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Facioscapulohumeral muscular dystrophy is a hereditary progressive myopathy caused by aberrant expression of the transcription factor DUX4 in skeletal muscle. No approved disease-modifying treatments are available for this disorder. We aimed to assess the safety and efficacy of losmapimod (a small molecule that inhibits p38α MAPK, a regulator of DUX4 expression, and p38β MAPK) for the treatment of facioscapulohumeral muscular dystrophy. We did a randomised, double-blind, placebo-controlled phase 2b trial at 17 neurology centres in Canada, France, Spain, and the USA. We included adults aged 18–65 years with type 1 facioscapulohumeral muscular dystrophy (ie, with loss of repression of DUX4 expression, as ascertained by genotyping), a Ricci clinical severity score of 2–4, and at least one skeletal muscle judged using MRI to be suitable for biopsy. Participants were randomly allocated (1:1) to either oral losmapimod (15 mg twice a day) or matching placebo for 48 weeks, via an interactive response technology system. The investigator, study staff, participants, sponsor, primary outcome assessors, and study monitor were masked to the treatment allocation until study closure. The primary endpoint was change from baseline to either week 16 or 36 in DUX4-driven gene expression in skeletal muscle biopsy samples, as measured by quantitative RT-PCR. The primary efficacy analysis was done in all participants who were randomly assigned and who had available data for assessment, according to the modified intention-to-treat principle. Safety and tolerability were assessed as secondary endpoints. This study is registered at ClinicalTrials.gov , number NCT04003974. The phase 2b trial is complete; an open-label extension is ongoing. Between Aug 27, 2019, and Feb 27, 2020, 80 people were enrolled. 40 were randomly allocated to losmapimod and 40 to placebo. 54 (68%) participants were male and 26 (33%) were female, 70 (88%) were White, and mean age was 45·7 (SD 12·5) years. Least squares mean changes from baseline in DUX4 - driven gene expression did not differ significantly between the losmapimod (0·83 [SE 0·61]) and placebo (0·40 [0·65]) groups (difference 0·43 [SE 0·56; 95% CI –1·04 to 1·89]; p=0·56). Losmapimod was well tolerated. 29 treatment-emergent adverse events (nine drug-related) were reported in the losmapimod group compared with 23 (two drug-related) in the placebo group. Two participants in the losmapimod group had serious adverse events that were deemed unrelated to losmapimod by the investigators (alcohol poisoning and suicide attempt; postoperative wound infection) compared with none in the placebo group. No treatment discontinuations due to adverse events occurred and no participants died during the study. Although losmapimod did not significantly change DUX4-driven gene expression, it was associated with potential improvements in prespecified structural outcomes (muscle fat infiltration), functional outcomes (reachable workspace, a measure of shoulder girdle function), and patient-reported global impression of change compared with placebo. These findings have informed the design and choice of efficacy endpoints for a phase 3 study of losmapimod in adults with facioscapulohumeral muscular dystrophy. Fulcrum Therapeutics. [ABSTRACT FROM AUTHOR]

This multicenter observational study aimed to assess how pain reduction, induced by local anesthesia, affects the relative angular contributions of the shoulder girdle and trunk to the maximal angular performance during a semi-constrained overhead reach task in patients with ongoing shoulder pain. Twenty-nine individuals (age 59.0 SD 12.8 years;16-male) with symptomatic shoulders were administered corticosteroid and lidocaine injections by their attending orthopedic surgeon. Immediately before and after the injections, participants reached for a target on the ceiling ten times as high as possible while their pain levels, shoulder, and trunk movements were recorded. The analysis revealed that there was a significant reduction in pain following the injections. However, there were no significant differences in maximum shoulder and trunk inclination angles between the pre- and post-injection conditions. Notably, there were slight but statistically significant alterations in humeroscapular kinematics during the initial phase of arm elevation following the injections. In conclusion, acute pain relief following local anesthetics is not associated with immediate alterations in maximum shoulder girdle and trunk inclination angles during a semi-constrained overhead reach task in patients with ongoing shoulder pain. However, there are signs of small alterations in humeroscapular kinematics during the initial phase of arm elevation. [ABSTRACT FROM AUTHOR]

Facioscapulohumeral muscular dystrophy (FSHD) is marked by progressive muscle weakness in facial, shoulder girdle, upper arms, lower limbs, and abdominal muscles, causing considerable morbidity and decreasing quality of life. There are currently no approved therapies for FSHD. The primary form, FSHD1, is linked to harmful overactivity of the DUX4 gene, resulting in muscle atrophy and weakness. Studies indicate that abnormal DUX4 expression triggers inflammatory processes in the initial stages of the disease. Patients with FSHD1 had increased inflammatory and reduced anti-inflammatory cytokines levels, indicating chronic inflammation. IL-6 levels strongly correlate with clinical severity in patients, and with functional scores in patients and FSHD-like mouse models. Here we present the study design of ReInForce (NCT06222827), a bicentric, randomized, double-blind, placebo-controlled, Phase 2 study to investigate the safety and efficacy of satralizumab, an IL-6 receptor inhibitor, in adults with FSHD1. Patients (N=40) will receive 120 mg satralizumab or placebo subcutaneously at Weeks 0, 2, 4 and then every 4 weeks until Week 48. The 48 weeks of the Double-Blind period will be followed by a 48-week Open Label period. The study will evaluate efficacy by assessing changes in muscle composition and function, as well as measures of clinical disease progression. Given the pathological relevance of inflammation in FSHD, and the correlation of IL-6 levels with disease severity, satralizumab may reduce muscle and systemic inflammation, thereby reducing fibrofatty degeneration in FSHD. [ABSTRACT FROM AUTHOR]

The finding of a short D4Z4-allele in a patient with shoulder-facial weakness is consistent with the diagnosis of FSHD1. However, when a normal or borderline length D4Z4 fragment is found, alternative diagnoses must be considered, and an extended diagnostic workout is then necessary. We analyzed 33 cases from 5 Italian neuromuscular Centers, tested for a clinical suspect of FSHD and displaying D4Z4 alleles > 38kb, classified according to the CCEF clinical categories (as per initial phenotype). Patients underwent extensive assessments, eventually including muscle biopsy and/or broad-spectrum genetic investigation, revealing pathogenic/likely pathogenic variants in different genes (ACMG classes 4 and 5), or significant comorbidities. Alternative diagnoses were distributed within the clinical categories as follows: category A: 6 SMCHD1, 1 COL6A , and 1 Inclusion-Body Myositis-like case; category B1: 3 SMCHD1 ; category D: 4 CAPN3 (2 recessive and 2 dominant), 3 COL6A, 1 DMPK, 2 DMD (Becker phenotype), 1 EMD , 1 FKRP , 1 GAA , 1 MYH7 , 1 RYR1 , 1 SEPN1 , 1 SGCG , and 1 PMP22 -linked CMT-like distal phenotype. Other FSHD-mimics included also a post-radiation cervical syndrome, a chronic inflammatory demyelinating polyneuropathy (CIDP), a multiple sclerosis (MS), and a Turner syndrome. D4Z4-allele genetic analysis is justified in all cases exhibiting facial and shoulder girdle weakness, but its interpretation requires a thorough characterization of phenotype. In fact, especially in cases with atypical features (Category D), various concomitant/alternative conditions may be diagnosed, besides the more common FSHD type 2 due to SMCHD1 mutations. Therefore, a cautious diagnostic conclusion is required, especially in cases with borderline length D4Z4 alleles. [ABSTRACT FROM AUTHOR]

Limb girdle myopathies (LGM) form a group of clinically and genetically heterogeneous diseases responsible of progressive weakness predominantly affecting the shoulder and pelvic girdles muscles. Duchenne muscular dystrophy (DMD) and sarcoglycanopathies have been for decades recognized as the main myopathy's subtypes in Tunisia. We have performed a retrospective study including the patients diagnosed with LGM since January 2014 until December 2023, with an age onset of at least 2 years old. We have reviewed the full family history and medical data. All of the patients underwent CK levels dosage, EMG, muscle biopsy and molecular genetic studies. We excluded the patients diagnosed with DMD. We obtained a cohort of 44 patients, 60% of cases were males and 40% were females. Targeted genetic diagnosis of sarcoglycanopathies was performed in 50% of our patients. LGMDR5 was the most frequent subtype, with three identified variants of mutations in the SGCG gene: c521 del T (hot-spot mutation), c582 ins A and c525 del T. In the other half of our cohort, larger genetic analysis, with a LGMD panel or a whole exome sequencing (WES), showed mutations in the CAPN3 (LGMDR1), DYSF (LGMDR2), FKRP (LGMDR9), POMT1 (LGMDR11), GMPPB (LGMDR19), and COL6A1 (LGMDR22) genes. In addition, mutations in new genes that were not previously described in Tunisia were also identified: TITIN, RYR1, LMNA, GGPS1, PYROXD1, COL13A1 and VMA21. We emphasize the genetic variability of LGM in Tunisia and North Africa. The list of the implicated genes is continuously extending, exceeding so far the sarcoglycanopathies group. [ABSTRACT FROM AUTHOR]

