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Bones & Joints

Anatomy and kinematics of the glenohumeral, acromioclavicular, sternoclavicular, and scapulothoracic joints and their role in shoulder girdle dysfunction.

Overview

Current evidence regarding shoulder instability and reconstruction remains fragmented, with no conclusions on treatment recommendations possible for studies lacking comparative methods [2]. For primary synovial chondromatosis, arthroscopic management is an effective choice offering low morbidity and early functional return [3]. In chronic traumatic anterior sternoclavicular joint instability, specific operative procedures guided by magnetic resonance imaging findings yield satisfactory stability and clinical outcomes [6]. While both free bone graft transfer and the Latarjet procedure provide comparable success in joint stabilization for anterior shoulder instability with glenoid bone loss, neither technique prevents the progression of instability arthropathy [7]. Long-term data indicate the coracoid graft remains present in 97% of cases at a mean 8-year follow-up in patients with no or minimal preoperative glenoid bone loss [8].

For acute sternoclavicular joint dislocations, no high-level evidence supports one surgical technique over another, though early intervention is preferable to late intervention [28]. Total clavicle reconstruction with free peroneal graft for chronic nonbacterial osteomyelitis meets patient satisfaction, yet advantages and complications require careful discussion due to limited evidence of superior clinical outcomes [12]. In glenohumeral instability with significant bone loss, anatomic descriptions of bone and soft tissue, along with coracoid safety margin measures, provide essential tools for surgical correction [50]. Regarding osteoarthritis, both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic acromioclavicular joint disease, though each carries a unique set of potential complications [49].

Total shoulder arthroplasty via a subscapularis-sparing approach can accomplish anatomic restoration [13]. However, retained osteophytes and significant mismatch of the humeral head diameter raise concerns regarding long-term outcomes for this technique [13]. Evidence remains insufficient for proper guidelines on acute acromioclavicular dislocation due to the scarcity of level 1 or 2 studies [27]. Furthermore, observed differences in knee scores between study groups not matched for clinically relevant factors are at least as likely to represent differences in patient populations as they are to represent differences in operative technique or implant design [30].

Anatomy & Pathophysiology

Osseous Geometry and Morphology

Glenohumeral geometry exhibits specific variations based on gender and population, with studies in the normal Japanese population revealing a glenoid surface measuring 25.05 mm in the front-back sense and 34.71 mm in the upper-lower sense [22, 41]. In osteoarthritic shoulders, significant posterior translation of the humeral head occurs compared to nonpathologic controls [60]. The posterior ridge of the greater tuberosity moves with the humeral head, rendering it less dependent on patient size, sex, arm position, and rotator cuff quality [61]. In cases of acromioclavicular joint dislocations, the scapula on the injured side demonstrates more internal rotation, forward tilt, and less upward rotation than the healthy contralateral side [62].

Kinematics and Biomechanics

While understanding the needs of patients with a weight-bearing shoulder aids in comprehending pathology and managing the condition, precise, easy-to-use, and low-cost non-invasive methods to analyze shoulder complex kinematics have not yet been developed [20, 35]. Three-dimensional CT reconstruction allows for reliable evaluation of the scapulohumeral relationship [60]. In the context of brachial plexus palsy, structural differences in rotator cuff muscles alter the direction of humeral head forces on the developing glenoid fossa, potentially leading to osseous deformities [44]. For three-part humeral head fractures treated with blocked threaded wires, the construct is biomechanically valid, allowing only micromovements insufficient to cause humeral head rotation and translation [38]. Reconstruction of the lateral humeral offset is critical for optimizing the moment arm of the deltoid and rotator cuff and for restoring normal soft tissue tension [56].

Surgical Outcomes and Reconstruction

Shoulder fusion in brachial plexus palsy provided active abduction greater than 45° in more than 75% of cases and active rotation greater than 45° in almost 65% of cases [23]. Both open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement significantly improved shoulder function and are relatively safe procedures [45]. Overall, glenoid allografts most accurately restored articular geometry for large glenoid bone defects in anterior shoulder instability [46]. Comprehensive reviews cover sternoclavicular joint anatomy, biomechanics, traumatic and non-traumatic disorders, and management strategies ranging from nonsurgical care to surgical reconstruction and excision [14].

Classification

Neer: The Neer classification system for proximal humeral fractures, applicable to both CT scans and plain radiographs, demonstrates poor reliability and reproducibility due to the difficulty in determining which specific segments are fractured [43].

Mitsuzawa: The Mitsuzawa classification system for dislocated and displaced proximal humeral fractures incorporates perspectives on glenohumeral compatibility and displacement, providing satisfactory intra- and interobserver reliability compared to the Neer and AO/OTA classifications [53].

