Background: The acromion clavicular joint dislocations are common injuries of the shoulder. The severity is dependent upon the degree of ligamentous injury. Surgical treatment is typically performed in higher grade acromioclavicular separation with several static and dynamic operative procedures with or without primary ligament replacement. Methods: 47 patients with acute Rockwood type III, IV, and V injuries were treated surgically with LARS reconstruction. The success of technique was evaluated by radiographic outcomes for each patient at every follow-up visit (one, three, 12 months), while to assess pain reduction and clinical evaluation Visual Analogue scale score (VAS) and Constant-Murley score (CMA) was performed, respectively. An One Way Analysis of Variance (Kruskal-Wallis test), a multiple comparison Turket test, or a t-test (Mann-Whitney Rank Sum Test) were used when required. Results: Follow-up radiographs revealed maintenance of anatomical reduction in 41 patients, and no bone erosions has been identified. In short-term joint functional recovery has been observed. Indeed, after 12 months pain on the VAS-scale in all groups decreased significantly (P < 0. 05), and the CMS revealed a significant overall improvement (P < 0. 05). Conclusion: These data demonstrate that the use of the LARS allows to provide stability to the joint and especially to ensure its natural elasticity, relieving pain and improving joint function already one month post-surgery.

Chondroblastomas are rare benign neoplasms and scarcely present in the acromion. We reported a case of chondroblastoma presented in the right acromion of a 36-year-old male. The patient had pain and restricted abduction. Moreover, the histological analysis of the biopsy sample was consistent with the diagnosis of chondroblastoma. The patient was treated with extended curettage and bone grafting. Besides, the 2-year follow-up of the patient was event-free. This case reveals that the chondroblastoma of acromion can be adequately treated by extended curettage. It also highlights the importance of acromion chondroblastoma in the differential diagnosis of shoulder pain to avoid the undertreatment of the patients.

Displaced fracture of the acromion without associated shoulder injury occurs rarely. A 31-year-old gentleman presented with an isolated acromion fracture resulting from a direct trauma to the top of his left shoulder. Open reduction and internal fixation using multiple pins was performed and the fracture was closed without complications. The patient achieved excellent shoulder function and ranked as satisfied in the constant shoulder score almost 14 months following the surgery. Fixation with pins can provide adequate stability in this rare type of shoulder fracture.

Background: Throwing movements are repetitive motions in overhead athletes that cause soft tissue adaptations and ultimately lead to shoulder joint damage. The current study purposed to determine the torque of internal and external rotation of joint shoulder in overhead athletes with and without impingement syndrome in the ball throwing position. Methods: This cross-sectional study was conducted on 63 male overhead athletes (33 with and 30 without shoulder impingement syndrome). Simulated maximum functional torque was evaluated while the athlete threw a ball into a net from a sitting position. A 6-camera Vicon Motion Capture system incorporated markers on the upper limb and trunk. A kinematic model of the upper limb was used in OpenSim software with inverse dynamics to obtain maximum torque. Results: The internal and external rotation and elevation torques differed significantly in athletes with shoulder impingement syndrome compared to those without impingement syndrome (P<0. 001, P=0. 012, and P<0. 001, respectively), while no significant difference was seen in shoulder depression (P=0. 283) between the two groups. Conclusion: The current findings suggest that there may be adaptations to shoulder strength and torque in response to throwing a ball that ultimately cause injury to the shoulder.

Background: Many different surgical techniques have been described to stabilize the acromion-clavicular (AC) dislocations. So far many of these procedures are performed only in arthroscopy. Objectives: In this study, we describe a new technique that utilizes the tightrope with a mini-invasive open approach for the acute stabilization of the acromion-clavicular joint (ACJ) dislocation. Patients and Methods: We set an prospective study aimed to verify the efficacy of this new surgical technique. We treated 28 patients with acute ACJ dislocation with ACJ TightRope ® System with dual mini access. We retrospectively reviewed the data of 34 patients treated with arthroscopic technique. They were considered as the control group. Results: At 6 month’ s follow-up, all the 28 patients showed a stable joint during clinical examination and obtained an average Constant score of 98. 62/100, with a complete recovery of ROM and strength in abduction. The mean operation time was of 33. 7 minutes. The mean recovery duration was 102. 8 days. No significant difference was found between the experimental and control groups (P > 0. 05). Conclusions: Results of this trial suggest the effectiveness of this new mini-invasive surgical technique in producing clinical and functional recovery in patients with ACJ dislocations.

Background: We use MRI to determine the mean acromiohumeral distance (AHD) in subacromial impingement (SI) and to identify which part of the subacromial space has the strongest effect on impingement. Objectives: To assess the association between AHD and SI and to determine which subacromial site most strongly correlates with impingement. Patients and Methods: The patient population was composed of 56 (70%) men and 24 (30%) women; 45 patients had SI and 35 did not. We measured the shortest distance from the outer margin of the inferior cortex of the acromion to the upper cortex of the humeral head at a total of six points. The mean AHD at each location was compared between patients with and without SI using Mann-Whitney tests. To define the optimal cutoff value at each location for the diagnosis of SI, we applied a receiver operating characteristic (ROC) curve and maximum Youden index. Results: Mean AHDs in patients with SI were smaller than those of normal patients. Differences in the length of the lateral and central portions were statistically significant (P < 0. 05). A 7. 9-mm cutoff value at the lateral anterior portion showed 96% sensitivity and 43% specificity for SI. Cutoff values of 7. 8mm(reader 1, senior radiologist) and 7. 5mm(reader 2, junior radiologist) at the lateral posterior portion showed 89% and 78% sensitivity and 46% and 57% specificity, respectively. Conclusion: Patients with SI had narrower AHDs than patients without impingement, and specifically, the lateral and central portions of the acromion played an important role in the development of SI.

