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Moroder P, Chamberlain A, Gabriel SM, Jacofsky MC, Sengun MZ, Spenciner DB, Tokish JM, Lacheta L. Effect of Active and Passive Function of the Posterosuperior Rotator Cuff on Compensatory Muscle Loads in the Shoulder. Orthop J Sports Med 2022; 10:23259671221097062. [PMID: 35647209 PMCID: PMC9134422 DOI: 10.1177/23259671221097062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Irreparable posterosuperior rotator cuff (PSRC) tears have been shown to result in shoulder pain and loss of function. Purpose/Hypothesis: The purpose of this study was to determine the effect of the loss of active or passive function of the PSRC on compensatory muscle loads in the deltoid and the remaining rotator cuff. It was hypothesized that both deactivation and resection of the PSRC would result in load increases in the remaining muscles and that resection of the PSRC would result in even higher required compensatory forces than would mere deactivation. Study Design: Controlled laboratory study. Methods: A total of 7 cadaveric shoulders were tested using a biomechanical shoulder simulator with 10 independently controlled actuators for various muscles (anterior, middle, and posterior deltoid; inferior and superior subscapularis; latissimus dorsi; pectoralis major; teres minor; supraspinatus; and infraspinatus) and 3-dimensional motion tracking. The muscle loads representing the latissimus dorsi and pectoralis major were each held constant, and the remaining muscle actuator forces required to abduct the arm in the scapular plane were determined. The actuator forces corresponding with arm elevation from 20° to 65° were compared at 5° increments for 3 testing conditions: (1) intact, active PSRC; (2) intact, deactivated PSRC; and (3) resected PSRC and shoulder capsule. Results: In both the deactivated and resected states, the teres minor showed a significant increase in required muscle forces through nearly the entire tested range of arm elevation compared to the active state. This was also the case for the subscapularis but only at higher elevation angles. The deltoid demonstrated increased muscle forces of at least 1 of its subunits between 25° and 55° of elevation when comparing the deactivated state or resected state to the active state. However, through nearly the entire range of elevation, no statistically significant differences were found between the deactivated and resected states for any of the actuator loads representing muscle forces. Conclusion: The loss of active function of the PSRC led to compensatory loads on the remaining rotator cuff and deltoid, regardless of the passive presence of the PSRC as a supposed subacromial spacer. Clinical Relevance: The findings encourage the exploration of treatment procedures that mimic the active function of the PSRC when the rotator cuff itself is irreparable.
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Affiliation(s)
- Philipp Moroder
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Aaron Chamberlain
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Marc C. Jacofsky
- Musculoskeletal Orthopedic Research and Education (MORE) Foundation, Phoenix, Arizona, USA
| | - Mehmet Z. Sengun
- DePuy Synthes Mitek Sports Medicine, Raynham, Massachusetts, USA
| | - David B. Spenciner
- DePuy Synthes Mitek Sports Medicine, Raynham, Massachusetts, USA
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - John M. Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Mirzayan R, Donohoe S, Batech M, Suh BD, Acevedo DC, Singh A. Is there a difference in the acromiohumeral distances measured on radiographic and magnetic resonance images of the same shoulder with a massive rotator cuff tear? J Shoulder Elbow Surg 2020; 29:1145-1151. [PMID: 32035821 DOI: 10.1016/j.jse.2019.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of our study was to compare the acromiohumeral distance (AHD) between radiographic and magnetic resonance images (MRIs) of the same shoulder with massive rotator cuff tears (MRCTs). METHODS Thirty-four shoulders with MRCTs that had an MRI and radiograph of the same shoulder within an average of 40.3 days (range: 8-109 days) were identified. AHD was measured digitally on radiograph and MRI by 3 examiners. Shoulders were grouped into Hamada grades <3 (group 1) and Hamada grades ≥3 (group 2). RESULTS The mean age was 66.4 years (range: 51-89). There were 19 men (59%). The Kappa for inter-rater reliability was 0.982 (95% confidence interval [CI] 0.975, 0.988) for radiographs and 0.88 (95% CI 0.75, 0.94) for MRI. There was a significant difference in the mean AHD of group 1 on radiograph vs. MRI (7.9 mm vs. 2.5 mm, respectively; P < .0001), but no difference in group 2 (1.8 mm vs. 2.2 mm, respectively; P = .45). There was no difference in AHD in group 1 between shoulders with Goutallier stage <3 (8.1 ± 1.9 mm) and those with Goutallier stage ≥3 (7.3 ± 2.1 mm) (P = .3479). There was no difference in AHD in group 2 between shoulders with Goutallier stage <3 (3.0 ± 0.1 mm) and those with Goutallier stage ≥3 (1.5 ± 1.0 mm) (P = .079). CONCLUSION There is a significant difference in AHD measurements between radiograph and MRI of the same shoulder with MRCT in early Hamada grades. AHDs measured on radiograph and MRI should not be used interchangeably in early Hamada grades to assess outcomes of superior capsule reconstruction and similar procedures.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA.