CAPN3 encodes calpain-3, a calcium-activated skeletal muscle-specific protease. Pathogenic variants in CAPN3 are associated with autosomal recessive and autosomal dominant limb-girdle muscular dystrophy (LGMDR1/LGMD2A and LGMDD4, respectively). Patients present with weakness of the pelvic and shoulder girdle and elevated creatine kinase levels. Here, we report in detail on three children and one adult from four unrelated Israeli families of Iraqi Jewish descent with features of LGMDR1, who were found to harbor the same homozygous missense variant in CAPN3 , p.Gln123Lys. All subjects manifested lower limb weakness with onset in the first or second decades of life; the three children presented with toe walking and significantly elevated creatine kinase levels (6,000-21,000U/L). The variant affects an evolutionarily conserved amino acid in a conserved domain of the protein common to the calpain super family. We conclude that the p.Gln123Lys variant in CAPN3 is associated with autosomal recessive limb-girdle muscular dystrophy with a recognizable clinical phenotype. Furthermore, this variant likely represents a founder mutation in individuals of Iraqi Jewish ancestry. These findings can help guide workup for individuals presenting with suggestive features and should be considered in relevant population screening. [ABSTRACT FROM AUTHOR]

Glycogen storage disease type 5 (GSD 5) is an autosomal recessive inherited metabolic myopathy caused by a deficiency of the enzyme muscle glycogen phosphorylase. The disease typically presents with difficulties related to physical activity resulting in exercise-induced muscle pain and weakness. Muscle weakness and wasting may occur later in life with a pattern of weakness involving the shoulder girdle and paraspinal muscles. The objective was to quantify fat replacement of paraspinal, shoulder-girdle, and extremity muscles using whole-body MRI in patients with GSD5 attending the highly specialized McArdle Service in London, UK. Observational and cross-sectional study. A total of 10 participants with a genetically confirmed diagnosis, mean age 51.4 years (range 18–76) in different stages of the disease, were enrolled and underwent T1 weighted MRI sequencing and whole-body quantitative muscle fat fraction analyses (DIXON). MRI findings were analysed using the semiquantitative Mercuri scale and individual muscle fat fractions (FFs), and were correlated with the medical history and clinical examination of the musculoskeletal system using the MRC Score and biochemical analysis. The results will be presented at the conference in detail. Footnote: The first and second authors contributed equally. [ABSTRACT FROM AUTHOR]

Cervical facet join pain is one of the leading etiologies of neck pain, with prevalence rates ranging from 33-60% of neck pain patient. Percutaneous radiofrequency ablation of the medial branch nerves has been shown to be an effective treatment for facet joint pain in appropriately selected patients. In contrast, well-done studies have not supported the use of intra-articular cervcial facet joint corticosteroid injections, however studies demonstrating lack of benefit are flawed, especially in patient selection. MRI with STIR (short tau inversion recovery) sequences may represent a diagnostic means of properly selecting patients for these injections. To evaluate success rates of intra-articular cervical facet joint corticosteroid injections in patients with increased peri-facet edema as demonstrated by MRI with STIR sequences. Prospective, observational, multi-site trial at one nonacademic and two academic spine centers. Consecutive patients with increased peri-facet MRI STIR signal who present for an intra-articular cervical facet joint corticosteroid injection and consent to participating in the study. Two to four weeks post-injection: NRS pain score, Neck Disability Index (NDI), Global Perception of Change, presence/absence of additional treatments (over-the-counter medication, prescription medication, and other treatments) 3 months post-injection: NRS pain score, Neck Disability Index (NDI), Global Perception of Change, presence/absence of additional treatments (over-the-counter medication, prescription medication, and other treatments). Patients with unilateral or bilateral neck and/or shoulder girdle/scapular and/or occipital pain without radicular pain of at least 4 weeks, and a 7-day average NRS score of at least 4/10, with peri-facet joint edema seen on MRI with STIR sequences at one or more cervical facet joints that correlates with the side and location of the patient's symptoms, who were undergoing intra-articular cervical facet joint corticosteroid injections as standard of care were enrolled in the study. Injections were performed only in the joint(s) that demonstrated increased STIR signal, and were performed by fellowship-trained interventional physiatrists. Outcomes were collected at 2-4 weeks and 3 months post-injection. The primary outcome was the proportion of patients who demonstrated at least 50% improvement in the NRS score. The following results are only from Site #1. Patient recruitment and data collection have also been completed at Sites #2 and #3, however the results are not available at the time of this submission (approximately 20 additional patients have been enrolled at these sites). The complete results will be available shortly. At 2-4 weeks post-injection, 58% (7/12) of patients met criteria for success (at least 50% improvement in NRS pain score), with 42% (5/12) reporting pain down to ≤ 2/10. 75% (9/12) reported improvement by at least one major category (ie, moderate to mild disability) on the NDI, and 92% (11/12) reported that they were better or much better on the global perception of change. At 3 months post-injection, 42% (5/12) of patients met criteria for success (at least 50% improvement in NRS pain score), with 33% (4/12) reporting pain down to ≤ 2/10. 42% (5/12) reported improvement by at least one major category (ie, moderate to mild disability) on the NDI, and 50% (6/12) reported that they were better or much better on the global perception of change. Intra-articular cervical facet joint corticosteroid injections appear to provide short-term, and possibly intermediate-term, relief of neck pain in patients with peri-facet edema as demonstrated by MRI with STIR sequences. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Background: Opiates are frequently used in the inpatient management of chest wall injury following blunt trauma. However, the daily sum of opiates used during acute care, and the impact that additional injuries or rib fracture displacement may have on daily opiate requirement is unknown.Methods: A retrospective sample of 85 adult patients admitted to a tertiary trauma centre between April 2018 and October 2019 after a major chest wall injury (Abbreviated Injury Scale >2) and referral to Acute Pain Management Service was used in this study. Daily opiate usage was calculated each day for the first seven days following initial admission and converted to morphine milliequivalents (MME). Additional adjunct analgesia therapy was also recorded each day. The presence of rib fracture displacement and concurrent clavicle/scapular fractures was also noted. A comparison of the average daily MME for the various subgroups of interest was performed.Results: The maximum average MME in patients with rib fractures typically occurs at day 2 post injury and admission, with the highest day 2 average MME being in the Patient Controlled Analgesia (PCA) and ketamine subgroup. Presence of rib displacement delayed the onset of maximal MME to day 3 and resulted in higher average MME over the total seven days. Patients with concurrent clavicle or scapular fractures also had higher average MME each day, regardless of the addition of a regional block.Conclusions: This study has demonstrated the daily opioid requirement is maximal on day 2 post-admission following isolated major chest wall injury. The addition of a regional block resulted in a reduction of the average MME used each day over the first seven days post-admission, compared to ketamine when added to PCA. The presence of displaced rib fractures or clavicle/scapular fractures increased the MME used each day, changed the day of peak consumption and increased the average daily opioid requirement during acute hospitalisation. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the effectiveness and safety of IncobotulinumtoxinA (IncoA) for the management of myofascial pain syndrome (MPS) in refractory patients. This single-center, observational, retrospective study includes 37 patients. The pain reduction was 4.7 points (95%CI: 5.6 to −3.8) from baseline to one-month post-injection (using a 10-point visual analogue scale). Only 18.9% experienced mild adverse events. In conclusion, IncoA is an effective and safe alternative for the treatment of MPS in refractory patients. [Display omitted] • We present the first results specifically addressing the treatment of shoulder girdle MPS with IncobotulinumtoxinA. • IncobotulinumtoxinA injections led to a significant reduction in symptomatic pain after failure of conventional treatment. • IncobotulinumtoxinA has demonstrated to be effective and safe. [ABSTRACT FROM AUTHOR]

