51
|
Miller RM, Popchak A, Vyas D, Tashman S, Irrgang JJ, Musahl V, Debski RE. Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics. J Shoulder Elbow Surg 2016; 25:641-9. [PMID: 26620280 DOI: 10.1016/j.jse.2015.08.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 08/22/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The high incidence of rotator cuff disease combined with high failure rates for nonoperative treatment of full-thickness rotator cuff tears underlines the importance of improving nonoperative management of rotator cuff tears. The study objective was to assess changes in in vivo glenohumeral kinematics of patients with a symptomatic full-thickness supraspinatus tear before and after a 12-week exercise therapy program. It was hypothesized that successful exercise therapy would result in improved kinematics (smaller translations and increased subacromial space). MATERIALS AND METHODS Five patients were recruited for the study and underwent dynamic stereoradiography analysis before and after a 12-week exercise therapy protocol to measure changes in glenohumeral joint translations and subacromial space during coronal plane abduction. Strength and patient-reported outcomes (American Shoulder and Elbow Surgeons; Disabilities of the Arm, Shoulder and Hand; Western Ontario Rotator Cuff Index) were also evaluated. RESULTS After therapy, no subject went on to receive surgery. It was found that the contact path length of the humerus translating on the surface of the glenoid was reduced by 29% from 67.2% ± 36.9% glenoid height to 43.1% ± 26.9% glenoid height (P = .036) after therapy. Minimum acromiohumeral distance showed a small increase from 0.9 ± 0.6 mm to 1.3 ± 0.8 mm (P = .079). Significant improvements in strength and patient-reported outcomes were also observed (P < .05). CONCLUSIONS Successful exercise therapy for treatment of small full-thickness supraspinatus tears results in improvements in glenohumeral joint kinematics and patient-reported outcomes through increases in rotator cuff muscle strength and joint stability. This study may enable identification of prognostic factors that predict the response of a patient with a rotator cuff tear to exercise therapy.
Collapse
Affiliation(s)
- R Matthew Miller
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam Popchak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dharmesh Vyas
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
52
|
Normative rearfoot motion during barefoot and shod walking using biplane fluoroscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1402-8. [PMID: 24902926 DOI: 10.1007/s00167-014-3084-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The ankle rearfoot complex consists of the ankle and subtalar joints. This is an observational study on two test conditions of the rearfoot complex. Using high-speed biplane fluoroscopy, we present a method to measure rearfoot kinematics during normal gait and compare rearfoot kinematics between barefoot and shod gait. METHODS Six male subjects completed a walking trial while biplane fluoroscopy images were acquired during stance phase. Bone models of the calcaneus and tibia were reconstructed from computed tomography images and aligned with the biplane fluoroscopy images. An optimization algorithm was used to determine the three-dimensional position of the bones and calculate rearfoot kinematics. RESULTS Peak plantarflexion was higher (barefoot: 9.1°; 95% CI 5.2:13.0; shod: 5.7°; 95% CI 3.6:7.8; p = 0.015) and neutral plantar/dorsiflexion occurred later in the stance phase (barefoot: 31.1%; 95% CI 23.6:38.6; shod: 17.7%; 95% CI 14.4:21.0; p = 0.019) during barefoot walking compared to shod walking. An eversion peak of 8.7° (95% CI 1.9:15.5) occurred at 27.8% (95% CI 18.4:37.2) of stance during barefoot walking, while during shod walking a brief inversion to 1.2° (95% CI -2.1:4.5; p = 0.021) occurred earlier (11.5% of stance; 95% CI 0.2:22.8; p = 0.008) during stance phase. The tibia was internally rotated relative to the calcaneus throughout stance phase in both conditions (barefoot: 5.1° (95% CI -1.4:11.6); shod: 3.6° (95% CI -0.4:7.6); ns.). CONCLUSIONS Biplane fluoroscopy can allow for detailed quantification of dynamic in vivo ankle kinematics during barefoot and shod walking conditions. This methodology could be used in the future to study hindfoot pathology after trauma, for congenital disease and after sports injuries such as instability. LEVEL OF EVIDENCE II.
Collapse
|
53
|
Millett PJ, Giphart JE, Wilson KJ, Kagnes K, Greenspoon JA. Alterations in Glenohumeral Kinematics in Patients With Rotator Cuff Tears Measured With Biplane Fluoroscopy. Arthroscopy 2016; 32:446-51. [PMID: 26603825 DOI: 10.1016/j.arthro.2015.08.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/26/2015] [Accepted: 08/25/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitatively measure the 3-dimensional (3D) glenohumeral translations during dynamic shoulder abduction in the scapular plane, using a biplane fluoroscopy system, in patients with supraspinatus rotator cuff tears. METHODS A custom biplane fluoroscopy system was used to measure the 3D position and orientation of the scapula and humerus of 14 patients with full-thickness supraspinatus or supraspinatus and infraspinatus rotator cuff tears and 10 controls as they performed shoulder abduction over their full range of motion. The 3D geometries of the scapula and humerus were extracted from a computed tomography scan of each shoulder. For each frame, the 3D bone position and orientation were estimated using a contour-based matching algorithm, and the 3D position of the humeral head center was determined relative to the glenoid. For each subject the superior-inferior and anterior-posterior translation curves were determined from 20° through 150° of arm elevation. RESULTS The humeral head in shoulders with rotator cuff tears was positioned significantly inferior compared with controls for higher elevation angles of 80° to 140° (P < .05). For both groups the humeral head translated inferiorly during shoulder abduction from 80° (P = .044; rotator cuff tear v controls: -0.2 ± 1.3 v 1.2 ± 1.4 mm) up to 140° (P = .047; rotator cuff tear v controls: -1.3 ± 2.2 v 0.44 ± 1.4 mm). There was no significant translation in the anterior- posterior direction. CONCLUSIONS Patients with well-compensated single or 2-tendon rotator cuff tears show no dynamic superior humeral head migration but unexpectedly show an inferior shift during active elevation. It is unclear whether the size of the translational differences found in this study, while statistically significant, are also of clinical significance. LEVEL OF EVIDENCE Level III, comparative study.
Collapse
Affiliation(s)
- Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic, Vail, Colorado, U.S.A..
| | - J Erik Giphart
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Kine Kagnes
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | |
Collapse
|
54
|
Rettig O, Krautwurst B, Maier MW, Wolf SI. Definition of anatomical zero positions for assessing shoulder pose with 3D motion capture during bilateral abduction of the arms. BMC Musculoskelet Disord 2015; 16:383. [PMID: 26646907 PMCID: PMC4673792 DOI: 10.1186/s12891-015-0840-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background Surgical interventions at the shoulder may alter function of the shoulder complex. Clinically, the outcome can be assessed by universal goniometry. Marker-based motion capture may not resemble these results due to differing angle definitions. Methods The clinical inspection of bilateral arm abduction for assessing shoulder dysfunction is performed with a marker based 3D optical measurement method. An anatomical zero position of shoulder pose is proposed to determine absolute angles according to the Neutral-0-Method as used in orthopedic context. Static shoulder positions are documented simultaneously by 3D marker tracking and universal goniometry in 8 young and healthy volunteers. Repetitive bilateral arm abduction movements of at least 150° range of motion are monitored. Similarly a subject with gleno-humeral osteoarthritis is monitored for demonstrating the feasibility of the method and to illustrate possible shoulder dysfunction effects. Results With mean differences of less than 2°, the proposed anatomical zero position results in good agreement between shoulder elevation/depression angles determined by 3D marker tracking and by universal goniometry in static positions. Lesser agreement is found for shoulder pro-/retraction with systematic deviations of up to 6°. In the bilateral arm abduction movements the volunteers perform a common and specific pattern in clavicula-thoracic and gleno-humeral motion with maximum shoulder angles of 32° elevation, 5° depression and 45° protraction, respectively, whereas retraction is hardly reached. Further, they all show relevant out of (frontal) plane motion with anteversion angles of 30° in overhead position (maximum abduction). With increasing arm anteversion the shoulder is increasingly retroverted, with a maximum of 20° retroversion. The subject with gleno-humeral osteoarthritis shows overall less shoulder abduction range of motion but with increased out-of-plane movement during abduction. Conclusions The proposed anatomical zero definition for shoulder pose fills the missing link for determining absolute joint angles for shoulder elevation/depression and pro-/retraction. For elevation-/depression the accuracy suits clinical expectations very well with mean differences less than 2° and limits of agreement of 8.6° whereas for pro-/retraction the accuracy in individual cases may be inferior with limits of agreement of up to 24.6°. This has critically to be kept in mind when applying this concept to shoulder intervention studies.
