicular and the acromioclavicular joints intact and if the sternum is placed in a vertical position Fig. 33a . Sixty-six such specimens obtained from cadavers were studies the clavicles fell into one of three types, each of which exhibited specific features Fig. 33b Type 1 in this group the clavicles...
Classifications of proximal humeral fractures
11.1 Classification of proximal humeral fractures according to Neer 93 The classification adopted is based, neither on the level of the fracture nor on the mechanism of injury, but on the presence or absence of displacement of one or more of the four major segments. Since all minimally displaced fractures pose analogous problems in treatment and prognosis, it seems logical that they be grouped together, regardless of the number of fracture lines. Displaced fractures require more accurate...
Classification of fractures of the clavicle according to Neer [95101106
Neer classified the clavicular fractures in three groups 1. Midclavicular fracture middle third 80 Fig. 37 f 2. Fracture of the distal clavicle or interligamentous fracture 15 3. Fracture of the inner clavicle inner third 5 Distal fractures comprise 10 of clavicular injuries and can be classified into two types, depending upon the status of the ligaments Fig. 37 a . Type I resents no problem and requires little or no treatment. It occurs more frequently in ratio of 3 1. The full extent of the...
Classification of SCjoint injury according to Allman [1
This is an injury to the capsule and to the sternoclavicular ligament or A Grade I sprain of the sternoclavicular joint results from a mild medially directed force applied to the lateral aspect of the involved shoulder of from the shoulder being suddenly forced forward. There is no laxity of the joint, and pain is minimum. A Grade II sprain of the sternoclavicular joint is characterized by rupture of the sternoclavicular ligaments without rupture of the costoclavicular ligament. Pain and...
Classification of fractures of the clavicle according to Jager and Breitner [62
In consideration of the treatment, Jager and Breitner expanded Neer's classification of lateral clavicular fractures Fig. 38 . Type I represents the lateral fracture without ligamentous injury with or without involvement of the AC-joint stable . The interligamenteous fractures were distinguished into Type lia with avulsion of the pars conoidea from the proximal fragment unstable Type lib with isolated avulsion of the pars trapezoidea from the lateral fragment moderate unstable Type ill...
Stages of calcifying tendinitis according to Uhthoff [130
The authors discriminate between degenerative calcification and calcifying tendinosis. The incidence of calcification increases with age in cases of degenerative calcification, whereas it peaks during the fifth decade in cases of calcifying tendinits. Moreover, degenerative diseases never exhibit a potential for self-healing. Futhermore, the histologic and ultrastructural features of degenerative calcification and calcifying tendinosis are quite different. The authors proposed that the...
Variants of the origin of the long head of the biceps from the scapula and
One hundred fresh-frozen shoulders were studied. Each specimen was dissected to expose the intact shoulder capsule. The authors then photographed the tendon attachment to the supraglenoid tubercle, recording the percentage of fibres arising from the tubercle, the anterior labrum, and the posterior labrum. Four types of attachment could be distinguished Type I All of the labral part of the attachment was to the posterior labrum, with none to the anterior labrum Fig. 16 a Type II Most was to the...
Extraarticular dislocation combined with a partial tear of the subscapularis
In this type the long biceps tendon is completely dislocated to a point over the lesser tuberosity. The deeper portions of the subscapu-laris tendon still insert into the lesser tuberosity, separating the biceps tendon from the joint space. Invariably there is a rupture of the common attachment of the superior glenohumeral ligament and cor-acohumeral ligament. The biceps tendon, then, is displaced over the anterior wall of the groove and slips or glides medially over the torn fibres of the...
according to Rockwood et al [115
Rockwood modified the classification described by Tossy et al. 129 by adding Type IV, V and VI on the basis of Type 3 injury according to Tossy. Type 1 up to Type 3 are identical to Tossy's classification. The treatment of complete acromioclavicular dislocations remains controversial. However, since the treatment for the majority of type IV, V, and VI injuries is operative, it seems reasonable and practical to remove them from all-inclusive type III category and to create an expanded, more...
Classification of instability according to Silliman and Hawkins [119
The current classification scheme is based on an algorithmic approach. Many factors, such as direction, degree, chronology, cause, frequency, and volition play a role in this scheme Fig. 26 . Fig. 26. Algorithm of classification of instability. From 119 Fig. 26. Algorithm of classification of instability. From 119 7.6 Grading of glenohumeral translation according to Hawkins et al. 57, 119 Glenohumeral translation is assessed also with the patient supine. Here the arm is grasped in a position of...
Classifications of necrosis of the humeral head
14.1 Classification of osteonecrosis of bone according to Cruess 25 Since the diagnosis of osteonecrosis is made on radiologic and clinical grounds, it must be emphasized that the insult that leads to either radiographic changes or symptoms must have occurred at least months earlier. There have been various attempts at staging the development of the lesion to aid in understanding the process and to apply appropriate therapy. The most widely recognized system of staging is that of Marcus et al....