The Trichomycterinae is a diversified catfish clade exhibiting numerous ecological specializations, thus offering fine opportunities for studies on vertebrate evolution, but insufficient knowledge on phylogenetic relationships and taxonomy impedes advanced evolutionary studies. Recent studies have contributed to a better taxonomical resolution of some trichomycterine groups, but several taxa remain poorly known, with taxonomical placement still undetermined. This study is directed to two similar undescribed species with unclear generic placement, collected in the savannahs of central Brazil, in the headwaters of the two most important South American river systems, the Amazon and Paraná basins central Brazil. A multigene phylogeny integrated to a comparative osteological analysis supports a clade, with the new species forming a subclade sister to a trichomycterine subclade endemic to southern South America. The comparative osteological analysis provided some characters from the jaw suspensorium, opercular series, branchial arches, neurocranium, and pectoral girdle that are useful to diagnose members of the clade. The two species may be distinguished by meristic data, morphometrics, osteology, and colour pattern. Following recent efforts for a better understanding about diversity and relationships of trichomycterines, the present study provides phylogenetic and morphological basis for the taxonomical resolution of this important trichomycterine clade. However, much more research is necessary to improve trichomycterine taxonomy, including further studies providing a proper generic classification encompassing the whole Trichomycterinae. [ABSTRACT FROM AUTHOR]

Single-photon emission computed tomography (SPECT) imaging forms part of the bone scintigraphy examination to significantly improve the detection of skeletal lesions. It has been observed that patients undergoing lumbar spine SPECT scintigraphy frequently complain of general discomfort in the shoulder girdle. Music has been used as an intervention during medical procedures or imaging examinations in an attempt to relieve discomfort and anxiety. The aim of this study was to determine the effect of music, as an intervention, on the perceived discomfort in the shoulder girdle during lumbar spine SPECT scintigraphy. A pretest-posttest quasi-experimental design with two groups was used to conduct this study. Ninety-six consecutive patients routinely referred for lumbar spine SPECT scintigraphy were recruited from two private nuclear medicine practices in Gauteng. Patients were systematically assigned to the control or experimental group. Patients were asked to rate their discomfort at various time points. The results indicate that the group exposed to music as an intervention more frequently reported a decrease in discomfort as compared with the control group. The experimental group also reported less percentage increase in discomfort. There were statistically significant differences in discomfort scores 10 min into the SPECT and after the SPECT between the control and intervention groups. Discomfort scores of the control group had a noticeable increase after the SPECT had started. Music as an intervention during SPECT imaging is more of a distraction than an analgesic and can be used to increase patient comfort and the patients' experience. • Music is more of a distraction than an analgesic during SPECT imaging. • Music makes patients feel less anxious and more relaxed and eases discomfort during lengthy imaging examinations. • Sedative music has shown to have a positive effect during other imaging modalities. [ABSTRACT FROM AUTHOR]

Fixation of clavicle fractures has now become a more popular option as it provides better outcome compared with conservative management. Wide-awake local anesthesia no tourniquet (WALANT) has been effectively used in plating of distal radius and olecranon fractures. This paper expands the usage of WALANT into the shoulder girdle, namely plating of the clavicle that has not been described. The operation is typically performed under general anesthesia. We report a case series of 16 patients who successfully underwent fixation of the clavicle under the wide-awake technique. The clavicle fractures were grouped under the AO Fracture Classification. The WALANT solution comprised 1% lidocaine, 1:100,000 epinephrine, and 10:1 sodium bicarbonate. A total of 40 mL was injected in each patient with 10 mL subcutaneously along the clavicle followed by 30 mL subperiosteally at multiple intervals and directions. The Numerical Pain Rating Score was 0 during WALANT injection and during surgery except for 2 patients with Numerical Pain Rating Scores of 1 and 2, respectively, during reduction. We conclude that clavicle plating under WALANT is a good alternative option of anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: The coordination of the glenohumeral joint and the shoulder girdle has been known as scapulohumeral rhythm. The effects of anatomical total shoulder arthroplasty (aTSA) are still subject to research. Former studies showed a higher amount of scapula lateral rotation to compensate for reduced glenohumeral elevation. The purpose of the present study was to confirm this mechanism and examine additional effects on the sternoclavicular and acromioclavicular joints' kinematics.Methods: 3D motion analysis was used to examine 23 shoulders of 16 patients with a mean age of 71.2 (SD: 5.2) years with a mean follow up of 5.4 (SD: 2.1) years after aTSA and to compare kinematics and coordination to 22 shoulders of 11 healthy age-matched individuals with a mean age of 69.6 (SD: 5.3) years while performing elevation movement in frontal and sagittal plane.Results: The ratio of glenohumeral to shoulder girdle contribution was reduced compared to healthy individuals: Shoulder girdle contribution to elevation was 36.5% (SD: 8.1) in the aTSA group vs. 28.5% (SD: 8.2) in the control group in the sagittal plane and 38.1% (SD: 9.1) vs. 30.2% (SD: 7.1) in the frontal plane. Kinematics of the sternoclavicular and acromioclavicular joints showed significantly different patterns.Conclusion: Patients after aTSA showed altered shoulder girdle kinematics and higher contribution of the shoulder girdle towards elevation. Whether this is a result of the surgery, of limited glenohumeral range of motion or due to the preoperative status remains unclear. Further investigation with a prospective study design is necessary. [ABSTRACT FROM AUTHOR]

Facioscapulohumeral muscular dystrophy (FSHD) is a rare condition affecting 1/20,000 persons and the third most common muscular dystrophy condition, with an autosomal dominant pattern of inheritance characterized by progressive muscular weakness primarily involving the face, shoulder girdle, and upper arm. The condition is associated with atrophic musculature of the trunk and core leading to difficulties with gait, posture, and function. FSHD leaves as many as 20% of patients wheelchair-bound and most commonly presents with low back, neck, and shoulder pain. We present the case of a patient with FSHD who underwent multiple spinal fusion surgeries without relief in her back pain. Imaging studies serve to highlight the extent of paraspinal muscle atrophy and provides the basis for a discussion on the preoperative factors that may predict patients most likely to benefit from surgery. We then provide a brief review of the literature on the role of paraspinal muscle atrophy in back pain. This case adds to our understanding of the surgical management of patients with FSHD and patients with atrophic core musculature as a whole. [ABSTRACT FROM AUTHOR]

In a seminal study on elasmobranch systematics, Maisey proposed the monophyly of a large lineage of sharks based primarily on the sharing of an orbitostylic jaw suspension. This group was later redefined as the Squalomorphi, which included Squatinidae but not Batoidea. Subsequent morphological analyses, however, rejected Maisey's scheme, which was left aside for nearly two decades until the first molecular phylogenies began to cluster again the orbitostylic sharks into a monophyletic group. In a broad comparative investigation of the anatomy of the appendicular skeleton of cartilaginous fishes, we discovered new evidence supporting the monophyly of squalomorph sharks: the presence of a posterior process at the lateral region of the coracoid bar serving as a origin site for the depressor pectoralis II muscle. This feature would be the first strong morphological evidence in 40 years potentially supporting the monophyly of Squalomorphi. [ABSTRACT FROM AUTHOR]

• Five patients with pathogenic mutation in the TCAP gene are reported. • All patients exhibited limb girdle muscular dystrophy but without cardiomyopathy. • Varying severity of fatty infiltration and calves asymmetric affected were found in muscle MRI. • Rimmed vacuoles, monocyte invasion, lobulated fibers, and necrotic fibers were observed in muscle histopathology. Limb girdle muscular dystrophy LGMD R7 telethonin-related is a rare autosomal recessive muscle disorder characterized by proximal muscle weakness of pelvic and shoulder girdles. Mutation in TCAP is responsible for LGMD R7, and the disease has a wide geographic distribution in diverse populations, but genotype-phenotype relationships remain unclear. We collected 5 LGMD R7 patients from three unrelated Chinese families. The average onset age was 16 ± 1.41; the initial symptoms included progressive proximal muscle weakness in limbs, difficulty in fast running, and asymmetric muscle atrophy in calves. Muscle MR imaging showed varying severity of fatty infiltration in the pelvic girdle, thigh, and calf muscles, and the severity of muscle infiltration was related to the length of the disease course. Muscle histopathology revealed aberrantly sized muscle fibers, internal nuclei, split fibers, rimmed vacuoles, monocyte invasion, and necrotic fibers. Sequencing identified one novel and one previously reported TCAP mutation. Our study extends the known distribution of this rare muscular dystrophy and presents the first detailed clinical and genetic characterizations of LGMD R7 cases from the Chinese population. Our work expands the mutation spectrum known for LGMD R7 and emphasizes the need for clinicians to consider TCAP mutations when evaluating patients with symptoms of limb girdle muscular dystrophy. [ABSTRACT FROM AUTHOR]