Lateral Clavicle: A classification system for lateral clavicle fractures demonstrates substantial inter- and intraobserver reliability [36].

Other Considerations: Glenohumeral Geometry: The glenohumeral geometry is both gender and population specific, suggesting that future joint replacements may be designed to address these differences [22]. Knee Anatomy: The anatomy of the knee includes the newly recognized anterolateral ligament [25]. Outcome Interpretation: Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant [30]. Joint Physiology: A paper serves as a comprehensive essay revisiting the subject of diarthrodial joints, synthesizing new information on joint development, cell differentiation, and biochemical processes to provide a consistent view of the field that supersedes earlier reviews [48].

Clinical Presentation

History taking must address specific mechanical symptoms and systemic factors. Painful clicking of the thumb interphalangeal joint can be caused by a sesamoid bone [1]. Assessment of recurrent dislocation alone is inadequate to define natural history or treatment rationale [2]. Understanding the needs of patients helps physicians better comprehend the pathology and manage the weight-bearing shoulder [20].

Inspection and palpation reveal distinct patterns across the shoulder girdle and sternoclavicular region. Sternoclavicular joint osteoarthritis is a very common incidental finding on CT scans, particularly with increasing age [9], with nearly 90% of patients older than 50 years showing some evidence of sternoclavicular joint osteoarthritis changes on CT scans [9]. Nontraumatic disorders of the clavicle are uncommon and frequently the diagnosis is not obvious [16]. Physical tests have utility in evaluating patients with acromioclavicular joint pathologic lesions [17], and a combination of physical tests is more helpful than isolated tests for evaluating acromioclavicular joint pathologic lesions [17]. The BvR test is a highly sensitive test in patients presenting with isolated acromioclavicular joint related symptoms [18] and demonstrates acromioclavicular joint pathology better than other accepted tests [18].

Range-of-motion and stability assessments are critical for scapular and glenohumeral pathology. Surgeons could reliably and accurately identify superior, medial, and lateral border involvement in scapula fractures using the AO/OTA classification system [19]. Superior, medial, and lateral border involvement in scapula fractures is considered clinically relevant and likely sufficient for the treatment decision process and outcome prognosis [19]. Bony lesions constitute a critically important entity in the management of shoulder instability, although they are relatively rare compared with soft-tissue pathology [11]. Common benign and malignant shoulder bone and soft-tissue tumors and tumor-like conditions have key features and treatment options that help determine diagnosis and treatment plans [15]. Scapular winging articles review relevant anatomy, etiology, clinical evaluation, diagnostic testing, and treatment [37], with differences in diagnosis and management between scapular winging arising from neurogenic causes and traumatic muscular detachment [37].

Special tests and operative decision axes guide management of complex presentations. The arthroscopic approach offers a unique advantage in diagnosing and treating occult intra-articular pathology during distal clavicle excision [10]. Operative management of a symptomatic os acromiale that has failed initial nonoperative treatment leads to decreased symptoms and improvement in clinical outcomes [21]. Shoulder fusion provided active abduction greater than 45° in more than 75% of cases in patients with brachial plexus palsy [23] and provided active rotation greater than 45° in almost 65% of cases in patients with brachial plexus palsy [23].

Red-flag patterns and systemic reviews dictate urgency and algorithmic pathways. Primary synovial chondromatosis of the shoulder can be managed arthroscopically with low morbidity and early functional return [3]. Current evidence on traumatic and non-traumatic conditions affecting the sternoclavicular joint has been analyzed to provide a management algorithm [4], covering anatomy, biomechanics, traumatic and atraumatic conditions, and management options [5]. Treatment for nontraumatic disorders of the clavicle varies by disorder and may include symptomatic and expectant management, drug therapy, and nonsurgical or surgical treatment [16]. Prompt diagnosis of posterior sternoclavicular dislocations leading to early treatment may help to prevent complications [39].

Investigations

Plain radiography: While physical tests, particularly in combination, hold utility for evaluating acromioclavicular joint (ACJ) pathologic lesions, the BvR test demonstrates AC joint pathology better than other accepted tests and is highly sensitive in patients presenting with isolated AC-related symptoms [17, 18]. Comprehensive investigation is appropriate before surgical excision of the thumb IP joint sesamoid bone [1].

MRI: Undertaking a specific operative procedure based on magnetic resonance imaging (MRI) diagnosis and structural anatomic MRI findings provides satisfactory outcomes regarding joint stability and clinical outcomes [6]. MRI reveals more bursitis and tendinitis on the fractured side irrespective of clavicle shaft shortening [24]. The anatomy of the knee has been described in depth with the addition of the newly recognized anterolateral ligament [25].

