Search Results (178)

Background/Objectives: Falls and upper limb injuries (ULI) are prevalent in older adults, yet whether ULI independently predisposes to subsequent falls remains poorly characterized. This nationwide cohort study evaluated the association between ULI and future fall risk using Taiwan’s National Health Insurance Research Database (2011–2019, follow-up through 2020). Methods: Adults aged ≥ 50 years with newly diagnosed ULI—defined as fractures (clavicle, scapula, humerus, radius, ulna, hand), sprains, strains, or open wounds of the shoulder, arm, elbow, forearm, wrist, or hand—were propensity score-matched 1:1 to controls by age, sex, and eight major comorbidities. Fall occurrence was identified by validated ICD codes, and Cox regression estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results: The cohort included 110,600 participants (mean follow-up 4.4 years). Fall incidence was 2.8 versus 1.6 per 1000 person-years in ULI versus control groups. Patients with ULI had 62% higher fall risk (adjusted HR 1.62, 95% CI: 1.43–1.84, p < 0.001), corresponding to 1.2 additional falls per 1000 person-years. Kaplan–Meier curves showed early divergence sustained throughout follow-up. Conclusions: ULI is independently associated with subsequent fall risk in older adults and may serve as a sentinel marker warranting fall-prevention strategies in clinical practice. Full article

Background and Objectives: Many patients suffer from chronic pain of the shoulder, neck, upper back, and/or arm. They may be diagnosed with fibromyalgia, complex regional pain syndrome, myofascial pain, thoracic outlet, subacromial pain, cervical radiculopathy, cervicogenic headaches, post-mastectomy pain, and/or occupational shoulder disorder. The pectoralis minor (PM) is the only muscle of the scapula controlled by the lower trunk of the brachial plexus. In the Human Disharmony Loop (HDL), this neurologic asymmetry produces persistent protraction of the scapula. Protraction deforms the scapula’s connections, generating headaches and neck stiffness, upper back tightness, shoulder weakness, and hand numbness. We hypothesize patients with the above who meet HDL diagnostic criteria will benefit from PM tenotomy with brachial plexus neurolysis (PM+ICN). Materials and Methods: Patients diagnosed with the above disorders who also met HDL criteria of medial coracoid tenderness and scapula protraction on exam underwent PM+ICN, with secondary neurolysis after 3 months if needed. Clinical neuropathy was diagnosed via the scratch-collapse test. Outcomes included self-reported Visual Analogue Score pain scores, active shoulder abduction range of motion (ROM), prevalence of occipital headaches. Results: N = 318 patients were included. Average age was 51; 68.0% were female. Following treatment, average pain decreased from 7.3/10 to 2.1/10 (p < 0.001), average shoulder ROM increased from 96 to 170 degrees (p < 0.001), and occipital headaches decreased from 76.7% to 1.6% (p < 0.001). Scapular protraction normalized from 98.8% static to 92.5% none (p < 0.001). Overall, 17% required subsequent neurolysis, chiefly of the axillary, radial, and ulnar nerves. The pain reductions were statistically indistinguishable across all diagnoses (p = 0.709, I² = 0.02%). Average follow-up was 22 months. Conclusions: PM+ICN significantly reduced self-reported pain and headaches in select intractable patients. The PM pathologizing the scapula may constitute a shared anatomic mechanism that contributes to chronic pain across heterogenous disorders of the upper limb. Full article

Introduction: During an excavation in 2022 of a mass grave within a cemetery in Castilla-La Mancha containing the remains of executed victims of the Spanish Civil War and Francoist dictatorship, the scientific team discovered a medallion with a name and a date inscribed on it. The medallion was associated with an individual recovered from a grave containing 12 other individuals in 5 separate stratigraphic layers. This paper aims to outline the identification process of the deceased from the skeletal remains and associated medallion. Methods: This process included archival research, gathering witness testimonies, archaeological evidence, osteological examination and DNA analysis. Results: After restoration, the medallion revealed the words “VIVA LA FIJL. VIVA LA FAI.” on one face and “MUERO POR LA LIBERTAD.” on the other. The human skeletal remains associated with the medallion showed male morphological characteristics and were estimated to be between 21 and 30 years old at the time of death, with a height between 1.64 and 1.67 m. There was skeletal evidence of ballistic trauma on the right mandible and the right scapula. Genetic analysis confirmed an mtDNA match with his maternal niece. Discussion/Conclusions: This study demonstrates the importance of a multidisciplinary approach to the identification of human remains from the Spanish Civil War and the Dictatorship which followed, and how the objects found within a mass grave can be useful in aiding a positive identification. Full article