Classifications of scapular fractures
12.1 Classification of scapula fractures according to Euler and Ruedi 37 Basically scapular fractures can be classified into intracapsular and extracapsular fractures. This classification is to be geared to anatomical structures and represents an ascending order of the injury severity. The aim is to give a prognosis to the expected loss of function Fig. 47 . Scapula blade, isolated or comminuted B Fractures of the processes C Fractures of the scapular neck C1 Anatomical neck C2 Surgical neck C3...
Classification of shoulder instability according to Gerber et al [44 45 118
Hyperlaxity can be combined with instability, however it is not a primarily disease, but it characterises an individual constitution. Therefore multidirectional instability should be distinguished from multidirectional hyperlaxity and should be considered into a classification of shoulder instability. This differentiation of laxity and instability lead to the following classification 2 Unidirectional instability without hyperlaxity 3 Unidirectional instability with hyperlaxity 4...
Classification of clavicular fractures according to Craig [24
On the base of Allman's classification Craig introduced in 1990 a more detailed classification of clavicular fractures that was based on the variable fracture patterns seen within the three broad groups of Allman's clavicle fracture classification Group I fracture of the middle third Group II fracture of the distal third - Type I minimal displacement interligamentous - Type II displaced secondary to a fracture medial to the coracocla-vicular ligaments A. Conoid and trapezoid attached B. Conoid...
of the labrumligament complex in posttraumatic anterior shoulder instability
Each stage is defined by the presence of a new lesion Fig. 31 . Stage 1 The first stage is marked by an isolated simple lesion at the labral attachment, that is, an isolated labral detachment with a present periosteal hinge Bankart lesion . The first anterior hinge is the only structure to collapse in the first stage. Stage 2 The second stage is marked by the appearance of a double lesion on the IGHL attachment it is a combined labral and IGHL detachment lesion. The IGHL detachment is deformed...
mmmmn
Fig. 44 f The AO classification of proximal humeral fractures Proximal and distal segments In the proximal and distal segments the fractures are either extraarticular type A or articular. The articular fractures are either partial articular type B or complete articular type C . The three exceptions are the proximal humerus A extraarticular unifocal, B extraarticular bifocal, and C articular , the proximal fe mur A trochanteric area, B neck, C head , and the malleolar segment A infrasyndesmotic,...
Type VI
- a complete absence of any synovial recesses Fig. 23 g - was observed in 11.4 of the specimens Fig. 23. Types of arrangement of the synovial recesses, a Anatomy of glenohumeral ligaments, b Type I. c Type II. d Type III. e Type IV. f Type V. g Type VI Fig. 23. Types of arrangement of the synovial recesses, a Anatomy of glenohumeral ligaments, b Type I. c Type II. d Type III. e Type IV. f Type V. g Type VI
Classification of fractures of the clavicle in adult according to Robinson [114
A new classification was developed based on radiological review of the anatomical site and the extent of displacement, comminution and articular extension out of 1000 patients. There were satisfactory levels of inter- and intraobserver variation for reliability and reproducibility. Fractures of the medial fifth type 1 , undisplaced diaphyseal fractures type 2 A and fractures or the outer firth type 3 A usually had a benign prognosis. The incidence of complications of union was higher in...
Peithes line
- Classic Perthes lesion complete detachment of the labrum together with the inferior glenohumeral ligament from the glenoid rim, in which the inferior glenohumeral ligament is detached subperioste-al from the scapular neck periosteal pouch . - ALPSA lesion 104 deperiostation of the labrum and the inferior glenohumeral ligament from the anterior scapular neck with the development of a scar formation at the base of the periosteal pouch. Non-Bankart Capsular substance Quattro lesion HAGL lesion...
Classification of significant HillSachs lesions according to Burkhart and De
Dynamic arthroscopic examination of the shoulder as it went into abduction and external rotation revealed the geometric etiology of the symptoms there was an articular-arc deficit on the humeral side with an engaging Hill-Sachs lesion Fig. 30 a . That is, with the arm in abduction of 90 , if the shoulder was externally rotated more than 30 , the Hill-Sachs lesion would engage the anterior corner of the glenoid, and the patient would sense that engagement as a popping or catching sensation. The...
Bankait line
- Classic Bankart lesion failure in continuity at the transition zone between cartilage and labrum without detachment of periosteal ligament insertion. - Double labral lesion complete detachment of the labrum from the glenoid rim, the insertion of the inferior glenohumeral ligament at the limbus is intact. This means a double detachment of the labrum from the glenoid rim as well as the inferior glenohumeral ligament. - Bony Bankart lesion bony avulsion fracture of the glenoid rim combined with...