CT: CT is the gold standard and most reliable method for closed reduction of posterior sternoclavicular dislocations until further research establishes other modalities [57]. SCJ osteoarthritis is a very common incidental finding on CT scans, particularly with increasing age, with nearly 90% of patients older than 50 years showing some evidence of SCJ osteoarthritis changes [9]. Shortening of ≥ 20 mm in clavicle shaft malunion cannot be used as a poor prognostic criterion [24]. Fused os acromiale, which has not been described previously, might be mistaken for a free ossicle in the clinical setting [64]. 3D CT and 3D MRI show excellent correlation for glenoid surface area and glenoid bone loss calculations, though a slight difference exists between CT and autosegmented MRI values for bipolar bone loss measurements in shoulder instability [65].

Other Considerations: Current evidence on traumatic and non-traumatic conditions affecting the sternoclavicular joint provides an algorithm to manage these conditions [4]. Arthroscopic management is an effective treatment of choice for primary synovial chondromatosis of the shoulder with low morbidity and early functional return [3]. The arthroscopic approach offers a unique advantage in diagnosing and treating occult intra-articular pathology during distal clavicle excision [10]. Bony lesions constitute a critically important entity in the management of shoulder instability, although they may be relatively rare compared with soft-tissue pathology [11]. Key features and treatment options of commonly encountered benign and malignant shoulder bone and soft-tissue tumors and tumor-like conditions help determine the diagnosis and treatment plan [15]. Surgeons could reliably and accurately identify superior, medial, and lateral border involvement in the AO/OTA scapula fracture classification system, which is considered clinically relevant and likely sufficient for the treatment decision process and outcome prognosis [19]. One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention [33]. Conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods [2], and the sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate [2].

Treatment

Non-Operative

Management strategies for sternoclavicular joint disorders range from nonsurgical care to surgical reconstruction and excision [14]. Treatment for nontraumatic disorders of the clavicle varies by disorder and may include symptomatic and expectant management, drug therapy, and nonsurgical or surgical treatment [16]. A comprehensive investigation is appropriate before surgical excision of the thumb IP joint sesamoid bone [1].

Operative

Indications: Operative management of a symptomatic os acromiale that has failed initial nonoperative treatment leads to decreased symptoms and improvement in clinical outcomes [21]. Custom hemiarthroplasty appears to be a reasonable method to salvage proximal humeral dysplasia epiphysealis hemimelica when nonsurgical management has failed to provide relief [55]. Surgical stabilization of chronic traumatic anterior sternoclavicular joint instability based on magnetic resonance imaging diagnosis and structural anatomic magnetic resonance imaging findings provides a satisfactory outcome regarding joint stability and clinical outcomes [6].

Surgical Approach / Technique: Arthroscopic management is an effective treatment of choice for primary synovial chondromatosis of the shoulder with low morbidity and early functional return [3]. The arthroscopic approach for distal clavicle excision offers a unique advantage in diagnosing and treating occult intra-articular pathology [10]. Ilizarov treatment for post-infection nonunion of the supracondylar humerus was shown to be effective, reliable, and tolerated by patients [42].

Implant Selection: Both free bone graft transfer and Latarjet procedure cohorts showed comparable success in joint stabilization for anterior shoulder instability with glenoid bone loss [7]. Neither free bone graft transfer nor the Latarjet procedure could prevent the progression of instability arthropathy in anterior shoulder instability with glenoid bone loss [7]. At a mean follow-up of 8 years, the coracoid graft remained present in 97% of cases after Latarjet in patients with no or minimal preoperative glenoid bone loss (<5%) [8]. Outcomes for total clavicle reconstruction with free peroneal graft met patient satisfaction, but advantages and complications should be carefully discussed due to limited evidence of superior clinical outcome [12]. Allograft is not enough to achieve bone healing in congenital pseudarthrosis of the clavicle [47].

Adjuncts: Improved histology at the tendon-to-bone interface was correlated with improved final construct strength at the 12-week time point using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair [26].

Other Considerations: An algorithm exists to manage traumatic and non-traumatic conditions affecting the sternoclavicular joint [4]. Bony lesions constitute a critically important entity in the management of shoulder instability despite being relatively rare compared with soft-tissue pathology [11]. MRI showed more bursitis and tendinitis on the fractured side in clavicle shaft malunion, irrespective of the amount of shortening [24]. Shortening of ≥ 20 mm in clavicle shaft malunion cannot be used as a poor prognostic criterion [24]. Early intervention is preferable to late intervention for sternoclavicular joint dislocations [28]. No high-level evidence supports one surgical technique more than another for acute sternoclavicular joint dislocations [28]. Current evidence is insufficient for proper evidence-based guidelines regarding surgical versus non-operative treatments for acute AC dislocation due to the scarcity of level 1 or 2 studies [27]. The sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate [2]. Conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods [2].