Collapse
Affiliation(s)
- Oliver Rettig
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
| | - Britta Krautwurst
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
| | - Michael W Maier
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200 a, 69118, Heidelberg, Germany.
| |
Collapse
|
55
|
In vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders. J Shoulder Elbow Surg 2015; 24:1817-26. [PMID: 26234667 DOI: 10.1016/j.jse.2015.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/14/2015] [Accepted: 06/01/2015] [Indexed: 02/01/2023]
Abstract
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.
Collapse
|
56
|
Glenohumeral translations during range-of-motion movements, activities of daily living, and sports activities in healthy participants. Clin Biomech (Bristol, Avon) 2015; 30:1002-7. [PMID: 26162226 DOI: 10.1016/j.clinbiomech.2015.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 06/17/2015] [Accepted: 06/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Glenohumeral translations have been mainly investigated during static poses while shoulder rehabilitation exercises, activities of daily living, and sports activities are dynamic. Our objective was to assess glenohumeral translations during shoulder rehabilitation exercises, activities of daily living, and sports activities to provide a preliminary analysis of glenohumeral arthrokinematics in a broad range of dynamic tasks. METHODS Glenohumeral translations were computed from trajectories of markers fitted to intracortical pins inserted into the scapula and the humerus. Two participants (P1 and P2) performed full range-of-motion movements including maximum arm elevations and internal-external rotations rehabilitation exercises, six activities of daily living, and five sports activities. FINDINGS During range-of-motion movements, maximum upward translation was 7.5mm (P1) and 4.7mm (P2). Upward translation during elevations was smaller with the arm internally (3.6mm (P1) and 2.9mm (P2)) than neutrally (4.2mm (P1) and 3.7mm (P2)) and externally rotated (4.3mm (P1) and 4.3mm (P2)). For activities of daily living and sports activities, only anterior translation during reach axilla for P1 and upward translation during ball throwing for P2 were larger than the translation measured during range-of-motion movements (108% and 114%, respectively). INTERPRETATION While previous electromyography-based studies recommended external rotation during arm elevation to minimize upward translation, measures of glenohumeral translations suggest that internal rotation may be better. Similar amplitude of translation during ROM movement and sports activities suggests that large excursions of the humeral head may be caused not only by fast movements, but also by large amplitude movements.
Collapse
|
57
|
Sins L, Tétreault P, Hagemeister N, Nuño N. Adaptation of the AnyBody™ Musculoskeletal Shoulder Model to the Nonconforming Total Shoulder Arthroplasty Context. J Biomech Eng 2015; 137:101006. [DOI: 10.1115/1.4031330] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Indexed: 11/08/2022]
Abstract
Current musculoskeletal inverse dynamics shoulder models have two limitations to use in the context of nonconforming total shoulder arthroplasty (NC-TSA). First, the ball and socket glenohumeral (GH) joint simplification avoids any humeral head translations. Second, there is no contact at the GH joint to compute the contact area and the center of pressure (COP) between the two components of NC-TSA. In this paper, we adapted the AnyBody™ shoulder model by introducing humeral head translations and contact between the two components of an NC-TSA. Abduction in the scapular plane was considered. The main objective of this study was to adapt the AnyBody™ shoulder model to a NC-TSA context and to compare the results of our model (translations, COP, contact area, GH joint reaction forces (GH-JRFs), and muscular forces) with previous numerical, experimental, and clinical studies. Humeral head translations and contact were successfully introduced in our adapted shoulder model with strong support for our findings by previous studies.
Collapse
Affiliation(s)
- Lauranne Sins
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada
- École de technologie supérieure, Montréal, QC H3C 1K3, Canada e-mail:
| | - Patrice Tétreault
- Orthopaedics Surgery Department, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Local DR-1118-16, Montréal, QC H2L 4M1, Canada
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada e-mail:
| | - Nicola Hagemeister
- Department of GPA, École de technologie supérieure, Montréal, QC H3C 1K3, Canada
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada e-mail:
| | - Natalia Nuño
- Department of GPA, École de technologie supérieure, Montréal, QC H3C 1K3 Canada
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada e-mail:
| |
Collapse
|
58
|
El-Gohary M, McNames J. Human Joint Angle Estimation with Inertial Sensors and Validation with A Robot Arm. IEEE Trans Biomed Eng 2015; 62:1759-67. [PMID: 25700438 DOI: 10.1109/tbme.2015.2403368] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditionally, human movement has been captured primarily by motion capture systems. These systems are costly, require fixed cameras in a controlled environment, and suffer from occlusion. Recently, the availability of low-cost wearable inertial sensors containing accelerometers, gyroscopes, and magnetometers have provided an alternative means to overcome the limitations of motion capture systems. Wearable inertial sensors can be used anywhere, cannot be occluded, and are low cost. Several groups have described algorithms for tracking human joint angles. We previously described a novel approach based on a kinematic arm model and the Unscented Kalman Filter (UKF). Our proposed method used a minimal sensor configuration with one sensor on each segment. This paper reports significant improvements in both the algorithm and the assessment. The new model incorporates gyroscope and accelerometer random drift models, imposes physical constraints on the range of motion for each joint, and uses zero-velocity updates to mitigate the effect of sensor drift. A high-precision industrial robot arm precisely quantifies the performance of the tracker during slow, normal, and fast movements over continuous 15-min recording durations. The agreement between the estimated angles from our algorithm and the high-precision robot arm reference was excellent. On average, the tracker attained an RMS angle error of about 3(°) for all six angles. The UKF performed slightly better than the more common Extended Kalman Filter.
Collapse
|
59
|
Hawkes D, Alizadehkhaiyat O, Kemp G, Fisher A, Roebuck M, Frostick S. Electromyographic assessment of muscle fatigue in massive rotator cuff tear. J Electromyogr Kinesiol 2015; 25:93-9. [DOI: 10.1016/j.jelekin.2014.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022] Open
|
60
|
Dal Maso F, Raison M, Lundberg A, Arndt A, Begon M. Coupling between 3D displacements and rotations at the glenohumeral joint during dynamic tasks in healthy participants. Clin Biomech (Bristol, Avon) 2014; 29:1048-55. [PMID: 25217235 DOI: 10.1016/j.clinbiomech.2014.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Glenohumeral displacements assessment would help to design shoulder prostheses with physiological arthrokinematics and to establish more biofidelic musculoskeletal models. Though displacements were documented during static tasks, there is little information on their 3D coupling with glenohumeral angle during dynamic tasks. Our objective was to characterize the 3D glenohumeral displacement-rotation couplings during dynamic arm elevations and rotations. METHODS Glenohumeral displacements were measured from trajectories of reflective markers fitted on intracortical pins inserted into the scapula and humerus. Bone geometry was recorded using CT-scan. Only four participants were recruited to the experiment due to its invasiveness. Participants performed dynamic arm abduction, flexion and axial rotations. Linear regressions were performed between glenohumeral displacements and rotations. The pin of the scapula of one participant moved, his data were removed from analysis, and results are based on three participants. FINDINGS The measurement error of glenohumeral kinematics was less than 0.15mm and 0.2°. Maximum glenohumeral displacements were measured along the longitudinal direction and reached up to +12.4mm for one participant. Significant couplings were reported especially between longitudinal displacement and rotation in abduction (adjusted R(2) up to 0.94). INTERPRETATION The proposed method provides the potential to investigate glenohumeral kinematics during all kinds of movements. A linear increase of upward displacement during dynamic arm elevation was measured, which contrasts with results based on a series of static poses. The systematic investigation of glenohumeral displacements under dynamic condition may help to provide relevant recommendation for the design of shoulder prosthetic components and musculoskeletal models.