Tendons have unique mechanical properties, contributing to the transmission, amplification, and recycling of muscle energy. In this light, anuran tendons are especially interesting due to their highly mechanically demanding locomotor modes. Herein we aim to investigate the relation between tendons and muscles from two perspectives: (1) the tendinous area in relation to the potential force produced by associated muscles, and how this relation varies for different tendons of the anuran body; (2) the tendinous proportion of a tendo-muscle unit in relation to different locomotor modes and habitat uses in a monophyletic unranked anuran clade (Diphyabatrachia) which includes Leptodactylidae and Centrolenidae, two highly diverse frog family groups of the Neotropics. Our data suggest a significant and positive relation between tendon dimensions and potential muscle force for most of the analyzed elements. We also found that species of different locomotion and habitat use show a divergence of tendinous proportions for tendo-muscle units of the pectoral girdle and hindlimb. Notably, jumper-arboreal species differentiate from all others in all tendo-muscle units tested. Finally, the optimization of tendinous proportions showed great phylogenetic correspondence. These results are in agreement with the hypothesis that morphological variation is related to a combination of phylogenetic, functional, and ecological factors. [ABSTRACT FROM AUTHOR]

The geographic origins and distributional patterns of Gondwanan teleosauroids during the Jurassic have been fiercely debated over many years. Unlike the rich thalattosuchian fossil record from Laurasia, teleosauroids described from Gondwanan ecosystems are relatively scarce. Most of the known occurrences consist of isolated and fragmentary bones collected in Madagascar, Morocco, Tunisia, India, and Ethiopia. Nevertheless, these specimens, although fragmentary, have provided substantial information for assessing the evolutionary scenarios of multiple teleosauroid lineages and have shown that certain teleosauroid taxa were widespread rather than endemic to Western Europe. Here, a partial skeleton of a teleosauroid crocodylomorph is described. It was found in the late Middle Jurassic (Callovian) deposits of southeastern Tunisia by a team of French and Tunisian paleontologists; however, it has not been thoroughly studied at both macro- and microscopic scale until now. The new specimen is composed of an incomplete symphyseal portion of a lower jaw in addition to isolated teeth, osteoderms (both dorsal and ventral), thoracic and caudal vertebrae, and several thoracic ribs. The specimen has several morphological characters that are reminiscent of longirostrine teleosauroids. Due to the total absence of other cranial bones, as well as the pectoral and pelvic girdles, the specimen is not diagnostic to the generic level. However, these new remains represent the youngest ascertained occurrence of a definitive non-machimosaurin teleosauroid in Africa, provide additional insights into the geographic distribution of Thalattosuchia, and raise once again the question whether the origins of this clade were Gondwanan or Laurasian. [ABSTRACT FROM AUTHOR]

Background: Increasing global demand for specialized radiological investigations has resulted in delayed or non-reporting of plain trauma radiographs by radiologists. This is particularly true in resource-limited environments, where referring clinicians rely largely on their own radiographic interpretation. A wide accuracy range has been documented for non-radiologist reporting of conventional trauma radiographs. The Lodox Statscan whole-body digital X-ray machine is a relatively new technology that poses unique interpretive challenges. The fracture detection rate of trauma clinicians utilizing this modality has not been determined.Objective: An audit of the polytrauma fracture detection rate of clinicians evaluating Lodox Statscan bodygrams in two South African public-sector Trauma Units.Methods: A retrospective descriptive study of imaging data of Cape Town Level 1-equivalent public-sector Trauma Units during March-April 2015. Statscan bodygrams acquired for adult polytrauma triage were reviewed and correlated with follow-up imaging and patient records. Missed fractures were stratified by body part, mechanism of injury and ventilatory support. The fracture detection rate was determined with 95% confidence. The Generalised Fischer Exact Test assessed any association between the fracture site and failure of detection. Specialist orthopaedic review assessed the potential need for surgical management of missed fractures.Results: 227 patients (male = 193, 85%; mean age: 33 years) were included; 195 fractures were demonstrated on the whole-body triage projections. Lower limb fractures predominated (n = 66, 34%). The fracture detection rate was 89% (95% CI = 86-93%), with the site of fracture associated with failure of detection (p = 0.01). Twelve of 21 undetected fractures (57%) involved the elbow or shoulder girdle. All elbow fractures (n = 3, 100%), more than half the shoulder girdle fractures (9/13,69%) and 12% (15/123) of extremity fractures were undetected. One missed fracture (1/21,4.7%) unequivocally required surgical management, while a further 7 (7/21, 33.3%) could potentially have benefitted from surgery, depending on follow-up imaging findings.Conclusion: This is the first analysis of the accuracy of bodygram polytrauma fracture detection by clinicians. Particular review of the shoulder girdle, elbow and extremities for subtle fractures, in addition to standardized limb positioning, are recommended for improved diagnostic accuracy in this setting. These findings can inform clinician training courses in this domain. [ABSTRACT FROM AUTHOR]

According to scapulohumeral rhythm, shoulder abduction is followed through scapular upward rotation to ensure joint mobility and stability. Of interest, the shoulder abduction can be performed holding the scapula in different positions and in association with scapular elevation, with possible effects on shoulder muscle activity. Therefore, the aim of the study was to analyze the activity of relevant shoulder muscles and the activity ratios between the scapulothoracic muscles, during shoulder abduction performed in different combinations of scapular position (neutral, retracted, protracted) and scapular elevation. The electromyographic activity of middle deltoid, serratus anterior, upper, middle and lower fibers of trapezius was recorded during shoulder abduction movements executed holding the scapula in neutral, retracted and protracted position, and subsequently a shoulder elevation movement. The activation of each muscle and the scapulothoracic muscles activity ratios were determined every 15 degrees, from 15° to 120° of abduction. Scapular retraction led to higher activation of the entire trapezius muscle, whereas protraction induced higher upper trapezius, middle deltoid and serratus anterior activity, along with lower activity of middle and lower trapezius. Shoulder elevation led to higher activity of the upper trapezius and middle deltoid. Moreover, it induced lower activation of the serratus anterior and middle and lower trapezius, thus leading to high ratios between the upper trapezius and the other scapulothoracic muscles, especially between 15 and 75 degrees of abduction. This study highlights that shoulder abduction performed with scapular protraction and in combination with scapular elevation leads to increased activity of the middle deltoid and upper trapezius, resulting in imbalances between the scapulothoracic muscles that could hamper the optimal scapulohumeral rhythm. The abduction performed in the aforementioned scapular conditions also induce potential reciprocal inhibition effects between the movers and stabilizers muscles of scapula, suggesting different motor control strategies of integrating a common shoulder movement with various modification of the scapular position. [ABSTRACT FROM AUTHOR]

Purpose: The higher prevalence of work-related musculoskeletal disorders among women compared with men could be explained by sex-gender differences related to biological and physiological processes. The aim of this study was to evaluate sex differences in motor coordination during a sustained and repetitive motor task.Methods: Seventeen healthy females and 21 healthy males participated. The surface electromyography (sEMG) of the trapezius portions and serratus anterior were recorded. Root mean square (RMS) values were computed to assess the level of muscle activity. The standard deviation (SD) and coefficient of variation (CV) were computed as metrics of size of variability. The normalized mutual information (NMI) values were calculated as index of functional connectivity between muscles pairs.Results: Females had higher normalized RMS values for the upper trapezius (acromial fibers) and serratus anterior muscles compared with males. RMS decreased, SD and CV increased while NMI decreased for almost all muscle pairs over time.Conclusion: The present work showed some signs of sex differences in muscle coordination of the shoulder girdle during a sustained motor task, performed with the upper limb positioned below of the shoulder level. [ABSTRACT FROM AUTHOR]