We investigated whether bone morphology alone can inform implant selection in shoulder arthroplasty using a hypothesis-driven deep learning framework applied to preoperative computed tomography (CT) scans. The proposed approach extends a previously validated segmentation and pathology-staging pipeline by introducing implant-type prediction and a controlled human–AI comparison. The workflow combines CEL-UNet for 3D bone segmentation with ArthroNet⁺, a multi-task network assessing osteophytes, joint-space narrowing, humeroscapular alignment, and implant type. Trained on a multicenter cohort of 600 patients, CEL-UNet achieved Dice scores of 0.99 for the humerus and 0.98 for the scapula. ArthroNet⁺ achieved high performance in pathology classification (up to 95% for alignment tasks). Under morphology-only conditions, ten orthopedic surgeons achieved 61% accuracy with low inter-rater agreement (Fleiss’ $\mathsf{\kappa }\approx 0.15$), while the model reached 78% agreement with the implant choices observed in the dataset, reflecting the ability to reproduce clinical decision patterns rather than to identify an optimal implant selection. This performance is characterized by a class-dependent asymmetry, with higher recall for reverse implants than for anatomical ones. These findings indicate that bone morphology provides a measurable but incomplete signal for implant selection, and should therefore not be interpreted as reflecting clinical decision-making performance. The framework quantifies the morphology-driven component of surgical decision making under controlled conditions, supporting future integration with multimodal clinical data. Full article

Background/Objectives: The minimally invasive posterior deltoid-sparing (MIPDS) approach has been described for glenoid fractures; however, its outcomes for Ideberg type Ib, II, III, IV, and V fractures and the influence of concomitant injuries on functional recovery remain poorly understood. This study aimed to report minimum 2-year functional outcomes of these fracture types treated with the MIPDS approach using mini-plates, and to investigate the effect of concomitant thoracic trauma on clinical outcomes. Methods: Thirty-one patients with operatively treated glenoid fossa fractures were stratified into three groups: isolated glenoid fracture, concomitant thoracic trauma, and concomitant ipsilateral upper extremity fracture. Functional outcomes were assessed using the Constant, UCLA, and DASH scores at a minimum follow-up of 2 years. Results: No postoperative infection or nonunion occurred. Mean union time was 9.4 ± 2.4 weeks. Patients with thoracic trauma demonstrated significantly worse functional outcomes across all three scores compared to both other groups: lower Constant scores (70.9 ± 7.5 vs. 85.5 ± 5.9 and 82.6 ± 11.7; p = 0.012 and p = 0.042), lower UCLA scores (24.6 ± 7.9 vs. 32.5 ± 3.0 and 31.1 ± 3.2; p = 0.010 and p = 0.012), and higher DASH scores (29.3 ± 14.2 vs. 7.9 ± 9.2 and 9.5 ± 9.9; p = 0.003 and p = 0.006). Multivariate linear regression confirmed thoracic trauma as an independent predictor of higher DASH scores (β = 12.75, 95% CI: 2.00–23.50, p = 0.031, R² = 0.344). Conclusions: The MIPDS approach provides safe and effective fixation for Ideberg type Ib, II, III, IV, and V glenoid fractures with satisfactory functional outcomes at minimum 2-year follow-up. Concomitant thoracic trauma is a significant negative predictor of functional recovery, and the possibility of inferior functional outcomes in this patient group should be considered. Full article