| | - Steven Donohoe
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Michael Batech
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Brian D Suh
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Daniel C Acevedo
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Anshuman Singh
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
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The Superior Glenohumeral Joint Capsule Alone Does Not Prevent Superior Translation of the Humeral Head: An In Vitro Biomechanical Study. Arthroscopy 2018; 34:2962-2970. [PMID: 30253900 DOI: 10.1016/j.arthro.2018.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To answer 2 questions: What is the main structure that prevents the superior translation of the humeral head, the supraspinatus or the superior capsule (SC)? And what mechanism does the principal structure rely on to prevent the superior translation of the humeral head, the spacer effect or the tensional hammock effect? METHODS Eight shoulder specimens were assessed using a custom biomechanical testing system. Glenohumeral superior translation and subacromial peak pressure were compared using 6 models: the intact joint model, supraspinatus dysfunction model, supraspinatus defect model, SC tear model, SC defect model, and irreparable rotator cuff tear (IRCT) model. RESULTS Compared with the intact joint model, the supraspinatus defect model significantly increased the superior translation (by 2.6 mm; P < .001) and subacromial peak pressure (by 0.43 MPa; P = .013) at 0° glenohumeral abduction, while the SC defect model unremarkably altered the superior translation at 0° (by 0.6 mm; P = .582) and 45° (by 0.3 mm; P = .867) of glenohumeral abduction and the subacromial peak pressure at 0° (by 0.11 MPa; P = .961), 30° (by -0.03 MPa; P = .997), and 45° (by -0.33 MPa; P = .485) of glenohumeral abduction. The supraspinatus dysfunction model significantly increased the superior translation at 0° (by 1.7 mm; P < .001), 30° (by 1.2 mm; P = .005), and 45° (by 0.8 mm; P = .026) of glenohumeral abduction, but not the subacromial peak pressure compared with the intact joint model. However, no significant differences were found between the supraspinatus defect model and the supraspinatus dysfunction model with respect to the superior translation or subacromial peak pressure (all P > .05). CONCLUSIONS The anatomic SC has a negligible role in preventing the superior translation of the humeral head. CLINICAL RELEVANCE SC reconstruction is not a simple anatomic reconstruction, and its promising clinical outcome may be due to tensional fixation technique and choice of graft.