Contents
1.1 The morphology of the acromion according to Bigliani 1 1.2 Classification of the acromial morphology on sagittal oblique MRI according to Epstein 2 1.3 Types of os acromiale according to Liberson 4 1.4 Types of scapular notch according to Rengachary et al. 5 2.1 Stages of outlet impingement according to Neer 7 2.2 Stages of impingement in athletes according to Jobe 8 3 Classifications of calcifying tendinitis of rotator cuff 9 3.1 Stages of calcifying tendinitis according to Uhthoff 9 3.2...
Classification of pulley lesions according to Habermeyer et al [52
Group 1 isolated lesion of the superior glenohumeral ligament Fig. 21 a Group 2 lesion of the superior glenohumeral ligament and partial articular-side lesion of the supraspinatus tendon Fig. 21b Fig. 21. Classification of Pulley lesions. From Habermeyer et al. 52 . a Group 1 SGHL lesion only. b Group 2 SGHL lesion and partial articular-side supraspinatus tendon tear 55P . c Group 3 SGHL lesion and partial articular-side subscapularis tendon tear 55C . d Group 4 SGHL lesion with partial...
Classification of frozen shoulder according to Lundberg [81
Primary frozen shoulders were defined as follows a The total elevation in the shoulder joint restricted to 135 or less. b The restriction of motion localized to the humero-scapular joint. c No findings in the case history or in the clinical or radiological examination which could explain the decrease of the range of motion by the latter criterion cases with post-traumatic conditions, rheumatoid arthritis, osteoarthritis, hemiplegia and other more obvious changes, were excluded. The range of...
Classification of shoulder instability according to [127 Matsen et al [84
The authors find the most practical approach is to recognize two common types of glenohumeral instability. On the basis of a retrospective clinical study the authors noted that most patients who have recurrent glenohumeral instability can be classified into one of two large groups. The first group is characterized by a history of definite trauma, initiating a problem of unidirectional shoulder instability. The shoulders of these patients usually are found to have a rupture of the glenohumeral...
Subtypes of SLAP II lesions according to Morgan [88
The type II SLAP lesion as originally described by Snyder 122, 123 involved a detachment of the biceps anchor and the adjacent labrum from bone with an anterosuperior location. The authors have observed three types of type II SLAP lesions by anatomic location Anterior SLAP lesion anterosuperior type II SLAP lesion Fig. 19 a Posterior SLAP lesion posterosuperior type II SLAP lesion Fig. 19b Combined SLAP lesion combined anterior and posterior type II SLAP lesion Fig. 19 c
Classification of tendon retraction in the frontal plane according to Patte
Stage 1 proximal stump close to the bony insertion Stage 2 proximal stump at level of humeral head Stage 3 proximal stump at level of glenoid Fig. 11. Topography of tears in the frontal plane, in which three stages are easily recognized. In stage 1 the stump shows little retraction, in stage 2, it lies at the level of the humeral head, and in stage 3 it is seen at the level of the glenoid Fig. 11. Topography of tears in the frontal plane, in which three stages are easily recognized. In stage 1...
Radiologic staging of calcifying tendinitis of the shoulder joint according to
- The calcific deposit is clearly circumscribed and has a dense appearance - Formative phase Type II hybrid type - Clearly circumscribed and translucent, cloudy and dense - Assessment of stage is possible by performing a second X-ray examination after 6 to 12 weeks - Cloudy and translucent appearance without clear circumscription Fig. 6. Radiological appearance of calcific deposits of spontaneous process of calcifying tendinits Fig. 6. Radiological appearance of calcific deposits of spontaneous...
superior labrum anterior to posterior lesion according to Snyder [122 123
A SLAP lesion is defined as an injury of the superior labrum from anterior to posterior in relation to the biceps tendon anchor. Type 1 fraying and fragmentation of the free edge of the superior labrum. - This is often a relatively minor problem that is commonly encountered during routine arthroscopy in middle-aged and older patients Fig. 17 a . Type 2 the biceps anchor is significantly detached from the superior - Usually associated with fraying of the edge of the labrum. - The middle...
Classification of supraspinatus muscle atrophy in MRI according to Zanetti [142
Magnetic resonance imaging was performed on a 1.0-Tesla scanner. A sequence of parasagittal T1-weighted turbo spin-echo MRI images repetition time TR echo time TE 700 12 ms parallel to the glenohu-meral joint space was obtained. For quantitative assessment, areas and SIs of the rotator cuff muscle and the area of the fossa supraspinata were measured at the most lateral image on which the scapular spine is in contact with the rest of the scapula Fig. 14 a . Tangent Sign Qualitative assessment of...
