In vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders

doi:10.1016/j.jse.2015.06.003

Journal of Shoulder and Elbow Surgery

Volume 24, Issue 11, November 2015, Pages 1817-1826

https://doi.org/10.1016/j.jse.2015.06.003 Get rights and content

Background

Alteration in shoulder kinematics has been suggested as one cause of symptoms in shoulders with rotator cuff tears (RCTs). However, only a few studies comparing symptomatic and asymptomatic RCTs using kinematic analysis have been performed. The purpose of this study was to compare 3-dimensional (3D) scapular and glenohumeral kinematics during scapular-plane abduction among symptomatic RCTs, asymptomatic RCTs, and healthy shoulders.

Methods

This study included 7 healthy shoulders in subjects with a mean age of 62 years, 5 symptomatic RCTs in subjects with a mean age of 70 years, and 7 asymptomatic RCTs in subjects with a mean age of 67 years. All shoulders with RCTs had medium-sized tears (1-3 cm in the coronal plane) that were confirmed with magnetic resonance imaging. Biplane fluoroscopic images during scapular-plane abduction were recorded, and computed tomography–derived 3D bone models were matched with the silhouettes of the bones on the fluoroscopic images using 3D/2-dimensional model-image registration techniques. Angular values of the scapula and glenohumeral kinematics were compared among the 3 groups.

Results

Posterior tilt of the scapula was significantly smaller in the symptomatic RCTs (3.1° ± 1.8°) than in healthy shoulders (10.4° ± 0.8°) (P = .049). The humerus of the symptomatic shoulders was less externally rotated relative to the scapula throughout the activity than the healthy shoulders and asymptomatic RCTs (P = .006 and P = .028 respectively). However, there were no kinematic differences between the asymptomatic RCTs and healthy shoulders.

Conclusion

Kinematic changes in symptomatic RCTs might be associated with development of symptoms. Improvement of these kinematic changes may be a key to successful conservative treatment for symptomatic RCTs.

Section snippets

Patient selection

All examinations were performed in accordance with the rules and regulations of the local human research committee, and all subjects provided their informed consent to participate in this institutional review board–approved study. Subjects for the study were selected from patients with RCTs who were treated at our institutions.

“Symptomatic RCTs” were defined as shoulders with RCTs that had failed conservative treatment and were scheduled for arthroscopic rotator cuff repair. RCTs were confirmed

Upward rotation

The 3 groups showed a similar kinematic pattern in upward rotation of the scapula (Fig. 3). There were no significant differences among the 3 groups for upward rotation.

Posterior tilt

The scapula was tilted posteriorly with humeral elevation in all groups (Fig. 4). The asymptomatic RCTs and the healthy shoulders showed similar kinematic patterns in posterior tilt of the scapula, and the mean changes from the starting position to 120° of humeral elevation were 9.9° ± 2.1° and 10.4° ± 0.8°, respectively (P

Discussion

In this study, we found through 3D kinematic analyses using 3D/2D model-image registration techniques that there were significant differences in the posterior tilt angle of the scapula and in external rotation of the humerus relative to the scapula between the symptomatic RCTs and healthy shoulders. The difference in external rotation of the humerus between the symptomatic and asymptomatic RCTs was also significant.

Several studies have suggested that several factors are associated with pain and

Conclusion

Kinematic differences in symptomatic and asymptomatic RCTs and healthy shoulders were analyzed using 3D/2D model-image registration techniques. There were differences in the posterior tilt angle of the scapula and external rotation angle of the humerus relative to the scapula between the symptomatic and healthy shoulders. The difference in external rotation of the humerus between the symptomatic and asymptomatic RCTs was also significant. The differences may be associated with the occurrence of

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (23)