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Valencia AP, Iyer SR, Spangenburg EE, Gilotra MN, Lovering RM. Impaired contractile function of the supraspinatus in the acute period following a rotator cuff tear. BMC Musculoskelet Disord 2017; 18:436. [PMID: 29121906 PMCID: PMC5679320 DOI: 10.1186/s12891-017-1789-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/26/2017] [Indexed: 01/16/2023] Open
Abstract
Background Rotator cuff (RTC) tears are a common clinical problem resulting in adverse changes to the muscle, but there is limited information comparing histopathology to contractile function. This study assessed supraspinatus force and susceptibility to injury in the rat model of RTC tear, and compared these functional changes to histopathology of the muscle. Methods Unilateral RTC tears were induced in male rats via tenotomy of the supraspinatus and infraspinatus. Maximal tetanic force and susceptibility to injury of the supraspinatus muscle were measured in vivo at day 2 and day 15 after tenotomy. Supraspinatus muscles were weighed and harvested for histologic analysis of the neuromuscular junction (NMJ), intramuscular lipid, and collagen. Results Tenotomy resulted in eventual atrophy and weakness. Despite no loss in muscle mass at day 2 there was a 30% reduction in contractile force, and a decrease in NMJ continuity and size. Reduced force persisted at day 15, a time point when muscle atrophy was evident but NMJ morphology was restored. At day 15, torn muscles had decreased collagen-packing density and were also more susceptible to contraction-induced injury. Conclusion Muscle size and histopathology are not direct indicators of overall RTC contractile health. Changes in NMJ morphology and collagen organization were associated with changes in contractile function and thus may play a role in response to injury. Although our findings are limited to the acute phase after a RTC tear, the most salient finding is that RTC tenotomy results in increased susceptibility to injury of the supraspinatus.
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Affiliation(s)
- Ana P Valencia
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA.,Department of Kinesiology, University of Maryland School of Public Health, College Park, USA
| | - Shama R Iyer
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA
| | - Espen E Spangenburg
- Department of Physiology, East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA
| | - Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA.
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Sachdeva R, Farthing JP, Kim SY. Evaluation of supraspinatus strengthening exercises based on fiber bundle architectural changes. Scand J Med Sci Sports 2016; 27:736-745. [PMID: 27137171 DOI: 10.1111/sms.12689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 11/27/2022]
Abstract
Supraspinatus strengthening is an integral part of rehabilitation programs. However, there is disparity regarding the best exercise. Thus, we investigated the effects of supraspinatus strengthening exercises on muscle fiber bundle architecture using real-time ultrasound. Participants were randomized into full-can (FC; n = 12), empty-can (EC; n = 11,) and prone horizontal abduction (PHA; n = 11) groups and performed three sessions/week for 8 weeks. Each session involved four sets of exercise for weeks 1-4 and six sets for weeks 5-8 with eight repetitions/set. Images of supraspinatus were captured in 0° (relaxed) and 60° (contracted) glenohumeral abduction. Fiber bundle length (FBL), pennation angle, and muscle thickness were measured at beginning, mid, and end of training. Maximum isometric abduction strength was measured in full-can, empty-can, and prone horizontal abduction positions using a hand-held dynamometer. FBL decreased after 4 weeks in FC [relaxed: Δ = -0.54 cm, P = 0.001, d = 0.92; contracted: Δ = -0.27 cm, P = 0.008, d = 0.27] and EC [relaxed: Δ = -0.59 cm, P = 0.008, d = 0.86; contracted: Δ = -0.36 cm, P = 0.013, d = 0.59], but not in PHA [relaxed: Δ = -0.11, P = 0.121, d = 0.31; contracted: Δ = -0.06 cm, P = 0.486, d = 0.13]. Strength increased significantly from week 4-8 only in PHA (Δ = +0.96 kg, P = 0.004, d = 0.47) when tested in prone horizontal abduction position. Maintenance of FBL with increased strength indicates prone horizontal abduction may be a better exercise to strengthen supraspinatus.
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Affiliation(s)
- R Sachdeva
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - J P Farthing
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Y Kim
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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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.