The scapula is a complex bone. It involves the scapular body, scapular spine, acromion, and glenoid. While the majority of it is flat and the site of muscle attachments, it also includes the glenoid and is involved with shoulder joint mechanics. Scapula fractures are uncommon, and their treatment depends on the fracture location, amount of displacement, and other patient and fracture characteristics. This publication aims to briefly present the approach for scapular fracture open reduction internal f ixation...

Background and Objectives: Due to high prevalence of postural changes during aging, modern corrective methods can be used to improve posture abnormalities. Therefore, the present study aimed to examine the effect of trainings based on modern corrective approaches on posture status and spine function of elderly women. Materials and Methods: In this randomized clinical trial study, the statistical population included the elderly women aged 60 to 65 years with kyphosis more than 42 degrees in the city of Paveh in 2018, of which 30 were selected by convenience sampling and randomly divided into two groups of experimental and control. The experimental group participated in the selected corrective training sessions, based on the principles of USA’ s National Academy of Sports Medicine, for 6 weeks, 3 sessions a week and 60 minutes each session. The angle of kyphosis and function of spine were measured before and after intervention. Data analysis was performed using paired t-test and multivariate analysis of covariance. Results: Comparing the mean of pre/post test results showed a significant improvement in the angle of kyphosis, spine extension, distance acromion (p=0. 001) and chest expansion (p=0. 002) in the experimental group. The comparison of findings between the two groups showed a significant difference for the improvement of the angle of kyphosis, spine extension, distance acromion and chest expansion (p=0. 001) in the experimental group. Conclusion: Given the comprehensiveness of the corrective trainings program in this study, experts can use its positive effects in corrcting posture of elderly people.

Background: Impingement syndrome is one of the numerous causes of shoulder pain. The purpose of this study is to define the factors that can affect the prognosis of conservative treatment of subacromial impingement syndrome. Materials and Methods: From July 2001 to 2002, 102 patients with subacromial impingement, being confirmed by clinical tests of impingement, were enrolled in a prospective case-series study. They were treated conservatively with corticosteroid injection in subacromial bursa, NSAID administration and physiotherapy, and were followed for 12 months. Any patient with less than 11 months follow-up, with radiographic evidence of glenohumeral and acromioclavicalur arthritis, history of acute traumatic rupture of rotator cuff, proximal fracture of humorous, frozen-shoulder, and diabetes was excluded from the study. The scoring system of Constant and Murley was used for evaluation of treatment outcome. Results: 89 patients (44 male and 45 female) with mean age of 56.4 years completed the study. 67 patients (75.3%) were properly treated. There was a significant difference in Constant scores before and after treatment (p<0.05). A poor prognosis could be anticipated in those with weakness and/or atrophy of rotator cuff muscles, more than 120 days interval between initiation of symptoms and treatment, hooked acromion morphology, Acromio-Humeral Interval of less than 7 mm, moderate to severe restriction in active range of motion, and spur in antero-inferior edge of acromion. Age, gender, hand dominancy, side of involvement and history of previous trauma had no significant effect. Conclusion: Patients with "some defined poor prognostic factors" will fail conservative treatment. It might be better to consider other treatment modalities, even surgery, early on.

Background: Impingement syndrome accounts as the one of the numerous causes of the shoulder pain. The purpose of this study is to define the factors that can affect the prognosis of conservative treatment of patients with subacromial impingement syndrome. Materials and Methods: From July 2001 since 2002, 102 patients that have referred to orthopedic clinic of Shariaty and Imam Khomeini Hospital with subacromial impingement, confirmed by clinical test of Impingement, Job"s and Hawkinds"s test were enrolled in a prospective case-series study. They were conservatively treated in 12 month period with non-surgical conservative treatment consist of corticosteriod injection in subacromial bursa, NSAID s administration and physiotherapy and were followed for 12 months. Patients with follow-up period less than 12 months, with radiological evidences of glenohumeral and acromioclavicalur arthritis, history of acute traumatic rupture of rotator cuff, proximal fracture of humorous, Frozen-shoulder history and patients with diabetes were excluded from the study. For evaluating of the treatment, Constant score were utilized. For determination of each variable effect, logistic regression was used. Results: 89 patients (44 male and 45 female) with the mean ago of 56/4 yr completed the study. 67 patients (75/3%) were properly treated There was a significant difference between before and after Constant score (52/6 vs. 74/6 P<0/05).Atrophy of rotator cuff muscles as the most important factor and time between initiation of the symptoms 120 days or more, acromion morphology hocked (type III), moderate to sever weakness, AHI (Acromial Humeral Interval) less than 7 mm, moderate sever active range of motion restriction, spur in ant-inf edge of acromion, were inversely affected the treatment results; Age, gender, involvement of dominant hand, side of involvement and history of pervious trauma had no significant effect. Conclusion: it is concluded that in patients with mentioned factors, conservative treatment results may not be satisfactory and in order to shortening the clinical course, it might be better to consider surgical treatment as soon as possible.