M.J. Bey et al.
Measuring dynamic in-vivo glenohumeral joint kinematics: technique and preliminary results
J Biomech
(2008)
L.J. Hébert et al.
Scapular behavior in shoulder impingement syndrome
Arch Phys Med Rehabil
(2002)
B.T. Kelly et al.
Differential patterns of muscle activation in patients with symptomatic and asymptomatic rotator cuff tears
J Shoulder Elbow Surg
(2005)
Y. Kon et al.
The influence of handheld weight on the scapulohumeral rhythm
J Shoulder Elbow Surg
(2008)
K. Matsuki et al.
In vivo 3-dimensional analysis of scapular kinematics: comparison of dominant and nondominant shoulders
J Shoulder Elbow Surg
(2011)
P.W. McClure et al.
Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo
J Shoulder Elbow Surg
(2001)
N. Nishinaka et al.
Determination of in vivo glenohumeral translation using fluoroscopy and shape-matching techniques
J Shoulder Elbow Surg
(2008)
G.A. Paletta et al.
Shoulder kinematics with two-plane x-ray evaluation in patients with anterior instability or rotator cuff tearing
J Shoulder Elbow Surg
(1997)
N. Shinozaki et al.
Differences in muscle activities during shoulder elevation in patients with symptomatic and asymptomatic rotator cuff tears: analysis by positron emission tomography
J Shoulder Elbow Surg
(2014)
T.L. Uhl et al.
Evaluation of clinical assessment methods for scapular dyskinesis
Arthroscopy
(2009)

K. Yamaguchi et al.

Glenohumeral motion in patients with rotator cuff tears: a comparison of asymptomatic and symptomatic shoulders

J Shoulder Elbow Surg

(2000)

Cited by (58)