Collapse
Affiliation(s)
- Fabien Dal Maso
- Laboratoire de simulation et de modélisation du mouvement, Département de kinésiologie, Université de Montréal, 1700, rue Jacques Tétreault, Laval, QC H7N 0B6, Canada.
| | - Maxime Raison
- École Polytechnique de Montréal, 6079, Succursale, Centre Ville, Montréal, QC H3C 3A7, Canada
| | | | - Anton Arndt
- Karolinska Institute, Stockholm, Sweden; The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Mickaël Begon
- Laboratoire de simulation et de modélisation du mouvement, Département de kinésiologie, Université de Montréal, 1700, rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
| |
Collapse
|
61
|
Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 2: glenohumeral joint. J Orthop Sports Phys Ther 2014; 44:646-55, B1-3. [PMID: 25103132 PMCID: PMC4684908 DOI: 10.2519/jospt.2014.5556] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To compare differences in glenohumeral joint angular motion and linear translations between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Numerous clinical theories have linked abnormal glenohumeral kinematics, including decreased glenohumeral external rotation and increased superior translation, to individuals with shoulder pain and impingement diagnoses. However, relatively few studies have investigated glenohumeral joint angular motion and linear translations in this population. METHODS Transcortical bone pins were inserted into the scapula and humerus of 12 asymptomatic and 10 symptomatic participants for direct bone-fixed tracking using electromagnetic sensors. Glenohumeral joint angular positions and linear translations were calculated during active shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups in angular positions were limited to glenohumeral elevation, coinciding with a reduction in scapulothoracic upward rotation. Symptomatic participants demonstrated 1.4 mm more anterior glenohumeral translation between 90° and 120° of shoulder flexion and an average of 1 mm more inferior glenohumeral translation throughout shoulder abduction. CONCLUSION Differences in glenohumeral kinematics exist between symptomatic and asymptomatic individuals. The clinical implications of these differences are not yet understood, and more research is needed to understand the relationship between abnormal kinematics, shoulder pain, and pathoanatomy.
Collapse
|
62
|
Glenohumeral joint cartilage contact in the healthy adult during scapular plane elevation depression with external humeral rotation. J Biomech 2014; 47:3100-6. [PMID: 25047740 DOI: 10.1016/j.jbiomech.2014.06.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/04/2014] [Accepted: 06/21/2014] [Indexed: 12/30/2022]
Abstract
The shoulder (glenohumeral) joint has the greatest range of motion of all human joints; as a result, it is particularly vulnerable to dislocation and injury. The ability to non-invasively quantify in-vivo articular cartilage contact patterns of joints has been and remains a difficult biomechanics problem. As a result, little is known about normal in-vivo glenohumeral joint contact patterns or the consequences that surgery has on altering them. In addition, the effect of quantifying glenohumeral joint contact patterns by means of proximity mapping, both with and without cartilage data, is unknown. Therefore, the objectives of this study are to (1) describe a technique for quantifying in-vivo glenohumeral joint contact patterns during dynamic shoulder motion, (2) quantify normal glenohumeral joint contact patterns in the young healthy adult during scapular plane elevation depression with external humeral rotation, and (3) compare glenohumeral joint contact patterns determined both with and without articular cartilage data. Our results show that the inclusion of articular cartilage data when quantifying in-vivo glenohumeral joint contact patterns has significant effects on the anterior-posterior contact centroid location, the superior-inferior contact centroid range of travel, and the total contact path length. As a result, our technique offers an advantage over glenohumeral joint contact pattern measurement techniques that neglect articular cartilage data. Likewise, this technique may be more sensitive than traditional 6-Degree-of-Freedom (6-DOF) joint kinematics for the assessment of overall glenohumeral joint health. Lastly, for the shoulder motion tested, we found that glenohumeral joint contact was located on the anterior-inferior glenoid surface.
Collapse
|
63
|
Peltz CD, Haladik JA, Hoffman SE, McDonald M, Ramo N, Moutzouros V, Bey MJ. Associations among shoulder strength, glenohumeral joint motion, and clinical outcome after rotator cuff repair. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2014; 43:220-226. [PMID: 24839628 PMCID: PMC8091163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Rotator cuff tears are a common condition causing pain and disability, but the relationships among clinical measures of shoulder function and measures of glenohumeral joint (GHJ) function are not well known. In the study reported here, dynamic in vivo GHJ motion was measured during abduction from biplane radiographs in 22 rotator cuff repair (RCR) patients and 36 control subjects. Isometric shoulder strength was measured and clinical outcomes were assessed using the Western Ontario Rotator Cuff (WORC) Index. Associations among WORC, GHJ motion, and several shoulder strength ratios were assessed with linear regression. An association was detected between higher ER/ABD (external rotation/coronal-plane abduction) strength ratio and a humerus positioned more inferiorly relative to the glenoid in control subjects and RCR patients. Higher ER/ABD strength ratio was also associated with better clinical outcome in RCR patients. These findings suggest a relationship between ER/ABD strength ratio and a more centrally located average superior/inferior contact center in RCR patients and control subjects. The ER/ABD strength ratio can be easily measured in a clinical setting and therefore can be used in larger studies to investigate its relation to clinical outcomes over time or perhaps to predict superior migration of the humeral head.
Collapse
|
64
|
Sakuda K, Sanada S, Tanaka R, Kitaoka K, Hayashi N, Matsuura Y. Functional shoulder radiography with use of a dynamic flat panel detector. Radiol Phys Technol 2014; 7:254-61. [PMID: 24515244 PMCID: PMC4097328 DOI: 10.1007/s12194-014-0257-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/19/2014] [Accepted: 01/20/2014] [Indexed: 11/25/2022]
Abstract
Our purpose in this study was to develop a functional form of radiography and to perform a quantitative analysis for the shoulder joint using a dynamic flat panel detector (FPD) system. We obtained dynamic images at a rate of 3.75 frames per second (fps) using an FPD system. Three patients and 5 healthy controls were studied with a clinically established frontal projection, with abduction of the arms. The arm angle, glenohumeral angle (G-angle), and scapulothoracic angle (S-angle) were measured on dynamic images. The ratio of the G-angle to the S-angle (GSR) was also evaluated quantitatively. In normal subjects, the G-angle and S-angle changed gradually along with the arm angle. The G-angle was approximately twice as large as the S-angle, resulting in a GSR of 2 throughout the abduction of the shoulder. Changes in G-angle and S-angle tended to be irregular in patients with shoulder disorders. The GSR of the thoracic outlet syndrome, recurrent dislocation of the shoulder joint, and anterior serratus muscle paralysis were 3–7.5, 4–9.5, and 3.5–7.5, respectively. The GSR of the anterior serratus muscle paralysis improved to approximately 2 after orthopedic treatment. Our preliminary results indicated that functional radiography by FPD and computer-aided quantitative analysis is useful for diagnosis of some shoulder disorders, such as the thoracic outlet syndrome, recurrent dislocation of the shoulder joint, and anterior serratus muscle paralysis. The technique and procedures described comprise a simple, functional shoulder radiographic method for evaluation of the therapeutic effects of surgery and/or rehabilitation.
Collapse
Affiliation(s)
- Keita Sakuda
- Division of Health Sciences, Radiology, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan,
| | | | | | | | | | | |
Collapse
|
65
|
In vivo 3D analysis of clavicular kinematics during scapular plane abduction: comparison of dominant and non-dominant shoulders. Gait Posture 2013; 39:625-7. [PMID: 23871318 DOI: 10.1016/j.gaitpost.2013.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to evaluate side-to-side differences in three-dimensional clavicle kinematics in normal shoulders during dynamic scapular plane elevation using model-image registration techniques. Twelve healthy males with a mean age of 32 years (range, 27-36 years old) were enrolled in this study. Clavicle rotations were computed with bilateral fluoroscopic images and CT-derived bone models using model-image registration techniques and compared between dominant and nondominant shoulders. There was no difference in retraction between both shoulders. The clavicle in dominant shoulders was less elevated during abduction than in nondominant shoulders (P=0.03). Backward rotation angles of dominant shoulders were significantly smaller than those of nondominant shoulders throughout the activity (P=0.03). Clavicular kinematics during scapular plane abduction were different according to hand-dominance.