Arthroscopic stages of adhesive capsulitis according to Neviaser [103
Adhesive capsulitis is a specific entity consisting of four identifiable In stage 1, patients usually present with signs and symptoms of the impingement syndrome. Their motion usually is restricted very little if at all, and that restriction fools the physician into believing this loss of motion and increased pain are due to a rotator cuff tendinitis the impingement sign . The usual treatment for the impingement syndrome fails, often to the point that decompression of the acromial arch is...
Classification of fatty muscle degeneration in cuff ruptures using CTscan
The areas of muscular hypodensity observed seem to correspond to fat tissue, which does not necessarily mean that there is a muscular atrophy, and CT scan patterns are said to be without specific diagnostic value. Fig. 15. Classification of muscles according to their degree of fatty infiltration Measurement of shoulder cuff muscle areas or volumes cannot be reliably or easily performed, particularly with a CT scan, but the assessment of fatty muscular infiltration remains a good tool in...
Classification of SLAP lesion according to Maffet et al [82
The authors performed a diagnostic arthroscopy in 63 patients. Of these, 62 had lesions that fit within the classifications system of Snyder 122, 123 . Thirty-eight percent in this study had significant biceps tendon-superior labrum injury that did not fit into the classification system proposed by Snyder 122, 123 . The authors defined three additional types of SLAP lesions Type I-IV are equivalent to Snyder's classification Type V an anterior-inferior Bankart lesion continues superiorly to...
Triangular defect
Reverse L Supraspinatus tear extends medially through rotator cuff interval in line with long head of biceps tendon Fig. 10 b A moderate-sized triangular defect is most commonly produced when a supraspinatus tear extends medially along its anterior border in a line with the long head of the biceps tendon. This limb of the tear is located through the relatively thin fibrocapsular area between the subscapularis and supraspinatus tendon. The long head of the biceps tendon travels below the...
Topography of rotator cuff tear in the sagittal plane according to Habermeyer
Sector A lesions localized anteriorly Sector A contains the subscapularis tendon, rotator interval and the long head of the biceps tendon Sector B lesions localized central superiorly Sector B circumscribes the at the apex located central area with the supraspinatus tendon Sector C lesions localized posteriorly Sector C localized the posteriorly located lesions of the infraspinatus and teres minor tendon The extension of the line of spina scapulae separates sector B from sector C. Fig. 8....
Arthroscopic classification of partialthickness rotator cuff tears according to
The author stated that any tear, whether partial or complete, should be classified as Stage III impingement according to Neer 97 . The following subclassification of Stage III is proposed to include both partialand full-thickness rotator cuff tears Table 1 . The classification of partial-thickness tears Fig. 9 34 indicates which surface is involved and grades the severity of the tear according to depth. The normal cuff is considered to be 10-12-mm thick. A Grade 1 partial tear less than 3-mm...
Classification of supraspinatus muscle atrophy in MRI according to Thomazeau
All MRI images were obtained with a 1 Tesla unit. The quantitative analysis was then performed on the spin-echo Tl-weighted oblique-sagittal images TR 480 ms, TE 12 ms, FOV 250X250, matrix 380X512 . To evaluate the atrophy of the supraspinatus muscle, the occupation ratio R of the supraspinatus fossa by the muscle belly is calculated. This analysis was based on the ratio between the surface of the muscle S1 and the surface delineated by the limits of the fossa S2 Fig. 12 . The selected...
Types of os acromiale according to Liberson [77 90
Liberson 77 reviewed the roentgenograms of 1800 shoulder girdles, chosen at random, and found 21 typical and 4 atypical cases of os acromiale, for an incidence of os acromiale of 1.4 . The lesion is bilateral in 62 of patients. Definition of os acromiale when there is a failure of union of any one of the ossifications centres to its neighbour, the resulting separate bone is an os acromiale. Four different types of unfused acromia were described Fig. 3 The most common nonunion is between the...
Type 3 hooked
Sagittal oblique T2-weigthed or fast spin-echo images were obtained at a 90 angle to the long axis of the supraspinatus tendon as determined with an axial localizing image. The acromions were classified according to their appearance on the image obtained just lateral to the acromioclavicular joint. This image consistently demonstrated the greatest longitudinal length of the acro-mion, and was at or just beyond the tip of the coracoid. Occasionally, it was difficult to differentiate between type...
Types of scapular notch according to Rengachary et al [110
Rengachary et al. 110 observed six basic types of supracapular notch in 211 cadaveric adult scapulae Fig. 4 Type I no notch The entire superior border of the scapula showed a wide depression from the medial superior angle of the scapula to the base of the coracoid process. Type II This type showed a wide, blunted v-shaped notch occupying nearly a third of the superior border of the scapula. The widest point in the notch was along the superior border of the scapula. Relative frequency 31 . Type...