Background/Objectives: The role of muscle trigger points (TrPs) in neuropathic pain (NP) components in whiplash-associated disorders (WAD) has not been investigated. Our aim was to systematically investigate if referred pain elicited by trigger points (TrPs) in neck musculature reproduces neuropathic pain (NP) characteristics in chronic whiplash-associated disorders (WAD) and to determine the association of TrPs with pain intensity, mechanosensitivity, and disability. Methods: An exploratory cross-sectional study was conducted (n = 64; chronic WAD: n = 32; age- and sex-matched healthy controls: n = 32). TrPs in upper trapezius, suboccipital, splenius capitis, levator scapulae, scalene, and sternocleidomastoid muscles were evaluated. Pain intensity, NP components, pain catastrophizing, and disability were assessed with an 11-point numerical pain rating scale (0–10), NP questionnaires (Douleur Neuropathique 4 [DN4], self-administered Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS], and Neuropathic Pain Symptom Inventory [NSPI]), the Pain Catastrophizing Scale, and the Neck Disability Index, respectively. Mechanosensitivity (pressure pain thresholds) was assessed bilaterally over C2–C3 and C5–6 zygapophyseal joints, second metacarpal, and tibialis anterior muscle. The Mann–Whitney U test and advanced chi-square (χ²) test, including rank-based ANCOVA adjusted for age and sex, were used for comparisons between groups. Additionally, multivariate analyses were also performed (rank-based MANCOVA adjusted for age, sex, and pain intensity). Spearman’s rho (r_s) and LOESS regression analysis, corroborated with linear regression and/or polynomial regression coefficient analysis, were used to explore associations between clinical variables in WAD. Results: Significant differences in distribution of TrPs, with a significant effect of sex, were found between groups (p < 0.05). In WAD, a greater number of active TrPs, mostly prevalent in levator scapulae and suboccipital muscles, was associated with higher pain intensity, number and intensity of NP components, and disability (0.372 < r_s < 0.570, p < 0.05), or local mechanical hyperalgesia (r_s = −0.362, p < 0.05). Conclusions: Referred pain elicited by active TrPs in the neck muscles reproduced NP symptoms in chronic WAD. This study contributes to a new understanding of pain mechanisms in WAD, highlighting the role of active TrPs in generating or maintaining NP symptoms and sensitization processes. Full article

Background and Objectives: Simultaneous bilateral scapular fractures are exceptionally rare injuries and are most commonly associated with high-energy trauma, convulsions, or electrical injury. Their occurrence following low-energy trauma is extremely uncommon. This study aimed to conduct a scoping review of the literature on simultaneous bilateral scapular fractures, with emphasis on demographic characteristics, mechanisms of injury, fracture patterns, treatment strategies, and clinical outcomes. To provide clinical context, the findings are illustrated by a case of a 43-year-old previously healthy recreational athlete who sustained simultaneous bilateral scapular fractures after a low-energy fall directly onto the back. Materials and Methods: A scoping review of the literature was conducted in accordance with PRISMA-ScR guidelines using the PubMed/MEDLINE and Scopus databases. Studies reporting simultaneous bilateral scapular fractures were identified and analyzed with respect to demographic characteristics, mechanisms of injury, fracture patterns, treatment modalities, and outcomes. Results: Thirty-seven studies published between 1946 and 2025 were included, comprising a total of 43 patients. Most cases resulted from high-energy trauma (41.9%), convulsions (25.6%), or electrical injury (16.3%). Low-energy trauma and spontaneous fractures were rare. The scapular body was the most commonly involved anatomical region. Conservative treatment predominated and was generally associated with favorable functional outcomes, while surgical intervention was reserved for displaced or intra-articular fractures. The illustrative case involved bilateral comminuted extra-articular fractures of the scapular bodies and spines without associated injuries and was managed conservatively, resulting in complete fracture healing and full, painless shoulder range of motion. Conclusions: The findings of this scoping review, illustrated by the representative clinical case, indicate that simultaneous bilateral scapular fractures may occur even after low-energy trauma in otherwise healthy individuals. Bilaterality alone should not be interpreted as an independent indication for surgical treatment when fractures are stable and minimally displaced. A high index of clinical suspicion and appropriate radiological evaluation are therefore warranted, particularly in emergency and trauma settings, in order to avoid missed or delayed diagnosis, even in cases with seemingly benign mechanisms of injury. Full article