Factors determining the short-term clinical outcomes of conservative treatment in patients with supraspinatus tear
2024, Journal of Bodywork and Movement Therapies
To identify factors influencing the better and worse changes in the Western Ontario Rotator Cuff Index of patients undergoing conservative treatment for supraspinatus tendon tear.
The study included 30 patients with supraspinatus tendon tear who underwent conservative treatment. The average duration of intervention was 35.4 days. The Western Ontario Rotator Cuff Index, shoulder range of motion, isometric muscle strength, supraspinatus tendon thickness, thickness of the supraspinatus, infraspinatus, and teres minor muscles, and acromiohumeral interval were assessed before and after the intervention. In the statistical analyses, change in the Western Ontario Rotator Cuff Index was the dependent variable, and the amount of change in each measurement variable before and after the intervention was the independent variable.
The average Western Ontario Rotator Cuff Index improved from 1067 at pre-treatment to 997 at post-treatment, but without a significant difference (p = 0.29). A multiple regression analysis revealed that supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption had a significant effect on the change in the Western Ontario Rotator Cuff Index (R² = 0.44, p < 0.01).
Supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption were important factors for the Western Ontario Rotator Cuff Index score in the early stages of conservative treatment for patients with supraspinatus tendon tear.
The influence of rotator cuff tear type and weight bearing on shoulder biomechanics in an ex vivo simulator experiment
2024, Journal of Biomechanics
Glenohumeral biomechanics after rotator cuff (RC) tears have not been fully elucidated. This study aimed to investigate the muscle compensatory mechanism in weight-bearing shoulders with RC tears and asses the induced pathomechanics (i.e., glenohumeral translation, joint instability, center of force (CoF), joint reaction force).
An experimental, glenohumeral simulator with muscle-mimicking cable system was used to simulate 30° scaption motion. Eight fresh-frozen shoulders were prepared and mounted in the simulator. Specimen-specific scapular anthropometry was used to test six RC tear types, with intact RC serving as the control, and three weight-bearing loads, with the non-weight-bearing condition serving as the control. Glenohumeral translation was calculated using instantaneous helical axis. CoF, muscle forces, and joint reaction forces were measured using force sensors integrated into the simulator. Linear mixed effects models (RC tear type and weight-bearing) with random effects (specimen and sex) were used to assess differences in glenohumeral biomechanics.
RC tears did not change the glenohumeral translation (p > 0.05) but shifted the CoF superiorly (p ≤ 0.005). Glenohumeral translation and joint reaction forces increased with increasing weight bearing (p < 0.001). RC and deltoid muscle forces increased with the presence of RC tears (p ≤ 0.046) and increased weight bearing (p ≤ 0.042).
The synergistic muscles compensated for the torn RC tendons, and the glenohumeral translation remained comparable to that for the intact RC tendons. However, in RC tears, the more superior CoF was close to where glenoid erosion occurs in RC tear patients with secondary osteoarthritis. These findings underscore the importance of early detection and precise management of RC tears.
Joint Track Machine Learning: An Autonomous Method of Measuring Total Knee Arthroplasty Kinematics From Single-Plane X-Ray Images
2023, Journal of Arthroplasty
Dynamic radiographic measurements of 3-dimensional (3-D) total knee arthroplasty (TKA) kinematics have provided important information for implant design and surgical technique for over 30 years. However, current methods of measuring TKA kinematics are too cumbersome, inaccurate, or time-consuming for practical clinical application. Even state-of-the-art techniques require human-supervision to obtain clinically reliable kinematics. Eliminating human supervision could potentially make this technology practical for clinical use.
We demonstrate a fully autonomous pipeline for quantifying 3D-TKA kinematics from single-plane radiographic imaging. First, a convolutional neural network (CNN) segmented the femoral and tibial implants from the image. Second, those segmented images were compared to precomputed shape libraries for initial pose estimates. Lastly, a numerical optimization routine aligned 3D implant contours and fluoroscopic images to obtain the final implant poses.
The autonomous technique reliably produces kinematic measurements comparable to human-supervised measures, with root-mean-squared differences of less than 0.7 mm and 4° for our test data, and 0.8 mm and 1.7° for external validation studies.
A fully autonomous method to measure 3D-TKA kinematics from single-plane radiographic images produces results equivalent to a human-supervised method, and may soon make it practical to perform these measurements in a clinical setting.
Biomechanical comparison of lower trapezius and latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears using a dynamic shoulder model
2022, Journal of Shoulder and Elbow Surgery
In the setting of irreparable posterosuperior rotator cuff tears (PSRCTs), lower trapezius transfer (LTT) may be anatomically better positioned for restoring the muscular force couple compared with latissimus dorsi transfer (LDT). The purpose of the study was to evaluate the effect of LTT and LDT on glenohumeral kinematics using a dynamic shoulder model.
Ten fresh-frozen cadaveric shoulders (mean age: 56.5 ± 17.2 years) were tested using a dynamic shoulder simulator. The maximum abduction angle (MAA), superior humeral head migration (SHM), and cumulative deltoid forces (CDFs) were compared across 4 conditions: (1) native; (2) irreparable PSRCT; (3) LTT using an Achilles tendon allograft; and (4) LDT. MAA and SHM were measured using 3-dimensional motion tracking. CDF was recorded in real time throughout the dynamic abduction motion by load cells connected to actuators.
Compared to the native state, the PSRCT resulted in a significant decrease (Δ–24.1°; P < .001) in MAA, with a subsequent significant increase after LTT (Δ13.1°; P < .001) and LDT (Δ8.9°; P < .001). LTT achieved a significantly greater MAA than LDT (Δ4.2°; P = .004). Regarding SHM, both LTT (Δ–9.4 mm; P < .001) and LDT (Δ–5.0 mm; P = .008) demonstrated a significant decrease compared with the PSRCT state. LTT also achieved significantly less SHM compared with the LDT (Δ–4.4 mm; P = .011). Further, only the LTT resulted in a significant decrease in CDF compared with the PSRCT state (Δ–21.3 N; P = .048), whereas LTT and LDT showed similar CDF (Δ–11.3 N; P = .346). However, no technique was able to restore the MAA, SHM, and CDF of the native shoulder (P < .001, respectively).