Complications

Instability: Surgical stabilization of chronic traumatic anterior sternoclavicular joint instability based on MRI diagnosis and structural anatomic MRI findings provides satisfactory outcomes regarding joint stability and clinical outcomes [6]. Conclusions regarding treatment recommendations for recurrent dislocation cannot be made from studies that do not compare treatment methods [2]. For anterior shoulder instability with glenoid bone loss, both free bone graft transfer and Latarjet procedure cohorts showed comparable success in joint stabilization [7]; however, neither procedure could prevent the progression of instability arthropathy in these patients [7]. At a mean follow-up of 8 years, the coracoid graft remained present in 97% of cases after Latarjet procedure in patients with no or minimal preoperative glenoid bone loss [8]. Specifically, patients with minimal preoperative glenoid bone loss (<5%) maintained coracoid graft presence in 97% of cases at a mean follow-up of 8 years after Latarjet procedure [8].

Other Considerations: Surgical excision of the thumb IP joint sesamoid bone requires a comprehensive investigation prior to the procedure [1]. Sternoclavicular joint osteoarthritis is a very common incidental finding on CT scans, particularly with increasing age, with nearly 90% of patients older than 50 years showing some evidence of changes [9]. One in five subjects with surgically treated acute acromioclavicular joint dislocations will have an associated intraarticular lesion that requires further intervention [33]. Operative excision of posttraumatic cleidoscapular synostosis following a clavicle fracture resulted in resolution of symptoms and deformity without recurrence at two-year follow-up [34]. Anatomic restoration of the shoulder can be accomplished using subscapularis-sparing total shoulder arthroplasty, but retained osteophytes and significant mismatch of the humeral head diameter raise concerns regarding long-term outcomes [13]. Clinical outcomes of reverse total shoulder arthroplasty at a minimum follow-up of 1 year were similar in high- and lower-risk groups for iatrogenic suprascapular neuropathy by screw violation [29]. Double-plating of proximal humeral fractures yields good clinical mid- to long-term results in complex and highly unstable fractures [31]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis for radial head arthroplasty [54]. Complication rates following surgical clavicle fracture care averaged 8.1% [59]. Advantages and complications of clavicle reconstruction with free peroneal graft should be carefully discussed with patients due to limited evidence of superior clinical outcome [12].

Recovery

Light activity (weeks): Early functional return is documented following arthroscopic management of primary synovial chondromatosis of the shoulder [3]. Patients undergoing operative excision of posttraumatic cleidoscapular synostosis achieved resolution of symptoms and deformity without recurrence at two-year follow-up [34]. Following distal release of deltoid muscle contracture, 96% of shoulders demonstrated a good clinical result [66].

Full activity (months): A patient with scapulothoracic cystic lymphatic malformation returned to full activity 18 months after surgery with a normal clinical examination of the right shoulder [68]. Double-plating of proximal humeral fractures yields good clinical mid- to long-term results in complex and highly unstable fractures [31]. Surgical stabilization of chronic traumatic anterior sternoclavicular joint instability provides satisfactory outcomes regarding joint stability and clinical outcomes based on MRI diagnosis and structural anatomic MRI findings [6].

Complete recovery / outcome plateau (months): At a mean follow-up of 8 years, the coracoid graft remained present in 97% of cases after the Latarjet procedure in patients with no or minimal preoperative glenoid bone loss [8]. Clinical outcomes of reverse total shoulder arthroplasty at a minimum follow-up of 1 year were similar in high- and lower-risk groups for iatrogenic suprascapular neuropathy by screw violation [29]. Improved histology at the tendon-to-bone interface was correlated with improved final construct strength at the 12-week time point in primary rotator cuff repair using an interposition bioresorbable scaffold [26].

Rehabilitation protocol: Both free bone graft transfer and Latarjet procedure cohorts for anterior shoulder instability with glenoid bone loss showed comparable success in joint stabilization [7]. Neither free bone graft transfer nor the Latarjet procedure could prevent the progression of instability arthropathy in patients with anterior shoulder instability and glenoid bone loss [7]. Retained osteophytes and significant mismatch of the humeral head distance raise concerns regarding long-term outcomes for anatomic restoration using subscapularis-sparing total shoulder arthroplasty [13].

Functional milestones: Arthroscopic management of primary synovial chondromatosis of the shoulder is associated with low morbidity and early functional return [3]. Surgical stabilization of chronic traumatic anterior sternoclavicular joint instability based on MRI diagnosis and structural anatomic MRI findings provides satisfactory outcomes regarding joint stability and clinical outcomes [6]. Both free bone graft transfer and Latarjet procedure cohorts for anterior shoulder instability with glenoid bone loss showed comparable success in joint stabilization [7].

Other Considerations: Neither free bone graft transfer nor the Latarjet procedure could prevent the progression of instability arthropathy in patients with anterior shoulder instability and glenoid bone loss [7]. Retained osteophytes and significant mismatch of the humeral head distance raise concerns regarding long-term outcomes for anatomic restoration using subscapularis-sparing total shoulder arthroplasty [13]. Improved histology at the tendon-to-bone interface was correlated with improved final construct strength at the 12-week time point in primary rotator cuff repair using an interposition bioresorbable scaffold [26].

Key Evidence

  • [L4] A comprehensive investigation is appropriate before surgical excision of the thumb IP joint sesamoid bone. (10.1016/j.jhsa.2011.11.015)
  • [Letter] The sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods. (10.1177/0363546510379343)
  • [L4] Arthroscopic management is an effective treatment of choice with low morbidity and early functional return. (10.1016/j.arthro.2006.07.009)
  • [L4] This review analyzes current evidence on traumatic and non-traumatic conditions affecting the sternoclavicular joint and provides an algorithm to manage these conditions. (10.1302/2058-5241.3.170078)
  • [L5] This review covers its anatomy, biomechanics, traumatic and atraumatic conditions, and management options. (10.1177/1758573218756880)
  • [L4] Undertaking a specific operative procedure based on these findings provides a satisfactory outcome with regards to joint stability and clinical outcomes. (10.1016/j.jse.2025.04.018)
  • [L2] Both cohorts showed comparable success in joint stabilization, but neither could prevent the progression of instability arthropathy. (10.1016/j.jse.2025.01.017)
  • [L4] At a mean follow-up of 8 years, the coracoid graft remained present in 97% of cases, even in patients with minimal preoperative glenoid bone loss (<5%). (10.1016/j.jse.2026.02.020)
  • [L3] SCJ osteoarthritis is a very common incidental finding on CT scans, particularly with increasing age, with nearly 90% of patients older than 50 years showing some evidence of these changes. (10.1016/j.jse.2016.04.029)
  • [L1] The arthroscopic approach offers a unique advantage in diagnosing and treating occult intra-articular pathology. (10.1016/j.jse.2006.10.006)
  • [L5] Although bony lesions may be relatively rare compared with soft-tissue pathology, they constitute a critically important entity in the management of shoulder instability. (10.1016/j.arthro.2008.05.015)
  • [Case_report] While outcomes met the patient's satisfaction, advantages and complications of clavicle reconstruction should be carefully discussed with patients due to limited evidence of superior clinical outcome. (10.1186/s12891-019-2588-y)
  • [L2] Although anatomic restoration of the shoulder can be accomplished using subscapularis-sparing TSA, retained osteophytes and significant mismatch of the HHD raise concerns regarding long-term outcomes. (10.1016/j.jse.2015.03.009)
  • [L5] This article reviews the key features and treatment options of the more commonly encountered benign and malignant shoulder bone and soft-tissue tumors and tumor-like conditions to help determine the diagnosis and treatment plan. (10.5435/jaaos-d-17-00449)
  • [L5] Nontraumatic disorders of the clavicle are uncommon and frequently the diagnosis is not obvious; treatment varies by disorder and may include symptomatic and expectant management, drug therapy, and nonsurgical or surgical treatment. (10.5435/00124635-200604000-00002)
  • [L3] These tests have utility in evaluating patients with acromioclavicular joint pathologic lesions, and a combination of these physical tests is more helpful than isolated tests. (10.1177/0363546503261723)
  • [L3] The BvR test is a highly sensitive test in patients presenting with isolated AC related symptoms, and demonstrates AC joint pathology better than other accepted tests. (10.1016/j.jse.2010.05.023)
  • [L2] Surgeons could reliably and accurately identify superior, medial, and lateral border involvement, which is considered clinically relevant and likely sufficient for the treatment decision process and outcome prognosis. (10.1016/j.jse.2013.07.040)
  • [L5] Understanding the needs of these patients helps physicians better comprehend the pathology and manage the weight-bearing shoulder. (10.5435/jaaos-d-15-00598)
  • [L4] Operative management of a symptomatic os acromiale that has failed initial nonoperative treatment leads to decreased symptoms and improvement in clinical outcomes. (10.1016/j.jse.2019.05.047)
  • [L5] The results suggest that the glenohumeral geometry is both gender and population specific, and future joint replacements may be designed to address these differences. (10.1016/j.jses.2017.11.007)
  • [L3] Shoulder fusion provided active abduction greater than 45° in more than 75% of cases and active rotation greater than 45° in almost 65% of cases. (10.1016/j.jhsa.2012.01.012)
  • [L4] Irrespective of the amount of shortening, MRI showed more bursitis and tendinitis on the fractured side, and shortening of ≥ 20 mm cannot be used as a poor prognostic criterion. (10.1016/j.xrrt.2026.100679)
  • [L5] Improved histology was correlated with improved final construct strength at the 12-week time point. (10.1016/j.jse.2019.05.024)
  • [L5] The author calls for high-level prospective randomized studies comparing surgical and non-operative treatments for acute AC dislocation, noting that current evidence is insufficient for proper evidence-based guidelines due to the scarcity of level 1 or 2 studies. (10.1007/s00167-016-4203-1)
  • [L4] No high-level evidence supports one surgical technique more than another, but early intervention is preferable to late intervention for SC joint dislocations. (10.5435/jaaos-d-20-01239)
  • [L3] However, the clinical outcomes of RTSA at a minimum follow-up of 1 year were similar in the high- and lower-risk groups. (10.1016/j.jse.2021.10.024)
  • [L4] Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant. (10.2106/00004623-199706000-00009)
  • [Abstract] Double-plating of proximal humeral fractures yields good clinical mid- to long-term results in complex and highly unstable fractures. (10.1016/j.jse.2022.01.036)
  • [L1] One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. (10.1007/s00167-020-05917-6)
  • [Case_report] The condition was successfully treated with operative excision, resulting in resolution of symptoms and deformity without recurrence at two-year follow-up. (10.2106/00004623-199902000-00013)
  • [L5] Despite technology innovations, a precise, easy to use and low-cost non-invasive method able to draw and analyze the kinematics of the shoulder complex has not been developed yet. (10.1177/17585732221090226)
  • [L4] The presented classification system as well as associated treatment algorithms for lateral clavicle fractures showed substantial inter- and intraobserver reliability. (10.1016/j.jse.2025.04.021)
  • [L5] This article reviews the relevant anatomy, etiology, clinical evaluation, diagnostic testing, and treatment of scapular winging, discussing the differences in diagnosis and management between scapular winging arising from neurogenic causes and traumatic muscular detachment. (10.1016/j.jhsa.2018.08.008)
  • [Abstract] The studied construct is biomechanically valid; it only allows micromovements that are not able to cause humeral head rotation and translation. (10.1016/j.jse.2022.01.037)
  • [Case_report] Prompt diagnosis of posterior SC dislocations leading to early treatment may help to prevent some of these complications. (10.1016/j.jse.2011.06.001)
  • [L5] Measures of the glenoid surface without the labrum were 25.05 mm in the front-back sense and 34.71 mm in the upper-lower sense, highlighting features of these static elements to be considered when planning reconstructive surgeries. (10.1177/2325967114s00242)
  • [L4] The present study revealed the glenohumeral geometry in the normal Japanese population. (10.1016/j.jse.2015.08.003)
  • [L4] Ilizarov treatment for post-infection nonunion of the supracondylar humerus was shown to be effective, reliable, and tolerated by the patients. (10.1016/j.jse.2011.04.021)
  • [L4] Classifications of proximal humeral fractures using the Neer system based on CT scans and plain radiographs are not very reliable or reproducible due to difficulty in determining which segments are fractured. (10.2106/00004623-199609000-00012)
  • [L1] Structural differences in the rotator cuff muscles alter the direction of the humeral head forces on the developing glenoid fossa and can lead to osseous deformities. (10.2106/jbjs.i.00193)
  • [L3] Both techniques significantly improved shoulder function and are relatively safe procedures. (10.1016/j.jse.2019.09.035)
  • [L5] Overall, glenoid allografts most accurately restored articular geometry. (10.1016/j.arthro.2017.04.002)
  • [L4] Allograft is not enough to achieve bone healing. (10.1016/j.jse.2016.09.020)
  • [L5] The paper serves as a comprehensive essay revisiting the subject of diarthrodial joints, synthesizing new information on joint development, cell differentiation, and biochemical processes to provide a consistent view of the field that supersedes earlier reviews. (10.2106/00004623-197052040-00007)
  • [L5] Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis, though each has a unique set of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique. (10.1177/0363546513485359)
  • [L5] The anatomic descriptions of bone and soft tissue, as well as a measure of correlation for the safety margin of the coracoid, provide tools for surgeons performing anatomic surgical procedures to correct glenohumeral instability with significant bone loss. (10.1016/j.arthro.2012.06.022)
  • [L4] The Mitsuzawa classification system, which incorporates perspectives on glenohumeral compatibility and displacement, provided satisfactory intra- and interobserver reliability compared to the Neer and AO/OTA classifications. (10.1186/s13018-024-05423-2)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [Case_report] This appears to be a reasonable method to salvage this difficult and challenging problem when nonsurgical management has failed to provide relief. (10.1016/j.jse.2011.08.043)
  • [L5] Reconstruction of the lateral humeral offset is critical for optimizing the moment arm of the deltoid and rotator cuff and for restoring normal soft tissue tension. (10.2106/00004623-199274040-00004)
  • [L4] CT is the gold standard, making this the most reliable method until further research establishes other modalities. (10.1016/j.jse.2011.07.015)
  • [L3] Complication rates following surgical clavicle fracture care averaged 8.1%. (10.1186/s12891-022-05075-5)
  • [L4] The study demonstrates that 3D CT reconstruction allows for reliable evaluation of the scapulohumeral relationship, revealing significant posterior translation of the humeral head in osteoarthritic shoulders compared to nonpathologic controls, which supports the pathomechanism of glenoid component loosening. (10.1016/j.jse.2016.02.035)
  • [L5] Unlike other landmarks, the ridge moves with the humeral head, making it less dependent on patient size, sex, arm position, and rotator cuff quality. (10.1016/j.jse.2017.10.034)
  • [L4] The scapula of the injured side was more internally rotated, forwardly tilted, and less upwardly rotated than on the healthy contralateral side. (10.1016/j.jseint.2025.01.012)
  • [L4] An anatomical study showed that fused os acromiale, which has not been described previously, might be mistaken for a free ossicle in the clinical setting. (10.2106/00004623-200003000-00010)
  • [L4] 3D CT and 3D MRI show excellent correlation for glenoid surface area and glenoid bone loss calculations, though a slight difference exists between CT and autosegmented MRI. (10.1016/j.arthro.2018.10.086)
  • [L3] Forty-seven (96 per cent) of the forty-nine shoulders had a good clinical result after distal release of the contracture. (10.2106/00004623-199802000-00010)
  • [Case_report] The patient returned to full activity 18 months after surgery with a normal clinical examination of the right shoulder. (10.1016/j.jse.2007.11.018)

