The term “dyskinesia” has often been used interchangeably with “winging,” leading to ambiguity in the literature. To address this, the broader term “scapulothoracic abnormal motion (STAM)” was introduced to describe any abnormal position or movement of the scapula on the chest, resulting in pain and dysfunction. Scapulothoracic abnormal motion has a wide range of causes, including musculoskeletal imbalances such as pectoralis minor hyperactivity, neurological impairments such as long thoracic nerve palsy, and genetic conditions like facioscapulohumeral muscular dystrophy (FSHD). This review aims to identify the different causes and classifications of STAM and to propose a detailed treatment algorithm specifically designed to manage these conditions effectively. Cite this article as: Gedik CC, Eren İ, Demirhan M, Elhassan B. A comprehensive review of scapulothoracic abnormal motion (stam): evaluation, classification, and treatment strategies. Acta Orthop Traumatol Turc., 2024;58(4):187-195.

Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition. Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle. There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft. The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores. There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon. In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.

Background: Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. Objective: This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. Methods: ASDs were classified according to the Berjano–Lamartina (BL) and Silva–Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. Results: Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). Conclusion: The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs.

Facioscapulohumeral dystrophy (FSHD) typically affects the periscapular muscles, resulting in scapular winging. Scapulothoracic arthrodesis (STA) stabilizes the scapula to provide better movement for these patients. Analgesia regimen for FSHD patients who received a single-shot erector spinae plane block (ESPB) and a catheter at the area were retrospectively analyzed in this study. Patients were asked to rate their pain postoperatively and only 5 of 10 patients needed rescue analgesic. No complications occurred. Our experience suggests that continuous ESPB may be helpful for providing analgesia in FSHD patients undergoing STA.

Objective: This study aimed to computationally evaluate the effects of lesions of varying sizes and locations on stress distribution and ankle stiffness across the nine-zone grid of the talar dome in three different ankle positions. Methods: An adult ankle geometry was modeled with 1 mm of cartilage on both sides of the tibiotalar contact. Lesions with diameters of 4.5, 6.4, and 9 mm were created on the talar dome at each grid partition, ranging from section 1 (anteromedial) to 9 (posterolateral). Thekey innovation of the study was the use of tilted talar planes to account for the dome’s curvature, enabling more accurate lesion model ing and biomechanical analysis. Percent changes in osteochondral von Mises stress distribution and ankle stiffness parameters were investigated using finite element analysis. Based on the designated design parameters, 81 different cases were modeled and simulated. Results: Zones 7 (posteromedial, −33.2% change in stiffness for a 9 mm defect), 3 (anterolateral, −24.2% change in stiffness for a 9 mmdefect), and 8 (mid-posterior, −48.8% change in stiffness for a 9 mm defect) were found to be the most critical zones, showing evidence of decreased ankle stiffness in neutral, dorsiflexion, and plantarflexion positions, respectively. Zone 9 (posterolateral; neutral −4.7%, dorsi f lexion 5.4%, plantarflexion 0.17% stiffness change for a 9 mm defect) was found to be the least critical zone in terms of biomechanical stiffness. Conclusion: From a clinical standpoint, since lesions in zones 8, 7, and 3 significantly impact joint biomechanics compared to other zones, more aggressive cartilage restoration or augmentation could be required while lesions in less problematic zones like zone 9 can be treated withmicrofracture surgery. Cite this article as: Aslan L, Subasi O, Karaismailoglu B, et al. In silico assessment of talus osteochondral lesion size and location on biomechanical load distribution using tilted talar dome planes. Acta Orthop Traumatol Turc., 2025;59(6):361-367.