Porcellini G, Donà A, Novi M, Delvecchio M, Micheloni G M, Giorgini A, Tarallo L, Baldelli I
Orthopaedic and Traumatology Department, Nuovo Ospedale di Sassuolo, Via Ruini 2, 41049, Sassuolo, MO, Italy.
Orthopaedic and Traumatologic Department, USL Toscana Centro, Ospedale di Fucecchio, Fucecchio, FI, Italy.
Musculoskelet Surg. 2024 Dec 27. doi: 10.1007/s12306-024-00877-3.
Poland syndrome is a congenital malformation characterized by agenesis or hypoplasia of pectoralis muscles. There is a limited literature on how the anatomic anomalies of PS may impact the movement of the shoulder. This study analyzes the effects of absence of the pectoralis muscles on the shoulder kinematic.
Clinical evaluation was performed analyzing range of motion (RoM), stability, cuff disease and internal rotation strength. In all patients, we used inertial sensors to analyze scapular motion in three degrees of freedom: medium-lateral rotation, posterior tilting and protraction-retraction. The same analysis was performed by dividing the patients into two groups by age to evaluate the presence of age-related alterations.
No differences in RoM between pathological and healthy side were observed. All patients were positive for posterior instability. No significant differences in strength in internal rotation were observed with average + 6,91% (s = 2,14) on the healthy side's strength. Kinematic analysis showed higher values of scapular medium-lateral rotation and anticipation of retraction of the pathological side during flexion and abduction. Reduced scapular tilt in under 18 years old was found.
The absence of the pectoralis muscles seems not to affect the RoM. The increased scapular rotation on the medium-lateral axis is probably due to the absence of humeral insertion of the pectoralis major and the absence of the scapular insertion of the pectoralis minor. The increased retraction in abduction it can be explained by a hypercontraction of the scapular stabilizers. The reduced tilt in under 18 years old is influenced by the lack of adaptation by the muscle groups involved.
波兰综合征是一种先天性畸形，其特征为胸肌发育不全或发育不良。关于波兰综合征的解剖学异常如何影响肩部运动的文献有限。本研究分析了胸肌缺失对肩部运动学的影响。
进行临床评估，分析活动范围（RoM）、稳定性、肩袖疾病和内旋力量。在所有患者中，我们使用惯性传感器分析肩胛骨在三个自由度上的运动：中外侧旋转、后倾和前伸-后缩。通过按年龄将患者分为两组进行相同的分析，以评估与年龄相关的变化。
未观察到患侧与健侧在RoM上的差异。所有患者后向不稳定均为阳性。内旋力量未观察到显著差异，健侧力量平均为+6.91%（标准差=2.14）。运动学分析显示，在屈曲和外展过程中，患侧肩胛骨中外侧旋转和后缩预期值更高。发现18岁以下患者肩胛骨倾斜度降低。
胸肌缺失似乎不影响RoM。肩胛骨在中外侧轴上旋转增加可能是由于胸大肌肱骨附着点缺失和胸小肌肩胛骨附着点缺失。外展时后缩增加可由肩胛骨稳定肌的过度收缩来解释。18岁以下患者倾斜度降低受相关肌群缺乏适应性影响。