• Anthropometric and shoulder motion data were captured for 25 volunteers ages 8–12. • Quasi-static displacement response corridors were created. • Forward and upward shoulder motions were analyzed. • Data will be applied to the Large Omni-directional Child Anthropomorphic Test Device. The shoulder girdle complex, through engagement with the seat belt, influences motor vehicle occupant upper body movement during frontal impacts, affecting the movement of the head and spine. The recently developed Large Omni-directional Child (LODC) anthropomorphic test device (ATD) was designed with flexible shoulder girdle structures that capture the unique kinematics in pediatric occupants. However, the LODC shoulder has not been evaluated for biofidelity due to the lack of biomechanical data available on pediatric shoulder responses. This study evaluated quasi-static pediatric shoulder girdle complex responses through non-invasive displacement measurements. These data were obtained to evaluate, and, if necessary, improve the biofidelity of the LODC ATD. Shoulder range of motion and anthropometric measurements were obtained from 25 pediatric volunteers, ages 8–12 years old. Loads were applied bilaterally exclusively to the shoulder complexes in increments of 25 N up to 150 N per shoulder at 90 and 135 degrees of shoulder flexion. Still photos were used to determine shoulder displacement in the sagittal plane from images captured prior to and following the load applications. Data analysis consisted of motion tracking to evaluate the absolute and relative displacement of the right acromion and T1. The displacements for each volunteer were normalized based on the volunteer's shoulder width compared to the shoulder width of the LODC ATD. For the 90° load, the acromion moved relative to T1 an average of 28.1 mm forward and 3.1 mm downward at maximum displacement. For the 135° load, the acromion moved relative to T1 an average of 15.5 mm forward and 42.7 mm upward at maximum displacement. Similar displacements at higher loads indicated that the volunteers achieved their maximum range of motion. The results of this study will be compared to the LODC ATD, assessing the biofidelity of the shoulder complex. [ABSTRACT FROM AUTHOR]

Standing is a popular alternative to traditionally seated computer work. However, no studies have described how standing impacts both upper body muscular and vascular outcomes during a computer typing task. Twenty healthy adults completed two 90-min simulated work sessions, seated or standing. Upper limb discomfort, electromyography (EMG) from eight upper body muscles, typing performance and neck/shoulder and forearm blood flow were collected. Results showed significantly less upper body discomfort and higher typing speed during standing. Lower Trapezius EMG amplitude was higher during standing, but this postural difference decreased with time (interaction effect), and its variability was 68% higher during standing compared to sitting. There were no effects on blood flow. Results suggest that standing computer work may engage shoulder girdle stabilizers while reducing discomfort and improving performance. Studies are needed to identify how standing affects more complex computer tasks over longer work bouts in symptomatic workers. [ABSTRACT FROM AUTHOR]

Scapular kinematics during sports performances can be recorded using skin-mounted trackers attached to the skin overlying the acromion for continuous data collection without restricting natural motions of the subject relative to medical imaging analyses limiting its use for wide-range or high-speed motions. This study aimed to describe the existence of a directional bias in the translational and rotational errors of skin-mounted trackers using a 3D magnetic resonance imaging (3D-MRI) protocol. 3D-MRI scans of the healthy right shoulders of 19 males were acquired in 12 arm positions. The relative transformation of the scapular configuration determined to be the measurement error, as recorded by the configuration of the small cuboid imitating a skin-mounted tracker relative to the actual scapular configuration measured by the voxel-based registration. These measurement errors were expressed with either positive or negative values to describe the bias. Overall translational errors in the lateral, anterior, and superior directions were 3.7 ± 8.4 mm, 9.5 ± 6.4 mm, and 6.2 ± 4.6 mm, respectively. Overall rotational errors in protraction, upward rotation, and posterior tilt were 7.8 ± 8.4°, 0.2 ± 7.4°, and − 4.0 ± 7.5°, respectively. The skin-mounted tracker displayed a high probability of displacement in antero-superior (93% and 91%) directions and rotates in a protracting manner (82%) relative to the position of the underlying bone with the gradual nature of its change. The existence of the directional bias with its gradual change suggests a statistical predictability in measurement errors, which can be used to predict accurate scapular translation and rotation. [ABSTRACT FROM AUTHOR]

Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the contributing factors to the development of subacromial impingement syndrome (SAIS). Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics of SAIS has not been reported. This study aimed to measure and compare fatigue progression within the shoulder girdle musculature of patients and healthy controls. 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital Anxiety and Depression Scale) were also assessed. The results were compared between patient and control groups according to the gender. Despite marked fatigue observed in the majority of muscles particularly during flexion and abduction at 90°, overall results indicated a lower tendency of fatigue progression in the impingement group across the tests (p < 0.05 - p < 0.001). Shoulder Strength, pain experience, and psychological status were significantly different between the two groups (P < .05). Lower tendency to fatigue progression in the impingement group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, which in turn lead to adaptations in motor programme to reduce muscle recruitment and activation. The significantly higher levels of pain experience and anxiety/depression in the impingement group further support this proposition. [ABSTRACT FROM AUTHOR]

This study investigated the acute effects of changing the work pace and implementing two pause types during an assembly task. Eighteen healthy women performed a simulated task in four different conditions: 1) slow or 2) fast work pace with 3) passive or 4) active pauses every two minutes. The root mean square (RMS) and exposure variation analysis (EVA) from the trapezius and serratus anterior muscles, as well as the rate of perceived exertion (RPE) from the neck-shoulder region, were observed. Decreased RMS and RPE as well as more variable muscle activity (EVA) were observed in the slow work pace compared with the fast one. The pause types had a limited effect, but active pauses resulted in increased RMS of the clavicular trapezius. The findings revealed the importance of work pace in the reduction of perceived exertion and promotion of variation in muscle activation during assembly tasks. However, the pause types had no important effect on the evaluated outcomes. [ABSTRACT FROM AUTHOR]

In vertebrates, skeletal muscles of the body are made up of epaxial and hypaxial muscles based on their innervation and relative position to the vertebral column. The epaxial muscles are innervated by the dorsal branches of the spinal nerves and comprise the intrinsic (deep) back muscles, while the hypaxial muscles are innervated by the ventral branches of the spinal nerves including the plexus and consist of a heterogeneous group of intercostal, abdominal, and limb as well as girdle muscles. The canonical view holds that the epaxial muscles are derived from the medial halves of the somites, whereas the hypaxial muscles are all derived from the lateral somitic halves. The rhomboid muscles are situated dorsal to the vertebral column and therefore in the domain typically occupied by epaxial muscles. However, they are innervated by a ventral branch of the brachial plexus called the N. dorsalis scapulae. Due to the apparent inappropriate position of the muscle in relation to its innervation we investigated its origin to help clarify this issue. To study the embryonic origin of the rhomboid muscles, we followed derivatives of the medial and lateral somite halves using quail-chick chimeras. Our results showed that the rhomboid muscles are made up of cells derived mainly from the lateral portion of the somite. Therefore the rhomboid muscles which lie within the epaxial domain of the body, originate from the hypaxial domain of the somites. However their connective tissue is derived from both medial and lateral somites. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the coordination of the shoulder girdle muscles among subjects with or without neck-shoulder pain performing repetitive arm movement at either a slow or fast pace.Methods: Thirty female adults were allocated to one of two groups-healthy controls or cases with neck-shoulder pain. Surface electromyography (sEMG) signals from the clavicular, acromial, middle and lower trapezius portions and the serratus anterior muscles were recorded during a task performed for 20min at a slow pace and 20min at a fast pace. The root mean square (RMS), relative rest time (RRT) and normalised mutual information (NMI, an index of functional connectivity between two muscles in a pair) were computed.Results: No significant differences on RMS, RRT and NMI were found between groups. For both groups, the fast movement pace resulted in increased levels of RMS, lower degrees of RRT and higher NMI compared to the slow pace. No interaction between group and movement pace was found.Conclusions: This study highlights the change in sEMG activity of muscles to meet the demands of performing a task at fast movement pace. The fast pace imposed a higher muscle demand evidenced by increased sEMG amplitude, low degree of muscle rest and increased functional connectivity for subjects in both the case and control groups. No indication of impaired sEMG activity was found in individuals with neck-shoulder pain. [ABSTRACT FROM AUTHOR]

Introduction Numerous pedicle and free flaps have been used to cover complex defects of the shoulder girdle and posterior neck triangle following tumor resection. We describe our choice of flap selection in these patients with case examples. Presentation of cases Three cases examples demonstrate our choice of flap selection. In the first case, an anterior shoulder girdle defect is covered by an anteriorly transposed latissimus dorsi muscle flap. The second case demonstrates the coverage of a posterior shoulder girdle defect by a posteriorly transposed latissimus dorsi muscle flap. Finally, the third case demonstrates the coverage of a posterior triangle neck defect using a superiorly transposed pectoralis major muscle flap. All reconstructions utilize muscle flaps (covered by split-thickness skin grafts) and not myocutaneous flaps. Discussion We demonstrate that these two pedicle muscle flaps are adequate for coverage of large complex defects of the shoulder girdle and posterior neck triangle. We also demonstrate the advantages of using muscle rather than myocutaneous flaps. Conclusion Pedicle latissimus dorsi and pectoralis major muscle flaps are simpler and preferred over free flaps for coverage of complex defects of the shoulder girdle and posterior neck triangle. The use of muscle rather than myocutaneous flaps will reduce the size of the original defect, make flap design easier and reduce donor site morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern.Methods: We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment.Results: We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern.Conclusions: Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic. [ABSTRACT FROM AUTHOR]