See Also

References

[1] Painful Clicking of the Thumb Interphalangeal Joint Caused by a Sesamoid Bone: A Report of Three Cases. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.11.015

[2] Letter to the Editor. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510379343

[3] Diagnosis and Arthroscopic Treatment of Primary Synovial Chondromatosis of the Shoulder. Arthroscopy. 2006. DOI: 10.1016/j.arthro.2006.07.009

[4] Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170078

[5] Sternoclavicular joint. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218756880

[6] Surgical stabilization of chronic traumatic anterior sternoclavicular joint instability based on magnetic resonance imaging diagnosis and structural anatomic magnetic resonance imaging findings. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.04.018

[7] Hawkins Award 2024: free bone graft transfer vs. Latarjet procedure for treatment of anterior shoulder instability with glenoid bone loss: five-year follow-up of a prospective randomized trial. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.017

[8] Long-Term Minimum 5-Year Follow-Up 3D CT Evaluation of Bone Graft Status After Latarjet in Patients with No or Minimal Preoperative Glenoid Bone Loss.. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.020

[9] The prevalence of osteoarthritis of the sternoclavicular joint on computed tomography. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.04.029

[10] Arthroscopic versus open distal clavicle excision: Comparative results at six months and one year from a randomized, prospective clinical trial. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.10.006

[11] Bony Instability of the Shoulder. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.05.015

[12] Total clavicle reconstruction with free peroneal graft for the surgical management of chronic nonbacterial osteomyelitis of the clavicle: a case report. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2588-y

[13] Total shoulder arthroplasty using a subscapularis-sparing approach: a radiographic analysis. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.03.009

[14] Chapter 77 Disorders of the Sternoclavicular Joint. 2019.

[15] Common Tumors and Tumor-like Lesions of the Shoulder. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00449

[16] Nontraumatic Disorders of the Clavicle. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200604000-00002

[17] Diagnostic Value of Physical Tests for Isolated Chronic Acromioclavicular Lesions. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546503261723

[18] Clinical evaluation of acromioclavicular joint pathology: Sensitivity of a new test. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.05.023

[19] The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.07.040

[20] The Weight-Bearing Shoulder. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-15-00598

[21] Os acromiale: systematic review of surgical outcomes. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.05.047

[22] Anatomic variations in glenohumeral joint: an interpopulation study. JSES Open Access. 2018. DOI: 10.1016/j.jses.2017.11.007

[23] Functional Outcome of Glenohumeral Fusion in Brachial Plexus Palsy: A Report of 54 Cases. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.012

[24] Does clavicle shaft malunion with more than 20 mm shortening have a clinical and radiological effect on the shoulder joint?. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100679

[25] Chapter 38 Knee Anatomy. 2020.