Background: Wrist–forearm orthoses used during self-feeding may alter scapular and shoulder mechanics and increase proximal load, but this has not been quantified. Methods: Seventeen right-hand-dominant young adults performed a spoon-feeding task under free and restricted conditions. A thermoplastic wrist–forearm orthosis positioned the wrist at approximately 30° dorsiflexion at rest and was intended to constrain wrist motion during the task without rigidly immobilizing forearm pronation–supination. Three-dimensional kinematics (scapula, shoulder, trunk, and distal joints) were recorded using inertial sensors, and surface electromyography was obtained from the upper trapezius, middle deltoid, and biceps brachii. Maximum joint angles and mean %MVC over the feeding cycle were compared between conditions (α = 0.05). Results: The restriction condition resulted in a more anteriorly tilted and downwardly rotated scapular posture, greater shoulder abduction and external rotation, and increased thoracic flexion, whereas maximum distal joint angles did not differ, suggesting a functional distal constraint rather than rigid immobilization. Middle deltoid and biceps brachii activities increased significantly, with a nonsignificant trend toward higher upper trapezius activation. Conclusions: In healthy young adults, limited wrist motion and forearm rotation during spoon-feeding were associated with altered proximal coordination, including scapular, shoulder/trunk, and proximal muscle changes. Full article

Background/Objectives: Pediatric thoracic trauma requires prompt stabilization and timely imaging; however, actual sequencing and escalation triggers are infrequently delineated at the pathway level. The aim of this study was to analyze imaging pathways observed in routine clinical practice at our institution and to outline a preliminary escalation framework integrating injury mechanism, clinical severity, and initial ultrasound findings. Methods: A retrospective cohort study was conducted at the “Louis Țurcanu” Clinical Emergency Hospital for Children, Timișoara, Romania, including 66 children admitted with primary thoracic trauma between January 2022 and December 2024. Clinical trajectory markers (transfer-in, ICU admission, length of stay) and imaging utilization/sequencing (FAST, CXR, CT, MRI/CTA) were extracted. We divided injuries into two groups: bony (like fractures of the clavicle or scapula) and non-bony. CT escalation was characterized as a chest CT conducted upon admission. Fisher’s exact and Mann–Whitney U tests were used for comparative analyses. Results: FAST was done on all patients but was infrequently positive. Imaging followed heterogeneous but structured patterns, most commonly FAST with CXR, with or without CT. A large group of them had CT scans without first having any X-rays. CT escalation was associated with fracture-pattern injuries and higher-acuity trajectories (transfer-in and ICU admission), as well as prolonged hospital stays. Pathway-level assessment demonstrated that CT escalation effectively captured bony injury patterns, whereas FAST proficiently sorted ICU-level trajectories. Conclusions: Pediatric thoracic trauma imaging functioned as a selective escalation system: FAST served as a universal bedside entry step, and CT operated as an injury pattern- and acuity-linked severity gate. Making this escalation logic clear may help with standardization while still protecting against radiation. Full article

Feline pulmonary carcinomas are rare and often carry a poor prognosis, particularly when associated with feline lung–digit syndrome. We report a cat with primary pulmonary carcinoma and extensive metastases—including digits, pleura, mandible, scapula, spleen, skeletal muscle, and distant lymph nodes—supporting the broader “MODAL syndrome” concept. Palliative therapy with toceranib phosphate and meloxicam achieved prolonged survival and excellent quality of life, with no adverse effects despite dose escalation. Rapid progression after discontinuation suggests a role for toceranib in delaying tumour growth. Immunohistochemistry revealed c-kit expression in one metastatic lesion but not in the primary tumour or most metastases, highlighting intratumoral heterogeneity and the complexity of targeted therapy. The observed benefit likely reflects toceranib’s multi-target activity (VEGFR2, PDGFR), impacting angiogenesis and tumour progression. This case represents the first report of toceranib phosphate use in feline pulmonary carcinoma and underscores its potential as a palliative option. Full article