Females present more neck/shoulder musculoskeletal disorders and have different activation strategies of the shoulder girdle muscles than males. However, the sensorimotor performance and potential sex differences are still largely unexplored. The aim of this study was to investigate sex differences in torque steadiness and accuracy during isometric shoulder scaption. We also examined the amplitude and variability of the activation of the trapezius, serratus anterior (SA), and anterior deltoid muscles during torque output evaluation. Thirty-four asymptomatic adults (17 females) participated. Torque steadiness and accuracy were evaluated during submaximal contractions at 20 % and 35 % of peak torque (PT). There was no sex difference in torque coefficient of variation, but females had significantly lower torque standard deviation (SD) values than males at the two intensities evaluated (p < 0.001) and lower torque median frequency values compared to males, regardless of intensity (p < 0.01). Females had significantly lower absolute error values than males for torque output at 35 %PT (p < 0.01) and lower constant error values compared to males, regardless of intensity (p = 0.01). Females had significantly higher muscle amplitude values than males, except for SA (p = 0.10) and in general, females showed higher muscle activation SD values compared to males (p < 0.05). Females may require more complex muscle activation patterns to achieve a more stable and accurate torque output. Therefore, these sex differences may reflect control mechanisms that may also be at play when explaining the greater risk of neck/shoulder musculoskeletal disorders in females than males. [ABSTRACT FROM AUTHOR]

The subclavius muscle runs underneath the clavicle. However, there have been a few reports of a duplicated subclavius muscle which is commonly referred to as subclavius posticus muscle due to its orientation being posterior to the proper subclavius muscle. Its occurrence seems to potentially create a narrowing interval at the superior thoracic aperture as it crosses over the brachial plexus. It might also have functional influence on the shoulder girdle. To provide comprehensive gross anatomy description of the variant "subclavius posticus muscle" and to investigate its reported clinical implications with emphasis on its involvement in causing brachial plexus compression. A scoping review with meta-analysis of the gross anatomy of the subclavius posticus muscle was conducted along with investigating its correlation to the thoracic outlet syndrome. Forty-seven articles were pooled through two rounds of the selection process. The relevant information was extracted and meta-analyzed. The scoping review and meta-analysis of the 47 articles revealed a total prevalence of 11/2069 (4.9%); 10/1369 (5.1%) in cadaveric studies, and 1/700 (5.0%) in MRI studies. The subclavius posticus muscle is a short triangular muscle with an average length of 12 cm and an average width of 1 cm. It originates from the sternal end of the first rib in most cases with reported variants of one case originating from the costoclavicular ligament and one case where it was fused with the proper subclavius muscle. Its insertion is more variable: on the superior border of the scapula with variable length in 71.35%, on the coracoid process of the scapula in 25.42%, and on the clavicle in 0.90%. The subclavian nerve seems to be the dominant nerve supply with a 57.6% prevalence, while 25.8% are innervated by the suprascapular nerve. Other reported nerves were the nerve to the myolohyoid (4.5%), accessory phrenic nerve (4.5%), and a direct branch from the brachial plexus (2.0%). The blood supply was reported (only once) to be from the suprascapular artery. However, the venous drainage was not established at all. The subclavius posticus muscle is a variant muscle occurring with a reported overall prevalence of 4.9%. It can compress the brachial plexus as it runs across at the space of the superior thoracic aperture with exquisite contact, and this can lead to a neurogenic thoracic outlet syndrome. It also can be involved in the vascular thoracic outlet syndrome. Lastly, it is important not to omit its potential influence in shoulder joint instability to some extent. [Display omitted] [ABSTRACT FROM AUTHOR]

Traumatic injuries involving the scapula and clavicle in skeletally immature patients have unique characteristics that distinguish them from similar injuries in the mature skeleton. Fractures involving unossified cartilage and unfused epiphyses are difficult to appreciate on plain radiographs and computed tomography (CT) imaging. Knowledge of the developmental anatomy and normal radiological appearances during different stages of development of these bones is an essential prerequisite for the radiologist tasked with interpreting the imaging of such injuries in order to avoid potential diagnostic pitfalls. With increased availability and improved resolution of magnetic resonance imaging (MRI), we are now better able to distinguish between true joint dislocations and epiphyseal injuries. Making this distinction is important because it can have implications with regards to how the patient is managed and the prognosis. [ABSTRACT FROM AUTHOR]

Electromyography (EMG) biofeedback training affords patients a better sense of the different muscle activation patterns involved in the movement of the shoulder girdle. It is important to address scapular kinematics with labourers who have daily routines involving large amounts of lifting at shoulder level or higher. This population is at a heightened risk of developing subacromial impingement syndrome (SAIS). The purpose of this study was to investigate the acute effects of scapular stabilization exercises with EMG biofeedback training on scapular kinematics. Twenty-three healthy subjects volunteered for the study. Electrodes were placed on the upper and lower trapezius, serratus anterior, and lumbar paraspinals to measure EMG activity. Subjects underwent scapular kinematic testing, which consisted of humeral elevation in the scapular plane, before and after biofeedback training. The latter consisted of 10 repetitions of the I, W, T, and Y scapular stabilization exercises. Subjects were told to actively reduce the muscle activation shown on the screen for the upper trapezius during the exercises. The scapular external rotation had a statistically significant difference at all humeral elevation angles ( p <0.004) after biofeedback was administered. After the exercises, the scapula was in a more externally rotated orientation with a mean difference of 6.5°. There were no significant differences found with scapular upward rotation, or posterior tilt at all humeral elevation angles following biofeedback. Scapular kinematics are altered by EMG biofeedback training utilizing scapular stabilization exercises. However, only scapular external rotation was affected by the exercises. [ABSTRACT FROM AUTHOR]

Shoulder motions consist of a composite movement of three joints and one pseudo-joint, which together dictate the humerothoracic motion. The purpose of this work was to quantify the location of the centre of rotation (CoR) of the shoulder complex as a whole. Dynamic motion of 12 participants was recorded using optical motion tracking during coronal, scapular and sagittal plane elevation. The instantaneous CoR was found for each angle of elevation using helical axes projected onto the three planes of motion. The location of an average CoR for each plane was evaluated using digitised and anthropometric measures for normalisation. When conducting motion in the coronal, scapular, and sagittal planes, respectively, the coefficients for locating the CoRs of the shoulder complex are −61%, −61%, and −65% of the anterior–posterior dimension – the vector between the midpoint of the incisura jugularis and the xiphoid process and the midpoint of the seventh cervical vertebra and the eighth thoracic vertebra; 0%, −1%, and −2% of the superior–inferior dimension – the vector between the midpoint of the acromioclavicular joints and the midpoint of the anterior superior iliac spines; and 57%, 57%, and 78% of the medial–lateral dimension −0.129 times the height of the participant. Knowing the location of the CoR of the shoulder complex as a whole enables improved participant positioning for evaluation and rehabilitation activities that involve movement of the hand with a fixed radius, such as those that employ isokinetic dynamometers. [ABSTRACT FROM AUTHOR]

We assessed the concurrent validity of commercially available magnetic and inertial measurement units (MIMUs) for estimating mean postural angles for head flexion, thorax flexion and shoulder girdle elevation during gait in seven healthy individuals. Postural angles estimated with the MIMUs were compared with angles calculated using marker data from a gold standard motion capture system. Coefficients of determination of mean postural angles between measurement systems were 0.82 for head flexion, 0.58 for thorax flexion, and 0.77 for shoulder girdle elevation. Bland–Altman analysis showed good agreement between measurement systems. Intraclass correlation coefficients were 0.9 for head flexion, 0.73 for thorax flexion, and 0.87 for shoulder girdle elevation. Root mean square errors were less than 3° between measurement systems for all body segments. The present findings suggest that the MIMUs tested in this study are valid for estimating head flexion, thorax flexion and shoulder girdle elevation during gait. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects of a 6-week scapular upward rotation exercise (SURE) on scapular and clavicular alignment and scapular upward rotators strength in subjects with scapular downward rotation syndrome (SDRS). Seventeen volunteer subjects with SDRS were recruited from university populations. The alignment of the scapula and clavicle was measured using radiographic analysis and compared in subjects before and after a 6-week self-SURE program. A hand-held dynamometer was used to measure the strength of the scapular upward rotators. The subjects were instructed how to perform the self-SURE program at home. The 6-week self-SURE program was divided into two sections (the first section with non-resistive SURE during weeks 1-3, and the second section with resistive SURE using thera-band during weeks 4-6). The significance of the difference between pre- and post-program was assessed using a paired t-test, with the level of statistical significance set at p<0.05. Significant differences between pre- and post-program were found for scapular and clavicular alignment (p<0.05). Additionally, the comparison between pre- and post-program measurements of the strength of the scapular upward rotators showed significant differences (p<0.05). The results of this study showed that a 6-week self-SURE program is effective for improving scapular and clavicular alignment and increasing the strength of scapular upward rotator muscles in subjects with SDRS. [ABSTRACT FROM AUTHOR]