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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
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Chopp-Hurley JN, Dickerson CR. The potential role of upper extremity muscle fatigue in the generation of extrinsic subacromial impingement syndrome: a kinematic perspective. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mueller AM, Rosso C, Entezari V, McKenzie B, Hasebroock A, Cereatti A, Della Croce U, Nazarian A, Ramappa AJ, DeAngelis JP. The effect of supraspinatus tears on glenohumeral translations in passive pitching motion. Am J Sports Med 2014; 42:2455-62. [PMID: 25201441 DOI: 10.1177/0363546514547348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Supraspinatus tears are common in pitchers. However, the effect of these tears on glenohumeral (GH) mechanics is incompletely understood. PURPOSE/HYPOTHESIS To describe the effect of supraspinatus tears and repairs on GH kinematics during an abbreviated throwing motion using the intact shoulder girdle. The hypothesis was that supraspinatus tears would lead to an increase of GH translation in the coronal plane and supraspinatus repairs would restore GH kinematics. STUDY DESIGN Controlled laboratory study. METHODS Six shoulders from 3 fresh-frozen cadavers were tested in a novel 7 degrees of freedom robotic testing system. Torsos were mounted and the wrist was pinned to an actuator mounted on an upper frame. After the deltoid was removed, the shoulders were studied during an abbreviated throwing motion (ATM) from maximum external rotation to the midcoronal plane to establish a baseline. The ATM was repeated after creation of a 1-cm supraspinatus tear, after creation of a 3-cm supraspinatus tear, and after repair with a transosseous equivalent (TOE) technique. Retroreflective bone markers and high-speed infrared cameras were used to measure GH kinematics and calculate the center of rotation of the GH joint (CORGH) instantaneously. RESULTS The 1- and 3-cm supraspinatus tears did not significantly alter GH translation. The TOE repair shifted the CORGH posteriorly, as evidenced by a significant decrease in the overall GH translation in all 3 planes (P = .003, .019, and .026, for x-y, y-z, and x-z planes, respectively). CONCLUSION In contrast to a TOE repair of the supraspinatus tendon, isolated supraspinatus tears did not perturb GH kinematics in this cadaveric model of the throwing shoulder. CLINICAL RELEVANCE In throwing athletes, treatment of rotator cuff tears should be addressed with caution to avoid an unintended alteration in GH kinematics due to overtightening of the tendon.
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Affiliation(s)
- Andreas M Mueller
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Orthopaedic Department, University Hospital Basel, Basel, Switzerland
| | - Claudio Rosso
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Orthopaedic Department, University Hospital Basel, Basel, Switzerland
| | - Vahid Entezari
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Brett McKenzie
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Hasebroock
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ugo Della Croce
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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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.
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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]
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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.
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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
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Seitz AL, McClure PW, Finucane S, Boardman ND, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech (Bristol, Avon) 2011; 26:1-12. [PMID: 20846766 DOI: 10.1016/j.clinbiomech.2010.08.001] [Citation(s) in RCA: 257] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 07/30/2010] [Accepted: 08/02/2010] [Indexed: 02/07/2023]
Abstract
The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased extensibility of pectoralis minor or posterior shoulder. A unique extrinsic mechanism, internal impingement, is attributed to compression of the posterior articular surface of the tendons between the humeral head and glenoid and is not related to subacromial space narrowing. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. The varied nature of these mechanisms indicates that rotator cuff tendinopathy is not a homogenous entity, and thus may require different treatment interventions. Treatment aimed at addressing mechanistic factors appears to be beneficial for patients with rotator cuff tendinopathy, however, not for all patients. Classification of rotator cuff tendinopathy into subgroups based on underlying mechanism may improve treatment outcomes.
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Affiliation(s)
- Amee L Seitz
- Department of Physical Therapy, Virginia Commonwealth University-Medical College of Virginia Campus, Richmond, VA 23298-0224, USA.
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Favre P, Gerber C, Snedeker JG. Automated muscle wrapping using finite element contact detection. J Biomech 2010; 43:1931-40. [DOI: 10.1016/j.jbiomech.2010.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 03/11/2010] [Accepted: 03/11/2010] [Indexed: 01/27/2023]
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Bey MJ, Kline SK, Zauel R, Kolowich PA, Lock TR. In Vivo Measurement of Glenohumeral Joint Contact Patterns. EURASIP JOURNAL ON ADVANCES IN SIGNAL PROCESSING 2010; 2010:162136. [PMID: 21546990 PMCID: PMC3086287 DOI: 10.1155/2010/162136] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objectives of this study were to describe a technique for measuring in-vivo glenohumeral joint contact patterns during dynamic activities and to demonstrate application of this technique. The experimental technique calculated joint contact patterns by combining CT-based 3D bone models with joint motion data that were accurately measured from biplane x-ray images. Joint contact patterns were calculated for the repaired and contralateral shoulders of 20 patients who had undergone rotator cuff repair. Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition (i.e., repaired versus contralateral). Abduction angle had a significant effect on the superior/inferior contact center position, with the average joint contact center of the repaired shoulder 12.1% higher on the glenoid than the contralateral shoulder. This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics.
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Affiliation(s)
- Michael J Bey
- Department of Orthopaedic Surgery, Bone and Joint Center, Henry Ford Hospital, 2799 W. Grand Blvd., E&R 2015, Detroit, MI 48202, USA
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15
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Favre P, Moor B, Snedeker JG, Gerber C. Influence of component positioning on impingement in conventional total shoulder arthroplasty. Clin Biomech (Bristol, Avon) 2008; 23:175-83. [PMID: 17983693 DOI: 10.1016/j.clinbiomech.2007.09.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 06/28/2007] [Accepted: 09/25/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical experience suggests that component impingement can lead to eccentric implant loading and thereby cause glenoid loosening in conventional total shoulder arthroplasty. This study tests the hypothesis that certain implant component positioning configurations may lead to impingement within the physiological range of motion. METHODS A rigid-body model of the shoulder comprising the scapula and humerus was constructed. Within this 3D model, a commercially available total shoulder arthroplasty implant was positioned according to manufacturer guidelines. The configuration was modified around this default position to investigate the associated angle of inferior and superior impingement during glenohumeral elevation, as well as in lateral impingement during axial rotation at both 0 degrees and 60 degrees of glenohumeral elevation. Glenoid component size, version, inclination and inferior-superior offset as well as humeral component size, torsion, inclination, offset and height were examined. The influence of the humeral calcar anatomy was also investigated. FINDINGS Certain implant configurations caused component impingement in the physiological range of motion. The most sensitive parameters affecting impingement were: (1) the inclination of the glenoid component, (2) the inferior-superior position of the humeral component along the resection line and (3) the prominence of the humeral calcar. Glenoid offset and inclination and humeral head offset and height directly affected subacromial impingement. INTERPRETATION This study suggests that several intraoperatively adjustable implant positioning parameters can influence the likelihood of implant impingement in conventional total shoulder arthroplasty, and that the geometry of the humeral calcar should be taken into consideration when designing an operative strategy for shoulder joint replacement.
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Affiliation(s)
- Philippe Favre
- Laboratory for Orthopaedic Research, Department of Orthopaedics, Balgrist, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
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16
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Werner CML, Ruckstuhl T, Müller R, Zanetti M, Gerber C. Influence of psychomotor skills and innervation patterns on results of latissimus dorsi tendon transfer for irreparable rotator cuff tears. J Shoulder Elbow Surg 2008; 17:22S-28S. [PMID: 18201653 DOI: 10.1016/j.jse.2007.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 07/01/2007] [Accepted: 07/11/2007] [Indexed: 02/01/2023]
Abstract
This investigation was performed to analyze the influence of innervation and psychomotor skills on the outcome of latissimus dorsi transfer. Patients with the 10 best and 10 worst results after latissimus dorsi transfer for irreparable rotator cuff tears were selected. All patients meeting the inclusion criteria (n = 12) were subject to a psychomotor test battery (Motorische Leistungsserie) and electromyographic innervation assessment. There was no statistical difference between the 2 groups preoperatively in terms of the commonly tested factors known to influence the results of this procedure adversely. There was a significant difference in both the pattern and selectivity of innervation in the group that had better clinical results. The psychomotor findings were negatively correlated with the range of motion and the strength of the operative shoulder. Function of the operative shoulder could also be predicted by psychomotor function of the uninjured contralateral side. Psychomotor skills testing appears to be a new, potential method by which to predict the outcome of latissimus dorsi transfer.
