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JD Craik, R Malina, V Ramasamay & NJ Little
Subacromial Impingement & Rotator Cuff Tears
44% to 65% of all shoulder complaints
Two main theories:Mechanical (extrinsic) theoryDegenerative (intrinsic) theory
Anatomical Risk Factors
Type I
Type II
Type III
Bigliani Classification
Anatomical Risk Factors
AH
Coracoacromial Arch Height
Anatomical Risk Factors
AVP
Acromion Ventral Projection
Anatomical Risk Factors
AT
Acromion Tilt
Acromioglenoid Angle
AGA
Anatomical Risk Factors
CGACoracoglenoid Angle
Anatomical Risk Factors
ALP
Acromion Lateral Projection
Anatomical Risk Factors
CLP
Coracoid Lateral Projection
Anatomical Risk Factors
GV
Anatomical Risk Factors
Glenoid Version
GI
Glenoid Inclination
Anatomical Risk Factors
14 Mya
7 Mya
6 Mya
Anatomical risk factors unique or accentuated in human scapulae may play a more direct role in subacromial impingement and rotator cuff tear aetiology.
Hypothesis
Methods
Dry Bone Scapulae22 human17 gorilla
13 chimpanzee12 orangutan
Methods
Methods
Fiji Image J SoftwareMicrosoft Excel (Mac 2008)
Methods
VBL
Vertebral Border Length
Methods
Supraspinatus Area
Infraspinatus Area
Results Bigliani Classification
Type I
Type II
Type III
Bigliani Type I / II / III
0 / 8 / 4 1 / 11 / 1 4 / 13 / 0 3 / 17 / 2
Results Coracoacromial Arch Height
Increased Increased RiskRisk
mm
Results Acromion Ventral Projection
Increased Increased RiskRisk
mm
Results Acromion Tilt
Increased Increased RiskRisk
Degrees
Results Acromioglenoid Angle
Increased Increased RiskRisk
Degrees
Results Coracoglenoid Angle
Increased Increased RiskRisk
Degrees
Results Acromion Lateral Projection
Increased Increased RiskRisk
mm
Results Coracoid Lateral Projection
Increased Increased RiskRisk
mm
Results Glenoid Version
Increased Increased RiskRisk
Degrees
Results Glenoid Inclination
Increased Increased RiskRisk
Degrees
These anatomical risk factors are not unique to humans!
The extrinsic theory is not supported by these results as a primary aetiological factor
Therefore:
Results Fossa Ratio
??????
This study aimed to determine if any of the risk factors associated with impingement and rotator cuff tears are accentuated in humans
The extrinsic theory is not supported by these results as a primary aetiological factor
Reduction in Supraspinatus Fossa SizeMuscle / tendon insufficiency ?Force vector shift ?
Conclusions
Thank You