Background Studies revealed that pelvis and shoulder girdle kinematics is impaired in children with the diplegic form of bilateral cerebral palsy while walking. The features of 3D coordination between these segments, however, have never been evaluated. Methods The gait analyses of 27 children with bilateral cerebral palsy (18 males; mean age 124 months) have been retrospectively reviewed from the database of a Movement Analysis Laboratory. The spatial–temporal parameters and the range-of-motions of the pelvis and of the shoulder girdle on the three planes of motion have been calculated. Continuous relative phase has been calculated for the 3D pelvis–shoulder girdle couplings on the transverse, sagittal and frontal planes of motion to determine coordination between these segments. Data from 10 typically developed children have been used for comparison. Findings: Children with bilateral cerebral palsy walk with lower velocity ( P = 0.01), shorter steps ( P < 0.0001), larger base of support ( P < 0.01) and increased duration of the double support phase ( P = 0.005) when compared to typically developed children. The mean continuous relative phase on the transverse plane has been found lower in the cerebral palsy group throughout the gait cycle ( P = 0.003), as well as in terminal stance, pre-swing and mid-swing. The age, gait speed and pelvis range-of-motions on the transverse plane have been found correlated to continuous relative phase on the transverse plane. Interpretation: Compared with typically developed children, children with bilateral cerebral palsy show a more in-phase coordination between the pelvis and the shoulder girdle on the transverse plane while walking. [ABSTRACT FROM AUTHOR]

Lumkuia fuzzi is a small non-mammalian cynodont from the Middle Triassic of South Africa. It has traditionally been phylogenetically identified as a basal Probainognathia, but some studies place it more basally as the sister-group to Eucynodontia. Lumkuia is known from a single specimen comprising a skull and partial skeleton. Only the skull has been thoroughly described. Here we use synchrotron X-ray computed tomography to describe the dental series and postcranial skeleton of Lumkuia. The shoulder girdle, forearm, manual phalanges, partial vertebral column, and ribs are described. To assess the effect of these new observations on the phylogenetic position of Lumkuia , the scoring of this taxon is updated and new characters are added to two previous analyses, one supporting Lumkuia as a Probainognathia and the other in which the taxon is usually retrieved as a basal Eucynodontia. Our phylogenetic analyses all unambiguously support the position of Lumkuia as a basal Probainognathia. The most commonly retrieved synapomorphies shared by Lumkuia and the probainognathians are cranial (absence of an ectopterygoid and pineal foramen), postcranial (the procoracoid does not contribute to the glenoid fossa), and palaeoneurological (reduction of the external nasal ramus of the maxillary canal, presence of a cochlear canal) characters. The degree of skeletal ossification and stages of dental replacement and wear support that the specimen is a subadult. The forelimbs were adapted to sprawling and occasional scratch-digging, thus suggesting a facultative fossorial ecology for Lumkuia. [Display omitted] • The postcrania of Lumkuia fuzzi is described in detail using synchrotron imaging for the first time. • New phylogenetic analyses support that Lumkuia is a basal probainognathian. • Lumkuia was adapted for scratch-digging. • The dentition and dental replacement support that the holotype is a subadult. [ABSTRACT FROM AUTHOR]

Limb girdle muscular dystrophy R7 (LGMDR7), also known as LGMD2G, is a rare autosomal recessive muscular dystrophy characterized by progressive proximal muscle weakness of pelvic and shoulder girdles, muscle atrophy, calf hypertrophy and cardiomyopathy affecting both genders worldwide. LGMDR7 is caused by mutations in the TCAP gene that encodes for TCAP or telethonin protein. Here we report our first pilot experiment data showing that 1.5-month-old humanized TCAPKI-null (hTCAPKI) mice systemically injected with rAAV.TCAP vectors, encoding human TCAP transgene under several promoters, showed efficient human TCAP mRNA transcription, high level of TCAP protein expression in all tested muscles and significant vector biodistribution in tissues 4 weeks post vectors administration. Diluent treated hTCAPKI and age matched untreated C57Bl/6 (Bl6) were utilized as controls. RT-PCR analysis revealed both human and mouse TCAP transcripts in triceps (Tri), diaphragm (Dia) and heart tissues from hTCAPKI mice treated with rAAV.TCAP vectors, while control mice showed only mouse TCAP transcripts as expected. TCAP expression was determined by western blot. Robust TCAP expression was observed in all rAAV.TCAP treated mice showing up to 350% protein in triceps. Immunofluorescent (IF) staining confirmed properly localized TCAP protein in the Z-disc of sarcomeres in rAAV-treated skeletal muscles. qPCR biodistribution determined the TCAP transgene level in the skeletal muscles and high level in the liver. Further dose-escalation and toxicology studies will determine the minimum efficacious dose and safety of TCAP treatment in patients with LGMDR7/LGMD2G. [ABSTRACT FROM AUTHOR]

The purpose of this study was to clarify whether the activity of the shoulder girdle muscles could be estimated by measuring the elasticity of these muscles under several levels of muscle contraction through ultrasound real-time tissue elastography (RTE). Ten healthy men performed submaximal voluntary contractions (MVC) in each manual muscle testing position for the middle deltoid, upper trapezius, supraspinatus, levator scapulae, and rhomboid major. The elasticity of these muscles was measured using ultrasound RTE during the task. The strain ratio of the muscle to an acoustic coupler was calculated as an assessment index of the muscle elasticity. Higher strain ratio values imply lower elasticity. In addition, the electromyographic activity was recorded from surface electrodes attached only to the middle deltoid and upper trapezius. The strain ratios were negatively correlated with the normalized root mean square values for the middle deltoid ( r = −0.659, p < 0.001) and upper trapezius ( r = −0.554, p < 0.001). The strain ratios of all the muscles decreased with an increase from 10% MVC force to 30% MVC force. Ultrasound RTE may be useful for noninvasively assessing the activity of the shoulder girdle muscles at certain shoulder positions with low levels of muscle contraction. [ABSTRACT FROM AUTHOR]

Upper limb (UL) kinematic assessment protocols are becoming integrated into clinical practice due to their development over the last few years. We propose the ELEPAP UL protocol, a contemporary UL kinematic protocol that can be applied to different pathological conditions. This model is based on ISB modeling recommendations, uses functional joint definitions, and models three joints of the shoulder girdle. The specific aim of this study was to determine the within and between session reliability of the ELEPAP UL model. Ten healthy subjects (mean age: 13.6 ± 4.3 years) performed four reach-to-grasp and five functional tasks, which included a novel throwing task to assess a wide spectrum of motor skills. Three trials of every task in two different sessions were analyzed. The reliability of angular waveforms was evaluated by measurement error ( σ ) and coefficient of multiple correlation (CMC). Spatiotemporal parameters were assessed by standard error of measurement (SEM). Generally joint kinematics presented low σ w and σ b errors (<100). A selection of angular waveforms errors was presented to inspect error fluctuation in different phases, which was found to be related to the demands of the different movements. CMCw and CMCb values (>0.60) were found, demonstrating good to excellent reliability especially in joints with larger ranges of motion. The throwing task proved equally reliable, enhancing the universal application of the protocol. Compared to the literature, this study demonstrated higher reliability of the thorax, scapula and wrist joints. This was attributed to the highly standardized procedure and the implementation of recent methodological advancements. In conclusion, ELEPAP protocol was proved a reliable tool to analyze UL kinematics. [ABSTRACT FROM AUTHOR]

Objective: To describe the findings of focal high signal on T2 weighted (T2W) images of the bone marrow in the axial skeleton as assessed by whole-body MRI in healthy and asymptomatic children and adolescents.Material and Methods: We assessed the bone marrow of the mandible, shoulder girdle, thorax, spine, and pelvis on water-only Dixon T2W sequences as part of a whole-body MRI protocol in 196 healthy and asymptomatic children aged 5-19 years. Intensity (0-2 scale) and extension (1-4 scale) of focal high signal areas in the bone marrow were scored and divided into minor or major findings, based on intensity and extension to identify the potentially conspicuous lesions in a clinical setting.Results: We registered 415 areas of increased signal in the axial skeleton whereof 75 (38.3%) were major findings. Fifty-eight (29.6%) individuals had at least one major finding, mainly located in the pelvis (54, 72%). We found no differences according to gender. The number of minor findings increased with age (p = 0.020), but there were no significant differences in the number of major findings. The most conspicuous findings were in the pelvis, spine and sternum.Conclusion: Non-specific bone marrow T2W hyperintensities in the axial skeleton are frequently detected on whole-body MRI in healthy, asymptomatic children. Awareness of this is important as some findings may resemble clinically silent lesions in children with suspected multifocal skeletal disease. [ABSTRACT FROM AUTHOR]

Scapular kinematics in healthy adults is well described in the literature but little is known on typical children. This study aimed to compare the three-dimensional (3-D) scapular kinematics and scapulohumeral rhythm during the elevation and lowering of the arm in the scapular plane in typical children and healthy adults. Twenty-six healthy adults (35.34±11.65years, 1.70±0.10m, 70.00±12.30kg) and 33 typical children (9.12±1.51years, 1.40±0.10m, 35.40±10.45kg) participated in this study. 3-D scapular kinematics were obtained using an electromagnetic tracking device. The subjects were asked to elevate and lower their arm in the scapular plane. Children showed less scapular protraction compared to adults at 120° during arm elevation, more anterior tilt than adults in the elevation and also at 60°, 90° and 120° during lowering of the arm. Children also showed higher scapulohumeral rhythm during lowering of the arm compared to adults from 90° to 60°. It was also found a low to little correlation between scapular position and age. The study showed small but significant differences in scapular kinematics and scapulohumeral rhythm between children and adults. These results can help clinicians to improve diagnosis and treatment protocols directed to children with dysfunction, as reference values on scapular kinematics in healthy children are also provided in this study. [ABSTRACT FROM AUTHOR]

Abstract: Since total claviculectomy is an uncommon surgical procedure, few case reports exist in the literature. This report describes the three-dimensional scapulothoracic kinematics in a subject with unilateral total claviculectomy. Kinematic data were collected during shoulder protraction with arms at the side of the body, horizontal arm adduction at 90° of elevation, humeral internal/external rotation with the arm at 90° of elevation in the frontal plane, and elevation and lowering of the arm in the sagittal plane. Descriptive data were compared to the subject's contralateral shoulder. Scapulohumeral rhythm during arm elevation in the sagittal plane was calculated for both sides. Overall the subject demonstrated excessive scapular mobility. However, kinematics during elevation were similar to the contralateral side during elevation. The subject demonstrates good muscle control despite the lack of normal sternoclavicular and acromioclavicular joint articulations. His relatively well-preserved shoulder biomechanics belied his ongoing symptoms, especially involving pain with activities that required use of the arm away from the side. [Copyright &y& Elsevier]

Abstract: The aims of the present study were to assess the reliability of clavicular tilt angle measurement using goniometric and photographic measurements and to test the validity of the measurement by comparing the results with radiographic findings (gold standard). Clavicular tilt angles were measured in 18 healthy subjects (36 clavicles) using goniometric, photographic, and radiographic measurement. Repeated measurements using goniometric and photographic measurements were made in two test sessions conducted on different days by two examiners to assess inter-rater and intra-rater reliability of the two methods. Radiographic measurement was taken once, and the correlation between the radiographic findings and those of the indirect methods was calculated to test the validity of the goniometric and photographic measurement of clavicular tilt angle. No significant difference in clavicular tilt angle measurement was found between test sessions. The reliability of goniometric measurement (inter-rater intraclass correlation coefficients (ICC) = 0.85 (95% CI = 0.72–0.92) − 0.87 (95% CI = 0.77–0.87); intra-rater ICC = 0.80 (95% CI = 0.64–0.89)) and photographic measurement (inter-rater ICC = 0.89 (95% CI = 0.80–0.94) − 0.95 (95% CI = 0.91–0.98); intra-rater ICC = 0.84 (95% CI = 0.71–0.92) − 0.84 (95% CI = 0.69–0.91)) were excellent. The goniometric and photographic measurements of clavicular tilt angle were highly correlated with the radiographic findings (r = 0.83, 0.78, respectively). Goniometric and photographic measurements of clavicular tilt angle obtained by raters in this study may be considered reliable, and data obtained using the goniometric and photographic measurements are representative of radiographic findings of clavicular tilt angle. [Copyright &y& Elsevier]

Abstract: Changes in muscle activities are commonly associated with shoulder impingement and theoretically caused by changes in motor program strategies. The purpose of this study was to assess for differences in latencies and deactivation times of scapular muscles between subjects with and without shoulder impingement. Twenty-five healthy subjects and 24 subjects with impingement symptoms were recruited. Glenohumeral kinematic data and myoelectric activities using surface electrodes from upper trapezius (UT), lower trapezius (LT), serratus anterior (SA) and anterior fibers of deltoid were collected as subjects raised and lowered their arm in response to a visual cue. Data were collected during unloaded, loaded and after repetitive arm raising motion conditions. The variables were analyzed using 2 or 3 way mixed model ANOVAs. Subjects with impingement demonstrated significantly earlier contraction of UT while raising in the unloaded condition and an earlier deactivation of SA across all conditions during lowering of the arm. All subjects exhibited an earlier activation and delayed deactivation of LT and SA in conditions with a weight held in hand. The subjects with impingement showed some significant differences to indicate possible differences in motor control strategies. Rehabilitation measures should consider appropriate training measures to improve movement patterns and muscle control. [Copyright &y& Elsevier]

Abstract: The aim of this study was to determine the effect of isometric horizontal abduction using Thera-Band during three exercises (forward flexion, scaption, and wall push-up plus) in subjects with scapular winging by investigating the electromyographic (EMG) amplitude of the pectoralis major, serratus anterior and the pectoralis major/serratus anterior activity ratio. Twenty-four males with scapular winging participated in this study. The subjects performed the forward flexion, scaption, and wall push-up plus with and without isometric horizontal abduction using Thera-Band. Surface EMG was used to collect the EMG data of the pectoralis major and serratus anterior during the three exercises. Two-way repeated analyses of variance with two within-subject factors (isometric horizontal abduction condition and exercise type) were used to determine the statistical significance of pectoralis major and serratus anterior EMG activity and the pectoralis major/serratus anterior EMG activity ratio. Pectoralis major EMG activity was significantly lower during forward flexion and wall push-up plus with isometric horizontal abduction, and serratus anterior EMG activity was significantly greater with isometric horizontal abduction. Additionally, the pectoralis major/serratus anterior activity ratio was significantly lower during the forward flexion and wall push-up plus with isometric horizontal abduction. The results of this study suggest that isometric horizontal abduction using Thera-Band can be used as an effective method to facilitate the serratus anterior activity and to reduce excessive pectoralis major activity during exercises for activating serratus anterior. [Copyright &y& Elsevier]

Abstract: Background: Scapular taping is frequently used in the management of shoulder pain and as a part of injury prevention strategies in sports. It is believed to alter scapular kinematics and restore normal motion. However, there is little evidence to support its use. The aim of the study was to investigate the effect of shoulder taping on the scapular kinematics of asymptomatic subjects. Method: Thirteen asymptomatic subjects performed elevations in the sagittal and scapular planes with no tape and after the application of tape. A motion tracking system and a scapula locator method were used to measure the shoulder movement. Co-ordinate frames were defined for the thorax, humerus and scapula and Euler angles were used to calculate joints rotations. Results: Scapular taping increased the scapular external and upward rotations and posterior tilt in elevations in the sagittal plane (p <0.001). In the scapular plane, taping increased scapular external rotation (p <0.05). Conclusions: Taping affects scapulothoracic kinematics in asymptomatic subjects. The effect may be different for different planes of movement. The findings have implications on the use of taping as a preventive measure in high-risk groups. Further work is needed to assess the effect of taping on symptomatic populations. [Copyright &y& Elsevier]