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Affiliation(s)
- Clément M L Werner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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17
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Intermethod agreement and interobserver correlation of radiologic acromiohumeral distance measurements. J Shoulder Elbow Surg 2007; 17:237-40. [PMID: 18162412 DOI: 10.1016/j.jse.2007.06.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 06/26/2007] [Indexed: 02/01/2023]
Abstract
The acromiohumeral distance (AHD) measured on conventional, true anteroposterior radiographs taken with the patient standing and the arm held in neutral rotation can predict the presence or absence of a large, chronic rotator cuff tears, and narrowing of the acromiohumeral distance can predict irreparability of rotator cuff tears. The relation between AHD measured on conventional radiographs and the integrity of the rotator cuff tendons is well known. Conversely, the correlation between the AHD on conventional radiographs and that measured on magnetic resonance imaging (MRI) or computed tomography (CT) scans is unknown. It has also not been determined which method correlates better with fatty infiltration of the rotator cuff muscles and might thereby be a better prognostic value for the outcome of rotator cuff repair. Conventional radiographs, plus MRI and or CT studies taken at the same time of patients with rotator cuff tears, shoulder instability, primary glenohumeral osteoarthritis, or idiopathic frozen shoulder, were randomly selected, and the AHD was measured both on conventional radiographs and on MRI or CT. The values were correlated with the stage of fatty degeneration of the rotator cuff muscles in the cases of rotator cuff tears. The AHD on conventional radiographs was larger than on MRI and CT, and correlation of the values measured (conventional radiography vs MRI and CT) could be demonstrated. For rotator cuff diseases, a significant but moderate correlation (r = 0.6; P < .05) between conventional and MRI was identified, and the conventional values were approximately 0.6 mm greater than the corresponding MRI values. It is, therefore, possible to use the AHD read on MRI or CT studies for prognostic reasons, provided the values obtained are converted accordingly and remembering that the correlation of the values is only moderate.
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18
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McCully SP, Suprak DN, Kosek P, Karduna AR. Suprascapular nerve block results in a compensatory increase in deltoid muscle activity. J Biomech 2007; 40:1839-46. [PMID: 17034796 DOI: 10.1016/j.jbiomech.2006.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 07/24/2006] [Indexed: 11/27/2022]
Abstract
A balance exists between the deltoid and rotator cuff contribution to arm elevation. Both cadaver and computer models have predicted an increase in deltoid muscle force with dysfunction of the rotator cuff. The goal of the present study was to verify this phenomenon in vivo by examining the effects of paralysis of the supraspinatus and infraspinatus muscles with a suprascapular nerve block on the electrical activity of seven shoulder muscles. Electromyographic data were collected before and after the administration of the block. The block resulted in a significant increase in muscle activity for all heads of the deltoid, with a higher percentage increase noted at lower elevation angles. Although the deltoid activity was reduced as the subjects recovered from the block, even low levels of cuff dysfunction were found to result in increased deltoid activity. These results suggest that even small disruptions in the normal function of some rotator cuff muscles (e.g., due to fatigue or impingement syndrome), may result in an increase in deltoid activity. It is possible that such compensation may result in higher superior loads at the glenohumeral joint, possibly increasing the risk of tendon damage.
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Affiliation(s)
- Sean P McCully
- Department of Anatomy, BioSciences Institute, University College Cork School of Medicine, Cork, Ireland
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