Collapse
|
66
|
Robert-Lachaine X, Marion P, Godbout V, Bleau J, Begon M. Elucidating the scapulo-humeral rhythm calculation: 3D joint contribution method. Comput Methods Biomech Biomed Engin 2013; 18:249-58. [PMID: 23654344 DOI: 10.1080/10255842.2013.792810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The scapulo-humeral rhythm quantifies shoulder joint coordination during arm elevation. The common method calculates a ratio of gleno-humeral (GH) elevation to scapulo-thoracic upward rotation angles. However the other rotations also contribute to arm elevation. The objective is to propose a 3D dynamic scapulo-humeral rhythm calculation method including all rotations of the shoulder joints and compare with the common method. Twenty-nine skin markers were placed on the trunk and dominant arm of 14 healthy males to measure shoulder kinematics. Two-way repeated measures ANOVAs were applied to compare the two methods of calculation of joint contributions and scapulo-humeral rhythm during arm elevation. Significant main effects (p < 0.05) were observed between methods in joint contribution angles and scapulo-humeral rhythms. A systematic overestimation of the GH contribution was observed when only using the GH elevation angle because the scapula is moved outside a vertical plane. Hence, the proposed 3D method to calculate the scapulo-humeral rhythm allows an improved functional shoulder evaluation.
Collapse
Affiliation(s)
- Xavier Robert-Lachaine
- a Laboratoire d'Ingénierie du Mouvement, Département de Kinésiologie , Université de Montréal , Campus Laval, 1700 rue Jacques-Tétreault, Laval , QC , Canada H7N 0B6
| | | | | | | | | |
Collapse
|
67
|
Timmons MK, Lopes-Albers AD, Borgsmiller L, Zirker C, Ericksen J, Michener LA. Differences in scapular orientation, subacromial space and shoulder pain between the full can and empty can tests. Clin Biomech (Bristol, Avon) 2013; 28:395-401. [PMID: 23473974 DOI: 10.1016/j.clinbiomech.2013.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The empty and full can arm positions are used as diagnostic tests and in therapeutic exercise programs for patients with subacromial impingement syndrome. The adverse effects of these arm positions on the rotator cuff have not been fully described. The purpose of this investigation was to compare the acromio-humeral distance, three-dimensional scapular position, and shoulder pain during maximum isometric contractions in the empty and full can arm positions. METHODS Subjects with subacromial impingement syndrome (n=28) and a matched control group without shoulder pain (n=28) participated. Acromio-humeral distance, scapular/clavicular positions and shoulder pain were measured during maximal isometric contractions in each position. FINDINGS No difference was found in acromio-humeral distance (P=0.314) between the arm positions or between the groups (P=0.598). The empty can position resulted in greater scapular upward rotation (P<0.001, difference=4.9°), clavicular elevation (P<0.001, difference=2.7°), clavicular protraction (P=0.001, difference=2.5°) and less posterior tilt (P<0.001, difference=3.8°) than the full can position. No differences in the scapular positions were found between the groups. Positive correlations were seen between the scapular positions in the control and not in the subacromial impingement group. INTERPRETATION Our results did not show a difference in acromio-humeral distance between the arm positions or groups, indicating that the kinematic differences between the positions are not associated with altered acromio-humeral distance. The increased pain in the EC position might be due to the lack of an association amongst the scapular positions rather than the deficiency of a single scapular motion.
Collapse
Affiliation(s)
- Mark K Timmons
- Interprofessional Polytrauma and Traumatic Brain Injury Rehabilitation, Department of Veterans Affairs, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA.
| | | | | | | | | | | |
Collapse
|
68
|
Lalone EA, McDonald CP, Ferreira LM, Peters TM, King GW, Johnson JA. Development of an image-based technique to examine joint congruency at the elbow. Comput Methods Biomech Biomed Engin 2013; 16:280-90. [DOI: 10.1080/10255842.2011.617006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
69
|
Giphart JE, Brunkhorst JP, Horn NH, Shelburne KB, Torry MR, Millett PJ. Effect of plane of arm elevation on glenohumeral kinematics: a normative biplane fluoroscopy study. J Bone Joint Surg Am 2013; 95:238-45. [PMID: 23389787 DOI: 10.2106/jbjs.j.01875] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Understanding glenohumeral motion in normal and pathologic states requires the precise measurement of shoulder kinematics. The effect of the plane of arm elevation on glenohumeral translations and rotations remains largely unknown. The purpose of this study was to measure the three-dimensional glenohumeral translations and rotations during arm elevation in healthy subjects. METHODS Eight male subjects performed scaption and forward flexion, and five subjects (three men and two women) performed abduction, inside a dynamic biplane fluoroscopy system. Bone geometries were extracted from computed tomography images and used to determine the three-dimensional position and orientation of the humerus and scapula in individual frames. Descriptive statistics were determined for glenohumeral joint rotations and translations, and linear regressions were performed to calculate the scapulohumeral rhythm ratio. RESULTS The scapulohumeral rhythm ratio was 2.0 ± 0.4:1 for abduction, 1.6 ± 0.5:1 for scaption, and 1.1 ± 0.3:1 for forward flexion, with the ratio for forward flexion being significantly lower than that for abduction (p = 0.002). Humeral head excursion was largest in abduction (5.1 ± 1.1 mm) and smallest in scaption (2.4 ± 0.6 mm) (p < 0.001). The direction of translation, as determined by the linear regression slope, was more inferior during abduction (-2.1 ± 1.8 mm/90°) compared with forward flexion (0.1 ± 10.9 mm/90°) (p = 0.024). CONCLUSIONS Scapulohumeral rhythm significantly decreased as the plane of arm elevation moved in an anterior arc from abduction to forward flexion. The amount of physiologic glenohumeral excursion varied significantly with the plane of elevation, was smallest for scaption, and showed inconsistent patterns across subjects with the exception of consistent inferior translation during abduction.
Collapse
Affiliation(s)
- J Erik Giphart
- Department of BioMedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA
| | | | | | | | | | | |
Collapse
|
70
|
Lee SK, Yang DS, Kim HY, Choy WS. A comparison of 3D scapular kinematics between dominant and nondominant shoulders during multiplanar arm motion. Indian J Orthop 2013; 47:135-42. [PMID: 23682174 PMCID: PMC3654462 DOI: 10.4103/0019-5413.108882] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Generally, the scapular motions of pathologic and contralateral normal shoulders are compared to characterize shoulder disorders. However, the symmetry of scapular motion of normal shoulders remains undetermined. Therefore, the aim of this study was to compare 3dimensinal (3D) scapular motion between dominant and nondominant shoulders during three different planes of arm motion by using an optical tracking system. MATERIALS AND METHODS Twenty healthy subjects completed five repetitions of elevation and lowering in sagittal plane flexion, scapular plane abduction, and coronal plane abduction. The 3D scapular motion was measured using an optical tracking system, after minimizing reflective marker skin slippage using ultrasonography. The dynamic 3D motion of the scapula of dominant and nondominant shoulders, and the scapulohumeral rhythm (SHR) were analyzed at each 10° increment during the three planes of arm motion. RESULTS There was no significant difference in upward rotation or internal rotation (P > 0.05) of the scapula between dominant and nondominant shoulders during the three planes of arm motion. However, there was a significant difference in posterior tilting (P = 0.018) during coronal plane abduction. The SHR was a large positive or negative number in the initial phase of sagittal plane flexion and scapular plane abduction. However, the SHR was a small positive or negative number in the initial phase of coronal plane abduction. CONCLUSIONS Only posterior tilting of the scapula during coronal plane abduction was asymmetrical in our healthy subjects, and depending on the plane of arm motion, the pattern of the SHR differed as well. These differences should be considered in the clinical assessment of shoulder pathology.
Collapse
Affiliation(s)
- Sang Ki Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea,Address for correspondence: Dr. Sang Ki Lee, Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon 302-799, Korea. E-mail:
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Ha Yong Kim
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| |
Collapse
|
71
|
Validation of a novel method for quantifying and comparing regional ACL elongations during uniaxial tensile loading. J Biomech 2012; 45:2710-4. [DOI: 10.1016/j.jbiomech.2012.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 08/02/2012] [Accepted: 08/09/2012] [Indexed: 11/15/2022]
|
72
|
Abstract
Subacromial impingement syndrome is the most common shoulder disorder. Abnormal superior translation of the humeral head is believed to be a major cause of this pathology. The first purpose of the study was to examine the effects of suprascapular nerve block on superior translation of the humeral head and scapular upward rotation during dynamic shoulder elevation. The secondary purpose was to assess muscle activation patterns during these motions. Twenty healthy subjects participated in the study. Using fluoroscopy and electromyography, humeral head translation and muscle activation were measured before and after a suprascapular nerve block. The humeral head was superiorly located at 60 degrees of humeral elevation, and the scapula was more upwardly rotated from 30 to 90 degrees of humeral elevation after the block. The differences were observed during midrange of motion. In addition, the deltoid muscle group demonstrated increased muscle activation after the nerve block. The study's results showed a compensatory increase in humeral head translation, scapular upward rotation, and deltoid muscle activation due to the nerve block. These outcomes suggest that increasing muscular strength and endurance of the supraspinatus and infraspinatus muscles could prevent any increased superior humeral head translation. This may be beneficial in reducing shoulder impingement or rotator cuff tears over time.
Collapse
|
73
|
Favre P, Senteler M, Hipp J, Scherrer S, Gerber C, Snedeker JG. An integrated model of active glenohumeral stability. J Biomech 2012; 45:2248-55. [DOI: 10.1016/j.jbiomech.2012.06.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 06/07/2012] [Accepted: 06/09/2012] [Indexed: 01/02/2023]
|
74
|
Hawkes DH, Alizadehkhaiyat O, Kemp GJ, Fisher AC, Roebuck MM, Frostick SP. Shoulder muscle activation and coordination in patients with a massive rotator cuff tear: an electromyographic study. J Orthop Res 2012; 30:1140-6. [PMID: 22213234 DOI: 10.1002/jor.22051] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 12/02/2011] [Indexed: 02/04/2023]
Abstract
Adaptive muscle activation strategies following a massive rotator cuff tear (MRCT) are inadequately understood, and the relationship among muscles during everyday activities has not been considered. Thirteen healthy subjects comprised the control group, and 11 subjects with a MRCT the patient group. Upper limb function was assessed using the Functional Impairment test-hand, neck, shoulder, and arm (FIT-HaNSA). Electromyography (EMG) was recorded from 13 shoulder muscles, comprising five muscle groups, during a shelf-lifting task. Mean FIT-HaNSA scores were significantly lower in MRCT patients (p≤0.001), reflecting a severe functional deficit. In MRCT patients, EMG signal amplitude was significantly higher for the biceps brachii-brachioradialis (p < 0.001), upper trapezius-serratus anterior (p= 0.025), muscle groups and for the latissimus dorsi (p = 0.010), and teres major (p=0.007) muscles. No significant differences in the correlation among muscle groups were identified, pointing to an unchanged neuromuscular strategy following a tear. In MRCT patients, a reorganization of muscle activation strategy along the upper limb kinetic chain is aimed at reducing demand on the glenohumeral joint. Increased activation of the latissimus dorsi and teres major muscles is an attempt to compensate for the deficient rotator cuff. Re-education towards an alternate neuromuscular control strategy appears necessary to restore function.
Collapse
Affiliation(s)
- David H Hawkes
- Musculoskeletal Science Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | | | | |
Collapse
|
75
|
Elkinson I, Giles JW, Faber KJ, Boons HW, Ferreira LM, Johnson JA, Athwal GS. The effect of the remplissage procedure on shoulder stability and range of motion: an in vitro biomechanical assessment. J Bone Joint Surg Am 2012; 94:1003-12. [PMID: 22637206 DOI: 10.2106/jbjs.j.01956] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The remplissage procedure may be performed as an adjunct to Bankart repair to treat recurrent glenohumeral dislocation associated with an engaging Hill-Sachs humeral head defect. The purpose of this in vitro biomechanical study was to examine the effects of the remplissage procedure on glenohumeral joint motion and stability. METHODS Cadaveric shoulders (n = 8) were mounted on a biomechanical testing apparatus that applies simulated loads to the rotator cuff and the anterior, middle, and posterior heads of the deltoid muscle. Testing was performed with the shoulder intact, after creation of the Bankart lesion, and after repair of the Bankart lesion. In addition, testing was performed after Bankart repair with and without remplissage in shoulders with 15% and 30% Hill-Sachs defects. Shoulder motion and glenohumeral translation were recorded with an optical tracking system. Outcomes measured included stability (joint stiffness and defect engagement) and internal-external glenohumeral rotational motion in adduction and in 90° of composite shoulder abduction. RESULTS In specimens with a 15% Hill-Sachs defect, Bankart repair combined with remplissage resulted in a significant reduction in internal-external range of motion in adduction (15.1° ± 11.1°, p = 0.039), but not in abduction (7.7° ± 9.9, p = 0.38), compared with the intact condition. In specimens with a 30% Hill-Sachs defect, repair that included remplissage also significantly reduced internal-external range of motion in adduction (14.5° ± 11.3°, p = 0.049) but not in abduction (6.2° ± 9.3°, p = 0.60). In specimens with a 15% Hill-Sachs defect, addition of remplissage significantly increased joint stiffness compared with isolated Bankart repair (p = 0.038), with the stiffness trending toward surpassing the level in the intact condition (p = 0.060). In specimens with a 30% Hill-Sachs defect, addition of remplissage restored joint stiffness to approximately normal (p = 0.41 compared with the intact condition). All of the specimens with a 30% Hill-Sachs defect engaged and dislocated after Bankart repair alone. The addition of remplissage was effective in preventing engagement and dislocation in all specimens. None of the specimens with a 15% Hill-Sachs defect engaged or dislocated after Bankart repair. CONCLUSIONS In this experimental model, addition of remplissage provided little additional benefit to a Bankart repair in specimens with a 15% Hill-Sachs defect, and it also reduced specific shoulder motions. However, Bankart repair alone was ineffective in preventing engagement and recurrent dislocation in specimens with a 30% Hill-Sachs defect. The addition of remplissage to the Bankart repair in these specimens prevented engagement and enhanced stability, although at the expense of some reduction in shoulder motion.
Collapse
Affiliation(s)
- Ilia Elkinson
- H.U.L.C. Bioengineering Research Laboratory, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
76
|
Miranda DL, Schwartz JB, Loomis AC, Brainerd EL, Fleming BC, Crisco JJ. Static and dynamic error of a biplanar videoradiography system using marker-based and markerless tracking techniques. J Biomech Eng 2012; 133:121002. [PMID: 22206419 DOI: 10.1115/1.4005471] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The use of biplanar videoradiography technology has become increasingly popular for evaluating joint function in vivo. Two fundamentally different methods are currently employed to reconstruct 3D bone motions captured using this technology. Marker-based tracking requires at least three radio-opaque markers to be implanted in the bone of interest. Markerless tracking makes use of algorithms designed to match 3D bone shapes to biplanar videoradiography data. In order to reliably quantify in vivo bone motion, the systematic error of these tracking techniques should be evaluated. Herein, we present new markerless tracking software that makes use of modern GPU technology, describe a versatile method for quantifying the systematic error of a biplanar videoradiography motion capture system using independent gold standard instrumentation, and evaluate the systematic error of the W.M. Keck XROMM Facility's biplanar videoradiography system using both marker-based and markerless tracking algorithms under static and dynamic motion conditions. A polycarbonate flag embedded with 12 radio-opaque markers was used to evaluate the systematic error of the marker-based tracking algorithm. Three human cadaveric bones (distal femur, distal radius, and distal ulna) were used to evaluate the systematic error of the markerless tracking algorithm. The systematic error was evaluated by comparing motions to independent gold standard instrumentation. Static motions were compared to high accuracy linear and rotary stages while dynamic motions were compared to a high accuracy angular displacement transducer. Marker-based tracking was shown to effectively track motion to within 0.1 mm and 0.1 deg under static and dynamic conditions. Furthermore, the presented results indicate that markerless tracking can be used to effectively track rapid bone motions to within 0.15 deg for the distal aspects of the femur, radius, and ulna. Both marker-based and markerless tracking techniques were in excellent agreement with the gold standard instrumentation for both static and dynamic testing protocols. Future research will employ these techniques to quantify in vivo joint motion for high-speed upper and lower extremity impacts such as jumping, landing, and hammering.
Collapse
Affiliation(s)
- Daniel L Miranda
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
| | | | | | | | | | | |
Collapse
|
77
|
Lalone EA, Peters TM, King GW, Johnson JA. Accuracy assessment of an imaging technique to examine ulnohumeral joint congruency during elbow flexion. ACTA ACUST UNITED AC 2012; 17:142-52. [DOI: 10.3109/10929088.2012.673638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
78
|
Lagacé PY, Billuart F, Ohl X, Skalli W, Tétreault P, de Guise J, Hagemeister N. Analysis of humeral head displacements from sequences of biplanar X-rays: repeatability study and preliminary results in healthy subjects. Comput Methods Biomech Biomed Engin 2012; 15:221-9. [DOI: 10.1080/10255842.2010.522185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
79
|
Dynamic in vivo glenohumeral kinematics during scapular plane abduction in healthy shoulders. J Orthop Sports Phys Ther 2012; 42:96-104. [PMID: 22030448 DOI: 10.2519/jospt.2012.3584] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVES To measure superior/inferior translation and external rotation of the humerus relative to the scapula during scapular plane abduction using 3-D/2-D model image registration techniques. BACKGROUND Kinematic changes in the glenohumeral joint, including excessive superior translation of the humeral head and inadequate external rotation of the humerus, are believed to be a possible cause of shoulder impingement. Although many researchers have analyzed glenohumeral kinematics with various methods, few articles have assessed dynamic in vivo glenohumeral motion. METHODS Twelve healthy males with a mean age of 32 years (range, 27-36 years) were enrolled in this study. Fluoroscopic images of the dominant shoulder during scapular plane elevation were taken, and computed tomography-derived 3-D bone models were matched with the silhouette of the bones in the fluoroscopic images using 3-D/2-D model image registration techniques. The kinematics of the humerus relative to the scapula were determined using Euler angles. RESULTS On average, there was 2.1 mm of initial humeral translation in the superior direction from the starting position to 105° of humeral elevation. Subsequently, an average of 0.9 mm of translation in the inferior direction occurred between 105° and maximum arm elevation. The average amount of external rotation of the humerus was 14° from the starting position to 60° of humeral elevation. The humerus then rotated internally an average 9° by the time the shoulder reached maximum elevation. These changes in superior/inferior translation and external/internal rotation were statistically significant (P<.001 and P = .001, respectively), based on 1-way repeated-measures analysis of variance. CONCLUSION The observed glenohumeral translations and rotations characterize healthy shoulder function and serve as a preliminary foundation for quantifying pathomechanics in the presence of glenohumeral joint disorders.
Collapse
|
80
|
Zhu Z, Massimini DF, Wang G, Warner JJP, Li G. The accuracy and repeatability of an automatic 2D-3D fluoroscopic image-model registration technique for determining shoulder joint kinematics. Med Eng Phys 2012; 34:1303-9. [PMID: 22285714 DOI: 10.1016/j.medengphy.2011.12.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/05/2011] [Accepted: 12/22/2011] [Indexed: 10/14/2022]
Abstract
Fluoroscopic imaging, using single plane or dual plane images, has grown in popularity to measure dynamic in vivo human shoulder joint kinematics. However, no study has quantified the difference in spatial positional accuracy between single and dual plane image-model registration applied to the shoulder joint. In this paper, an automatic 2D-3D image-model registration technique was validated for accuracy and repeatability with single and dual plane fluoroscopic images. Accuracy was assessed in a cadaver model, kinematics found using the automatic registration technique were compared to those found using radiostereometric analysis. The in vivo repeatability of the automatic registration technique was assessed during the dynamic abduction motion of four human subjects. The in vitro data indicated that the error in spatial positional accuracy of the humerus and the scapula was less than 0.30mm in translation and less than 0.58° in rotation using dual plane images. Single plane accuracy was satisfactory for in-plane motion variables, but out-of-plane motion variables on average were approximately 8 times less accurate. The in vivo test indicated that the repeatability of the automatic 2D-3D image-model registration was 0.50mm in translation and 1.04° in rotation using dual images. For a single plane technique, the repeatability was 3.31mm in translation and 2.46° in rotation for measuring shoulder joint kinematics. The data demonstrate that accurate and repeatable shoulder joint kinematics can be obtained using dual plane fluoroscopic images with an automatic 2D-3D image-model registration technique; and that out-of-plane motion variables are less accurate than in-plane motion variables using a single plane technique.
Collapse
Affiliation(s)
- Zhonglin Zhu
- Department of Biomedical Engineering, Tsinghua University, Beijing, China.
| | | | | | | | | |
Collapse
|
81
|
Hawkes DH, Alizadehkhaiyat O, Fisher AC, Kemp GJ, Roebuck MM, Frostick SP. Normal shoulder muscular activation and co-ordination during a shoulder elevation task based on activities of daily living: an electromyographic study. J Orthop Res 2012; 30:53-60. [PMID: 21674607 DOI: 10.1002/jor.21482] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/26/2011] [Indexed: 02/04/2023]
Abstract
Studies of normal shoulder function have often failed to consider the inter-relationship between different muscle groups in activities relevant to daily life. Upper limb functional status was assessed in 12 healthy male volunteers using the Functional Impairment Test-Hand, Neck, Shoulder and Arm test (FIT-HaNSA). Electromyography was then used to study the activity and coordination of 13 muscles (10 by surface electrodes, 3 by fine-wire intramuscular electrodes) around the shoulder during a dynamic movement task based on the shelf-lifting task in FIT-HaNSA. Muscles were grouped for analysis into deltoid (anterior, middle, and posterior divisions), adductors (latissimus dorsi and teres major), rotator cuff (supraspinatus, infraspinatus, and subscapularis), and elbow flexor (brachioradialis, biceps brachii) groups. There were no significant inter-session effects. Using cross-correlation analysis to investigate the whole time-course of activation, there were highly significant positive correlations (p < 0.001) between the deltoid and rotator cuff, the deltoid and adductor and the adductor and rotator cuff groups, and a significant negative correlation between the deltoid and elbow flexor groups (p = 0.031). We conclude that the deltoid, adductor, and rotator cuff muscles all contribute to the muscular component of glenohumeral joint stability. Muscular stability can be adapted as required to meet task-specific demands.
Collapse
Affiliation(s)
- David H Hawkes
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | | | | | | | | |
Collapse
|
82
|
Oh JH, Jun BJ, McGarry MH, Lee TQ. Does a critical rotator cuff tear stage exist?: a biomechanical study of rotator cuff tear progression in human cadaver shoulders. J Bone Joint Surg Am 2011; 93:2100-9. [PMID: 22262382 DOI: 10.2106/jbjs.j.00032] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is unknown at which stage of rotator cuff tear the biomechanical environment is altered. The purpose of this study was to determine if a critical rotator cuff tear stage exists that alters glenohumeral joint biomechanics throughout the rotational range of shoulder motion, and to evaluate the biomechanical effect of parascapular muscle-loading. METHODS Eight cadaver shoulders were used with a custom testing system. Four progressive rotator cuff tear stages were investigated on the basis of footprint anatomy. Three muscle-loading conditions were examined: rotator cuff only; rotator cuff with deltoid muscle; and rotator cuff, deltoid, pectoralis major, and latissimus dorsi muscles. Testing was performed in the scapular plane with 0°, 30°, and 60° of shoulder abduction. The maximum internal and external rotations were measured with 3.4 Nm of torque. The position of the humeral head apex with respect to the glenoid was calculated with use of a MicroScribe 3DLX digitizing system throughout the rotational range of motion. The abduction capability was determined as the abduction angle achieved with increasing deltoid load. RESULTS Tear of the entire supraspinatus tendon significantly increased maximum external rotation and significantly decreased abduction capability with higher deltoid loads (p < 0.05). Tear of the entire supraspinatus tendon and half of the infraspinatus tendon significantly shifted the humeral head apex posteriorly at the midrange of rotation and superiorly at maximum internal rotation (p < 0.05). Loading the pectoralis major and latissimus dorsi muscles decreased the amount of humeral head elevation due to deltoid loading. CONCLUSIONS Tear of the entire supraspinatus tendon was the critical stage for increasing rotational range of shoulder motion and for decreased abduction capability. Further tear progression to the infraspinatus muscle was the critical stage for significant changes in humeral head kinematics. The pectoralis major and latissimus dorsi muscles played an important role in stabilizing the humeral head as the rotator cuff tear progressed.
Collapse
Affiliation(s)
- Joo Han Oh
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, USA
| | | | | | | |
Collapse
|
83
|
Bey MJ, Peltz CD, Ciarelli K, Kline SK, Divine GW, van Holsbeeck M, Muh S, Kolowich PA, Lock TR, Moutzouros V. In vivo shoulder function after surgical repair of a torn rotator cuff: glenohumeral joint mechanics, shoulder strength, clinical outcomes, and their interaction. Am J Sports Med 2011; 39:2117-29. [PMID: 21737834 PMCID: PMC4601100 DOI: 10.1177/0363546511412164] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical repair of a torn rotator cuff is based on the belief that repairing the tear is necessary to restore normal glenohumeral joint (GHJ) mechanics and achieve a satisfactory clinical outcome. HYPOTHESIS Dynamic joint function is not completely restored by rotator cuff repair, thus compromising shoulder function and potentially leading to long-term disability. STUDY DESIGN Controlled laboratory study and Case series; Level of evidence, 4. METHODS Twenty-one rotator cuff patients and 35 control participants enrolled in the study. Biplane radiographic images were acquired bilaterally from each patient during coronal-plane abduction. Rotator cuff patients were tested at 3, 12, and 24 months after repair of a supraspinatus tendon tear. Control participants were tested once. Glenohumeral joint kinematics and joint contact patterns were accurately determined from the biplane radiographic images. Isometric shoulder strength and patient-reported outcomes were measured at each time point. Ultrasound imaging assessed rotator cuff integrity at 24 months after surgery. RESULTS Twenty of 21 rotator cuff repairs appeared intact at 24 months after surgery. The humerus of the patients' repaired shoulder was positioned more superiorly on the glenoid than both the patients' contralateral shoulder and the dominant shoulder of control participants. Patient-reported outcomes improved significantly over time. Shoulder strength also increased over time, although strength deficits persisted at 24 months for most patients. Changes over time in GHJ mechanics were not detected for either the rotator cuff patients' repaired or contralateral shoulders. Clinical outcome was associated with shoulder strength but not GHJ mechanics. CONCLUSION Surgical repair of an isolated supraspinatus tear may be sufficient to keep the torn rotator cuff intact and achieve satisfactory patient-reported outcomes, but GHJ mechanics and shoulder strength are not fully restored with current repair techniques. CLINICAL RELEVANCE The study suggests that current surgical repair techniques may be effective for reducing pain but have not yet been optimized for restoring long-term shoulder function.
Collapse
Affiliation(s)
- Michael J. Bey
- Bone and Joint Center, Henry Ford Hospital, Detroit, Michigan
,Address correspondence to Michael J. Bey, PhD, Bone and Joint Center, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 ()
| | | | | | | | - George W. Divine
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | | | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | | | - Terrence R. Lock
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | | |
Collapse
|
84
|
Abstract
The rotator cuff provides dynamic stability and is critical to normal shoulder function. Forces generated by the rotator cuff facilitate the motions involved in activities of daily living and the more demanding movements of athletics and manual labor. Injury and pathology of the rotator cuff are common and the unique anatomical and biomechanical characteristics of the cuff contribute to the etiology of its injury. This review provides a biomechanical and anatomic context to understanding normal rotator cuff function and summarizes recent work describing biomechanical implications of cuff pathology.
Collapse
|
85
|
In vivo three-dimensional motion analysis of the shoulder joint during internal and external rotation. INTERNATIONAL ORTHOPAEDICS 2011; 35:1503-9. [PMID: 21674293 DOI: 10.1007/s00264-011-1219-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/18/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to assess accurately the three-dimensional movements of the scapula and humerus relative to the thorax during internal/external rotation motion with abduction of the shoulder joint. METHODS Ten right shoulders of ten healthy volunteers were examined using a wide-gantry open magnetic resonance imaging (MRI) system. MRI was performed every 30° from 90° external rotation to 90° internal rotation of the shoulder joint. RESULTS The contribution ratio of the scapulothoracic joint was 12.5% about the long axis of the humerus during internal/external rotation motion. With arm position changes from 90° external rotation to 60° internal rotation, most movement was performed by the glenohumeral joint. Conversely, at internal rotation of ≥60°, the scapula began to markedly tilt in the anterior direction. At 90° internal rotation, the scapula was significantly tilted anteriorly (p < 0.05) when compared with the other positions. CONCLUSIONS We clarified the existence of a specific scapulohumeral motion pattern, whereby the glenohumeral joint moves with internal rotation and the scapulothoracic joint moves with anterior tilt together with internal rotation motion of the shoulder joint.
Collapse
|
86
|
Yu J, Ackland DC, Pandy MG. Shoulder muscle function depends on elbow joint position: an illustration of dynamic coupling in the upper limb. J Biomech 2011; 44:1859-68. [PMID: 21640353 DOI: 10.1016/j.jbiomech.2011.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 03/23/2011] [Accepted: 04/14/2011] [Indexed: 11/28/2022]
Abstract
Shoulder muscle function has been documented based on muscle moment arms, lines of action and muscle contributions to contact force at the glenohumeral joint. At present, however, the contributions of individual muscles to shoulder joint motion have not been investigated, and the effects of shoulder and elbow joint position on shoulder muscle function are not well understood. The aims of this study were to compute the contributions of individual muscles to motion of the glenohumeral joint during abduction, and to examine the effect of elbow flexion on shoulder muscle function. A three-dimensional musculoskeletal model of the upper limb was used to determine the contributions of 18 major muscles and muscle sub-regions of the shoulder to glenohumeral joint motion during abduction. Muscle function was found to depend strongly on both shoulder and elbow joint positions. When the elbow was extended, the middle and anterior deltoid and supraspinatus were the greatest contributors to angular acceleration of the shoulder in abduction. In contrast, when the elbow was flexed at 90°, the anterior deltoid and subscapularis were the greatest contributors to joint angular acceleration in abduction. This dependence of shoulder muscle function on elbow joint position is explained by the existence of dynamic coupling in multi-joint musculoskeletal systems. The extent to which dynamic coupling affects shoulder muscle function, and therefore movement control, is determined by the structure of the inverse mass matrix, which depends on the configuration of the joints. The data provided may assist in the diagnosis of abnormal shoulder function, for example, due to muscle paralysis or in the case of full-thickness rotator cuff tears.
Collapse
Affiliation(s)
- Jay Yu
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | | | | |
Collapse
|
87
|
Matsuki K, Matsuki KO, Mu S, Yamaguchi S, Ochiai N, Sasho T, Sugaya H, Toyone T, Wada Y, Takahashi K, Banks SA. In vivo 3-dimensional analysis of scapular kinematics: comparison of dominant and nondominant shoulders. J Shoulder Elbow Surg 2011; 20:659-65. [PMID: 21194980 DOI: 10.1016/j.jse.2010.09.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 09/15/2010] [Accepted: 09/25/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alterations in scapular motion frequently are seen in association with various shoulder disorders. It is common clinically to compare the pathological shoulder with the contralateral shoulder, in spite of arm dominance, to characterize the disorder. However, there have been few articles that test the underlying assumption that dominant and nondominant shoulders exhibit comparable dynamic kinematics. The purpose of this study was to compare the 3-dimensional (3-D) scapular kinematics of dominant and nondominant shoulders during dynamic scapular plane elevation using 3-D-2-D (2-dimensional) registration techniques. MATERIALS AND METHODS Twelve healthy males with a mean age of 32 years (range, 27-36) were enrolled in this study. Bilateral fluoroscopic images during scapular plane elevation and lowering were taken, and CT-derived 3-D bone models were matched with the silhouette of the bones in the fluoroscopic images using 3-D-2-D registration techniques. Angular values of the scapula and scapulohumeral rhythm were compared between dominant and nondominant shoulders with statistical analysis. RESULTS There was a significant difference in upward rotation angles between paired shoulders (P < .001), while significant differences were not found in the other angular values and scapulohumeral rhythm. The dominant scapulae were 10° more downwardly rotated at rest and 4° more upwardly rotated during elevation compared to the nondominant scapulae. DISCUSSION/CONCLUSION Scapular motion was not the same between dominant and nondominant arms in healthy subjects. The dominant scapula was rotated further downward at rest and reached greater upward rotation with abduction. These differences should be considered in clinical assessment of shoulder pathology.
Collapse
Affiliation(s)
- Keisuke Matsuki
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
88
|
Massimini DF, Warner JJ, Li G. Non-invasive determination of coupled motion of the scapula and humerus—An in-vitro validation. J Biomech 2011; 44:408-12. [DOI: 10.1016/j.jbiomech.2010.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/10/2010] [Accepted: 10/07/2010] [Indexed: 11/26/2022]
|
89
|
Brainerd EL, Baier DB, Gatesy SM, Hedrick TL, Metzger KA, Gilbert SL, Crisco JJ. X-ray reconstruction of moving morphology (XROMM): precision, accuracy and applications in comparative biomechanics research. ACTA ACUST UNITED AC 2010; 313:262-79. [PMID: 20095029 DOI: 10.1002/jez.589] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
X-Ray Reconstruction of Moving Morphology (XROMM) comprises a set of 3D X-ray motion analysis techniques that merge motion data from in vivo X-ray videos with skeletal morphology data from bone scans into precise and accurate animations of 3D bones moving in 3D space. XROMM methods include: (1) manual alignment (registration) of bone models to video sequences, i.e., Scientific Rotoscoping; (2) computer vision-based autoregistration of bone models to biplanar X-ray videos; and (3) marker-based registration of bone models to biplanar X-ray videos. Here, we describe a novel set of X-ray hardware, software, and workflows for marker-based XROMM. Refurbished C-arm fluoroscopes retrofitted with high-speed video cameras offer a relatively inexpensive X-ray hardware solution for comparative biomechanics research. Precision for our biplanar C-arm hardware and analysis software, measured as the standard deviation of pairwise distances between 1 mm tantalum markers embedded in rigid objects, was found to be +/-0.046 mm under optimal conditions and +/-0.084 mm under actual in vivo recording conditions. Mean error in measurement of a known distance between two beads was within the 0.01 mm fabrication tolerance of the test object, and mean absolute error was 0.037 mm. Animating 3D bone models from sets of marker positions (XROMM animation) makes it possible to study skeletal kinematics in the context of detailed bone morphology. The biplanar fluoroscopy hardware and computational methods described here should make XROMM an accessible and useful addition to the available technologies for studying the form, function, and evolution of vertebrate animals.
Collapse
Affiliation(s)
- Elizabeth L Brainerd
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island 02912, USA.
| | | | | | | | | | | | | |
Collapse
|
90
|
Development and Validation of a Finite Element Model of the Superior Glenoid Labrum. Ann Biomed Eng 2010; 38:3766-76. [DOI: 10.1007/s10439-010-0105-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
|
91
|
Massimini DF, Li G, Warner JP. Glenohumeral contact kinematics in patients after total shoulder arthroplasty. J Bone Joint Surg Am 2010; 92:916-26. [PMID: 20360516 DOI: 10.2106/jbjs.h.01610] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of in vivo glenohumeral joint contact mechanics after total shoulder arthroplasty may provide insight for the improvement of patient function, implant longevity, and surgical technique. The objective of this study was to determine the in vivo glenohumeral joint contact locations in patients after total shoulder arthroplasty. We hypothesized that the glenohumeral joint articular contact would be centered on the glenoid surface because of the ball-in-socket geometric features of the implants. METHODS Dual-plane fluoroscopic images and computer-aided design models were used to quantify patient-specific glenohumeral articular contact in thirteen shoulders following total shoulder arthroplasty. The reconstructed shoulder was imaged at arm positions of 0 degrees, 45 degrees, and 90 degrees of abduction (in the coronal plane) and neutral rotation and at 90 degrees of abduction with maximum internal and external rotation. The patients were individually investigated, and their glenohumeral joint contact centroids were reported with use of contact frequency. RESULTS In all positions, the glenohumeral joint contact centroids were not found at the center of the glenoid surface but at an average distance (and standard deviation) of 11.0 +/- 4.3 mm from the glenoid center. Forty (62%) of the sixty-five total contact occurrences were found on the superior-posterior quadrant of the glenoid surface. The position of 0 degrees of abduction in neutral rotation exhibited the greatest variation of quadrant contact location; however, no contact was found on the superior-anterior quadrant of the glenoid surface in this position. CONCLUSIONS In vivo, glenohumeral joint contact after total shoulder arthroplasty is not centered on the glenoid surface, suggesting that kinematics after shoulder arthroplasty may not be governed by ball-in-socket mechanics as traditionally thought. Although contact locations as a function of arm position vary among patients, the superior-posterior quadrant seems to experience the most articular contact in the shoulder positions tested.
Collapse
Affiliation(s)
- Daniel F Massimini
- Bioengineering Laboratory, GRJ-1215, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | | | | |
Collapse
|
92
|
Assessment of Internal and External Prosthesis Kinematics during Strenuous Activities Using Dynamic Roentgen Stereophotogrammetric Analysis. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181cca7bb] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
93
|
Abstract
This was the third research meeting focused on scapular function and dysfunction, following similar meetings in 2003 and 2006. The purpose of this meeting, hosted by the Shoulder Center of Kentucky, was to continue to examine the biomechanical and clinical factors thought to be associated with the role of the scapula in shoulder function and dysfunction. Since the last Summit, much more information has been created in this area, and it was thought that enough progress had been made that an organized overview of current knowledge could provide some consensus statements to guide further research and provide assessment and treatment guidelines. A call for abstracts was extended to researchers with proven interest and published research on the scapula. The meeting was organized around 3 primary categories of information: scapular kinematics and dysfunction, clinical evaluation of the scapula, and interventions. The last session of the meeting involved development of consensus statements for each category. This document represents the current state of knowledge concerning the aspects of scapular function and dysfunction discussed at the Summit. It is expected that, as more knowledge is developed, the gaps will be filled in and a clearer understanding of the roles of the scapula in shoulder function will emerge. This issue includes the consensus statements and abstracts from the Summit.
Collapse
|
94
|
Favre P, Snedeker JG, Gerber C. Numerical modelling of the shoulder for clinical applications. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2009; 367:2095-2118. [PMID: 19380327 DOI: 10.1098/rsta.2008.0282] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Research activity involving numerical models of the shoulder is dramatically increasing, driven by growing rates of injury and the need to better understand shoulder joint pathologies to develop therapeutic strategies. Based on the type of clinical question they can address, existing models can be broadly categorized into three groups: (i) rigid body models that can simulate kinematics, collisions between entities or wrapping of the muscles over the bones, and which have been used to investigate joint kinematics and ergonomics, and are often coupled with (ii) muscle force estimation techniques, consisting mainly of optimization methods and electromyography-driven models, to simulate muscular action and joint reaction forces to address issues in joint stability, muscular rehabilitation or muscle transfer, and (iii) deformable models that account for stress-strain distributions in the component structures to study articular degeneration, implant failure or muscle/tendon/bone integrity. The state of the art in numerical modelling of the shoulder is reviewed, and the advantages, limitations and potential clinical applications of these modelling approaches are critically discussed. This review concentrates primarily on muscle force estimation modelling, with emphasis on a novel muscle recruitment paradigm, compared with traditionally applied optimization methods. Finally, the necessary benchmarks for validating shoulder models, the emerging technologies that will enable further advances and the future challenges in the field are described.
Collapse
Affiliation(s)
- Philippe Favre
- Laboratory for Orthopaedic Research, Department of Orthopaedics, Balgrist, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
| | | | | |
Collapse
|
95
|
Glenoid inclination: in vivo measures in rotator cuff tear patients and associations with superior glenohumeral joint translation. J Shoulder Elbow Surg 2009; 18:231-6. [PMID: 19062313 PMCID: PMC2669899 DOI: 10.1016/j.jse.2008.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 02/01/2023]
Abstract
Glenoid inclination has been associated with rotator cuff tears and superior humeral translation, but the relationship between glenoid inclination and superior humeral translation has not been assessed in vivo. This study compared glenoid inclination between repaired and contralateral shoulders in 21 unilateral rotator cuff repair patients. As a secondary analysis, we assessed the relationship between glenoid inclination and in vivo superior humeral translation. Glenoid inclination was measured from patient-specific, computed tomography-based bone models. Glenohumeral joint motion was measured from biplane radiographs collected during coronal-plane abductions. Glenoid inclination was significantly lower for the rotator cuff tear shoulders (90.7 degrees ) than the asymptomatic, contralateral shoulders (92.3 degrees , P = .04). No significant correlation existed between increased glenoid inclination and superior-inferior translation of the uninjured shoulder (P > .30). This study failed to support the theory that glenoid inclination is responsible for superior humeral translation and the development of subacromial impingement.
Collapse
|