[26] A prospective study comparing tendon-to-bone interface healing using an interposition bioresorbable scaffold with a vented anchor for primary rotator cuff repair in sheep. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.05.024

[27] Acromio-clavicular dislocation—let’s move further. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4203-1

[28] Acute Dislocations of the Sternoclavicular Joint: A Review Article. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-01239

[29] Three-dimensional analysis of baseplate screw penetration in reverse total shoulder arthroplasty: risk of iatrogenic suprascapular neuropathy by screw violation. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.10.024

[30] Demographic Biases of Scoring Instruments for the Results of Total Knee Arthroplasty. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199706000-00009

[31] Three-Dimensional Measurement Of Bone Fragment Displacement In Proximal Humerus Fractures: A Computerized Analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.036

[33] The prevalence of intraarticular associated lesions after acute acromioclavicular joint injuries is 20%. A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-05917-6

[34] Posttraumatic Cleidoscapular Synostosis Following a Fracture of the Clavicle. A Case Report. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199902000-00013

[35] Evaluation of the range of motion of scapulothoracic, acromioclavicular and sternoclavicular joints: State of the art. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221090226

[36] Differentiating and treating lateral clavicle fractures: a new simple classification system. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.04.021

[37] Anatomy, Etiology, and Management of Scapular Winging. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.08.008

[38] Three-Part Humeral Head Fractures Treated With A Definite Construct Of Blocked Threaded Wires: Finite Element And Parametric Optimization Analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.037

[39] Cerebrovascular accident in a 19-year-old patient: a case report of posterior sternoclavicular dislocation. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.06.001

[40] Anatomy and Function of the Glenoid Labrum. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00242

[41] Three-dimensional anthropometric analysis of the glenohumeral joint in a normal Japanese population. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.003

[42] Treatment of post-infection nonunion of the supracondylar humerus with Ilizarov external fixator. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.04.021

[43] Evaluation of the Neer System of Classification of Proximal Humeral Fractures with Computerized Tomographic Scans and Plain Radiographs. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199609000-00012

[44] Structural Changes in Muscle and Glenohumeral Joint Deformity in Neonatal Brachial Plexus Palsy. The Journal of Bone and Joint Surgery-American Volume. 2010. DOI: 10.2106/jbjs.i.00193

[45] Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.035

[46] Restoration of Articular Geometry Using Current Graft Options for Large Glenoid Bone Defects in Anterior Shoulder Instability. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.04.002

[47] Congenital pseudarthrosis of the clavicle: a report on 27 cases. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.09.020

[48] Diarthrodial Joints Revisited. The Journal of Bone & Joint Surgery. 1970. DOI: 10.2106/00004623-197052040-00007

[49] Degenerative Joint Disease of the Acromioclavicular Joint. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513485359

[50] Anatomic Study of the Coracoid Process: Safety Margin and Practical Implications. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.06.022

[51] Chapter 2 Disorders of the Acromioclavicular Joint, Sternoclavicular Joint, and Clavicle. 2019.

[52] Chapter 76 Disorders of the Acromioclavicular Joint. 2019.

[53] A new classification for dislocated and displaced proximal humeral fractures. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05423-2

[54] Mid- to long-term results after bipolar radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.05.022

[55] Treatment of proximal humeral dysplasia epiphysealis hemimelica with custom hemiarthroplasty: a case report. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.08.043

[56] The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders.. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274040-00004

[57] Use of an O-arm intraoperative computed tomography scanner for closed reduction of posterior sternoclavicular dislocations. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.07.015

[59] Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05075-5

[60] A three-dimensional comparative study on the scapulohumeral relationship in normal and osteoarthritic shoulders. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.035

[61] The posterior ridge of the greater tuberosity of the humerus: a suitable landmark for the posterior approach to the shoulder joint?. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.10.034

[62] Three-dimensional changes of scapulothoracic orientation in patients with acromioclavicular joint dislocations. JSES International. 2025. DOI: 10.1016/j.jseint.2025.01.012

[64] Os Acromiale: Frequency, Anatomy, and Clinical Implications. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200003000-00010

[65] Bipolar Bone Loss Measurements in Shoulder Instability: Poor Agreement Between 3‐D CT and Arthroscopic Values. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.10.086

[66] Contracture of the Deltoid Muscle. The Journal of Bone and Joint Surgery (American Volume). 1998. DOI: 10.2106/00004623-199802000-00010

[68] Scapulothoracic cystic lymphatic malformation in a thirteen-year-old child: A case report. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.11.018

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