Background: Reverse shoulder arthroplasty (RSA) relies on secure baseplate fixation to the glenoid. This carries a risk of suprascapular nerve (SSN) injury during peripheral screw insertion. Although fixed safe zones have been described, it remains unclear whether these scale with scapular morphometry or whether common screw positions confer differential SSN risk. Methods: Twenty cadaveric shoulders (ten pairs) were dissected. The superior safe zone (distance from the supraglenoid tubercle to SSN at the suprascapular notch) and posterior safe zone (distance from the glenoid rim to SSN at the spinoglenoid notch) were measured. Scapular dimensions (height, spine length, width) were measured. In ten shoulders, simulated RSA baseplate fixation was performed with superior screws placed at 11, 12, or 1 o’clock and posterior screws at 8, 9, or 10 o’clock. Screw lengths were based on glenoid depth. Cortical breach and SSN proximity were recorded. Linear regression assessed relationships between scapular dimensions and safe zones. Results: The superior safe zone (mean 2.9 ± 0.5 cm) significantly correlated with scapular dimensions (r = 0.78–0.86; p < 0.0001). All superior screws remained intraosseous across configurations. The posterior safe zone (1.9 ± 0.6 cm) showed no correlation. Posterior cortical breach occurred in 50% of specimens across all tested positions and was associated with smaller scapular spine length (p = 0.027). No significant difference in SSN proximity was observed between posterior screw positions. Conclusions: Scapular dimensions predict the superior, but not posterior, safe zone. Scapulae with shorter spine lengths demonstrated increased risk of posterior cortical breach, independent of screw position. These findings establish anatomical scalability of the superior safe zone and suggest that scapular morphometry may inform preoperative RSA planning; however, prospective validation is needed before routine clinical implementation. Full article

Background: This study aimed to investigate the potential biomechanical implications of biologically motivated modulation scenarios—Resolvin E1 (RvE1), Resolvin D1 (RvD1) and carvacrol—in the context of rotator cuff tears by using a reduced finite element (FE) modeling approach. The primary objective was to compare stress distribution and deformation behavior at the tendon–bone interface under standardized loading scenarios. Materials and Methods: A three-dimensional reduced FE model of the shoulder, including the scapula and proximal humerus, was constructed based on computed tomography data. A rotator cuff tear was represented at the tendon footprint on the greater tuberosity. Standardized boundary scenarios and loading vectors were applied. Three conceptual biological modulation scenarios (RvE1, RvD1, and carvacrol) were evaluated and compared with a baseline model representing a rotator cuff tear under identical geometric, material, boundary, and loading scenarios, without any biologically motivated modulation. Von Mises stress distribution at the greater tuberosity and tendon footprint, as well as maximum displacement of the proximal humerus, were analyzed descriptively and comparatively. Results: Compared with baseline scenarios, the RvE1 and RvD1 scenarios demonstrated reduced peak von Mises stress at the tendon footprint and lower overall humeral displacement. Peak footprint stress decreased from 10.8 MPa in the baseline model to 7.9 MPa (−26.9%) in the RvE1 scenario and to 8.6 MPa (−20.4%) in the RvD1 scenario. Similarly, maximum humeral displacement was reduced from 4.6 mm at baseline to 3.4 mm (−26.1%) with RvE1 and to 3.9 mm (−15.2%) with RvD1. In contrast, the carvacrol scenario exhibited increased localized stress concentration at the tendon footprint (12.4 MPa; +14.8%) and greater maximum displacement (5.8 mm; +26.1%). Conclusions: The findings suggested that modulation scenarios associated with specialized pro-resolving mediators (SPMs) were aligned with a more favorable mechanical environment at the tendon–bone interface compared with baseline scenarios, whereas the carvacrol scenario demonstrated less favorable biomechanical behavior under the modeled assumptions. Although the biological effects were represented conceptually and the results were interpreted as relative trends, this study highlighted the potential importance of resolution-oriented pathways in influencing tendon-to-bone biomechanics and supported further experimental and translational investigations in rotator cuff repair. Full article

Objectives: The Pulmonary Auscultatory Triangle (PAT) is a bilateral region on the back delimited by the trapezius, latissimus dorsi, and scapula. Beyond its relevance for pulmonary auscultation, PAT also represents an important anatomical window for posterior thoracic approaches. While its anatomy has been extensively described in adults, data on its developmental morphology during fetal life remain scarce. This original morphometric study aimed to characterize the morphometry and morphology of the PAT in human fetuses and to evaluate differences according to sex, side, and gestational age. Methods: A total of 80 PATs from 40 human fetuses (20 male and 20 female) were examined. Using ImageJ software 1.54k, we measured margin lengths (inferior trapezius, medial scapular, and superior latissimus), area, and perimeter. Morphological classification was performed based on internal angles. Associations with sex, side, and gestational age were statistically assessed. Results: The mean gestational age was 28.6 weeks. PAT had a mean area of 103.2 mm² and a mean perimeter of 49.1 mm. Mean margin lengths were 20.1 mm for the trapezius, 12.4 mm for the scapular margin, and 16.6 mm for the latissimus dorsi. Three morphologies were observed: acute (42.5%), obtuse (25.0%), and rectangular (32.5%). A significant asymmetry in shape distribution was found between sides (p = 0.034). Weak but statistically significant positive correlations with gestational age were found for perimeter and for the trapezius and latissimus dorsi margins, indicating progressive enlargement with fetal growth. Conclusions: This study provides the first detailed morphometric and morphological description of the PAT in human fetuses. The findings establish a developmental anatomical baseline for the posterior thoracic wall and highlight growth-related changes and side-related variability. Full article

Runx2 plays essential roles in osteoblast differentiation and chondrocyte maturation. Runx2 in the perichondrium has been reported to inhibit chondrocyte maturation through Fgf18 induction. To further investigate the functions of Runx2 in the perichondrium, we generated Runx2^fl/−Cre mice by crossing Runx2^fl/+, Runx2^+/−, and 2.3-kb Col1a1 Cre mice and compared them with Runx2^fl/− mice at E15.5, when the endochondral bones were cartilaginous. Skeletal preparation of the upper limbs in Runx2^fl/−Cre mice showed reduced mineralization of the humerus and scapula, and histological analysis of the femurs showed delays in the terminal differentiation of chondrocytes, as indicated by the absence of mineralization and Spp1 expression in the cartilage and osteoblast differentiation in the perichondrium, compared to those in Runx2^fl/− mice. mRNA sequence analysis showed that the expression of Nell1, which encodes a secreted protein that enhances chondrocyte maturation, in Runx2^fl/−Cre femurs was more than two-fold lower than that in Runx2^fl/− femurs. Nell1 expression was reduced in the perichondrium of Runx2^fl/−Cre femurs compared to that in Runx2^fl/− femurs. Nell1 expression was upregulated by Runx2 overexpression and downregulated by Runx2 siRNA. These findings indicate that Runx2 in perichondrial osteoblasts enhances the terminal differentiation of chondrocytes by inducing Nell1 expression. Full article

Background/Objectives: The identification of individuals from human remains is crucial in any scenario where their identity is unknown. The study of ontogenetic allometry, which refers to proportional changes in the shape and size of bones during growth, provides important baseline information for constructing biological profiles. Methods: This study focuses on the analysis of the ontogenetic allometry of the scapula in Portuguese reference skeletal samples, using geometric morphometric techniques. The sample includes 140 individuals (67 females, 73 males), ranging from birth to 89 years old. Scapulae were photographed, and seven landmarks and forty semi-landmarks were digitized using the “tps” programs. Statistical analyses were performed using the MorphoJ (v. 1.08.02) and PAST (v. 5.2) programs. Results: The results point to a significant and continuous growth of the scapula in the early stages of life, with a tendency to stabilize after adolescence. Centroid size significantly influenced shape variation across the full sample. Conclusions: These findings provide a descriptive baseline of scapular development that can aid future anthropological and forensic research, including studies on population variation and age-related morphological trajectories. Full article