LTT and LDT both achieved a significant increase in MAA along with significantly less SHM compared with the PSRCT state. Although LTT required significantly less compensatory deltoid forces compared with the PSRCT state, this was not observed for the LDT. Further, the LTT prevented loss of abduction motion and SHM more sufficiently. In the challenging treatment of irreparable PSRCTs, LTT may restore native glenohumeral kinematics more sufficiently, potentially leading to improved postoperative functional outcomes.
Increased Glenohumeral Joint Loads Due to a Supraspinatus Tear Can Be Reversed With Rotator Cuff Repair: A Biomechanical Investigation
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
In a rat model, Reuther et al. further observed a significant decrease in cartilage thickness and equilibrium elastic modulus following the creation of RCTs, suggesting that rotator cuff repair may allow for reversing altered loading conditions and, consequently, preserving the glenohumeral joint.9 Insufficiency of the rotator cuff has been shown to result in altered shoulder kinematics with disruption of the biomechanical synergy of the rotator cuff and deltoid muscles, which may be responsible for the correlation to degenerative changes of the glenohumeral joint.13-17 More specifically, Dyrna et al. found that in the setting of RCTs, considerable compensatory deltoid force was required to prevent loss of abduction motion.14
To evaluate the effect of an isolated full-thickness supraspinatus (SSP) tear on glenohumeral kinematics and contact mechanics, as well as to quantify improvement following rotator cuff repair (RCR).
Ten fresh-frozen cadaveric shoulders (mean age: 63.1 ± 4.6 years) were tested using a dynamic shoulder simulator. A pressure-mapping sensor was placed between the humeral head and the glenoid. Each specimen underwent the following three conditions: 1) native, 2) isolated full-thickness SSP tear, and 3) RCR. Maximum abduction angle (MAA) and superior humeral head migration (SHM) were measured using 3D motion tracking software. Cumulative deltoid force (CDF) and glenohumeral contact mechanics, including contact area (GCA) and contact pressure (GCP), were assessed at the resting position, as well as at 15°, 30°, 45°, and 60° of glenohumeral abduction.
Compared to native, the SSP tear resulted in a significant decrease in MAA (Δ−8.3°; P < .001) along with a SHM of 6.4 ± 3.8 mm, while significantly increasing CDF (Δ20.5 N; P = .008), GCP (Δ63.1 kPa; P < .001), and peak GCP (Δ278.6 kPa; P < .001), as well as decreasing GCA (Δ−45.8 mm²; P < .001) at each degree of abduction. RCR reduced SHM to 1.2 ± 2.5 mm, while restoring native MAA, CDF (Δ1.8 N), GCA (Δ4.5 mm²), GCP (Δ−4.5 kPa) and peak GCP (Δ19.9 kPa) at each degree of abduction (P > .999, respectively).
In a dynamic biomechanical cadaveric model, increased glenohumeral joint loads due to a full-thickness SSP tear can be reversed with RCR. More specifically, RCR restored native glenohumeral contact area and contact pressure, while preventing superior humeral head migration and decreasing compensatory deltoid forces.
These time 0 observations indicate that undergoing rotator cuff repair may prevent the development of degenerative changes by significantly reducing glenohumeral joint loads and ensuring sufficiently stable joint kinematics.
Comparison of glenohumeral joint kinematics between manual wheelchair tasks and implications on the subacromial space: A biplane fluoroscopy study
2022, Journal of Electromyography and Kinesiology
Scapula and humerus motion associated with common manual wheelchair tasks is hypothesized to reduce the subacromial space. However, previous work relied on either marker-based motion capture for kinematic measures, which is prone to skin-motion artifact; or ultrasound imaging for arthrokinematic measures, which are 2D and acquired in statically-held positions. The aim of this study was to use a fluoroscopy-based approach to accurately quantify glenohumeral kinematics during manual wheelchair use, and compare tasks for a subset of parameters theorized to be associated with mechanical impingement. Biplane images of the dominant shoulder were acquired during scapular plane elevation, propulsion, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury. A computed tomography scan of the shoulder was obtained, and model-based tracking was used to quantify six-degree-of-freedom glenohumeral kinematics. Axial rotation and superior/inferior and anterior/posterior humeral head positions were characterized for full activity cycles and compared between tasks. The change in the subacromial space was also determined for the period of each task defined by maximal change in the aforementioned parameters. Propulsion, sideways lean, and weight-relief raise, but not scapular plane elevation, were marked by mean internal rotation (8.1°, 10.8°, 14.7°, −49.2° respectively). On average, the humeral head was most superiorly positioned during the weight-relief raise (1.6 ± 0.9 mm), but not significantly different from the sideways lean (0.8 ± 1.1 mm) (p = 0.191), and much of the task was characterized by inferior translation. Scaption was the only task without a defined period of superior translation on average. Pairwise comparisons revealed no significant differences between tasks for anterior/posterior position (task means range: 0.1–1.7 mm), but each task exhibited defined periods of anterior translation. There was not a consistent trend across tasks between internal rotation, superior translation, and anterior translation with reductions in the subacromial space. Further research is warranted to determine the likelihood of mechanical impingement during these tasks based on the measured task kinematics and reductions in the subacromial space.

View all citing articles on Scopus

: Institutional review board approval of the study was obtained from the Internal Review Board of Chiba University Graduate School of Medicine (No. 1455).

View full text

Basic ScienceIn vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders

Background

Methods

Results

Conclusion

Section snippets

Patient selection

Upward rotation

Posterior tilt

Discussion

Conclusion

Disclaimer

J Biomech

Arch Phys Med Rehabil

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

J Shoulder Elbow Surg

Basic Science
In vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders