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Boulanger SM, Mahna A, Alenabi T, Gatti AA, Culig O, Hynes LM, Chopp-Hurley JN. Investigating the reliability and validity of subacromial space measurements using ultrasound and MRI. J Orthop Surg Res 2023; 18:986. [PMID: 38135882 PMCID: PMC10740303 DOI: 10.1186/s13018-023-04482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND While ultrasound (US) measures of the subacromial space (SAS) have demonstrated excellent reliability, measurements are typically captured by experts with extensive ultrasound experience. Further, the agreement between US measured SAS width and other imaging modalities has not been explored. This research evaluated the agreement between SAS measures captured by novice and expert raters and between US and magnetic resonance imaging (MRI). This study also evaluated the effect of US transducer tilt on measured SAS. METHODS Nine men and nine women participated in this study. US images were captured by a novice and expert with the participant in both seated and supine positions. An inclinometer was fixed to the US probe to measure transducer tilt. SAS width was measured in real time from freeze framed images. MRI images were captured, and the humerus and acromion manually segmented. The SAS width was measured using a custom algorithm. RESULTS Intraclass correlation coefficients (ICCs) between novice and expert raters were 0.74 and 0.63 for seated and supine positions, respectively. Intra-rater agreement was high for both novice (ICC = 0.83-0.84) and expert (ICC ≥ 0.94) raters. Agreement between US and MRI was poor (ICC = 0.21-0.49) but linearly related. CONCLUSIONS Moderate agreement between novice and expert raters was demonstrated, while the agreement between US and MRI was poor. High intra-rater reliability within each rater suggests that US measures of the SAS may be completed by a novice with introductory training.
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Affiliation(s)
- Stephen M Boulanger
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Alexandra Mahna
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Talia Alenabi
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Anthony A Gatti
- Department of Radiology, Stanford University, Stanford, CA, USA
- NeuralSeg Ltd., Hamilton, ON, Canada
| | - Oriana Culig
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Loriann M Hynes
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jaclyn N Chopp-Hurley
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
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Dickerson CR, McDonald AC, Chopp-Hurley JN. Between Two Rocks and in a Hard Place: Reflecting on the Biomechanical Basis of Shoulder Occupational Musculoskeletal Disorders. HUMAN FACTORS 2023; 65:879-890. [PMID: 31961724 DOI: 10.1177/0018720819896191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim was to review the biomechanical origins of occupational shoulder damage, while considering the complexity of shoulder mechanics and musculoskeletal consequences of diverse task demands. BACKGROUND Accessible measures of physical exposures are the primary focus of occupational shoulder assessments and analyses. This approach has led to guidelines and intervention strategies that are often inadequate for mitigating shoulder disorders amongst the complexity of modern workplace demands. Integration of complex shoulder mechanics into occupational assessments, analyses, and interventions is critical for reducing occupational shoulder injury risk. METHOD This narrative review describes shoulder biomechanics in the context of common injury mechanisms and consequent injuries, with a particular focus on subacromial impingement syndrome. Several modulators of shoulder injury risk are reviewed, including fatigue, overhead work, office ergonomics considerations, and pushing and pulling task configurations. RESULTS Relationships between work requirements, muscular demands, fatigue, and biomechanical tissue loads exist. This review highlights that consideration of specific workplace factors should be integrated with our knowledge of the intricate arrangement and interpersonal variability of the shoulder complex to proactively evaluate occupational shoulder demands and exposures. CONCLUSION A standard method for evaluating shoulder muscle exposures during workplace tasks does not exist. An integrated approach is critical for improved work design and prevention of shoulder tissue damage and accompanying disability. APPLICATION This review is particularly relevant for researchers and practitioners, providing guidance for work design and evaluation for shoulder injury prevention by understanding the importance of the unique and complex mechanics of the shoulder.
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Alfaro-Gomez U, Fuentes-Ramirez LD, Chavez-Blanco KI, Vilchez-Cavazos JF, Zdilla MJ, Elizondo-Omana RE, Guerra-Leal JD, Elizondo-Riojas G, Pinales-Razo R, Guzman-Lopez S, Quiroga-Garza A. Anatomical variations of the acromial and coracoid process: clinical relevance. Surg Radiol Anat 2020; 42:877-885. [PMID: 32418123 DOI: 10.1007/s00276-020-02497-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The acromial and coracoid process morphology is of clinical relevance due to associations with functional limitations and shoulder pathology. Our objective was to describe the anatomical characteristics of the acromial and coracoid process using computed tomography (CT). METHODS Descriptive, observational, transversal and retrospective study. A total of 155 CT of patients without shoulder pathology, of both genders, and indistinct age were evaluated and grouped by age: Group 1 < 25 years; group 2 25-40 years; group 3 > 40 years. The following parameters were evaluated: Acromial type (AcT), vertical coracoid distance (VCD), acromial tilt (AT), acromial projection (AP), critical shoulder angle (CSA), type of the subcoracoid outlet (TSO), and the area of the subcoracoid outlet (ASO). RESULTS Statistically significant differences were found between men and women for VCD (14.44 ± 4.79 vs. 11.76 ± 4.00 mm; p < 0.001) and AP (3.66 ± 4.71 vs. 1.62 ± 4.99 mm; p < 0.05) as well as between age groups 1 and 3 for AT (35.08 ± 11.53 vs. 28.41 ± 6.60; p < 0.05) and ASO (398.99 ± 153.91 vs. 255.56 ± 124.58 mm2; p < 0.001). An unexpected high ASO variation was identified with 11% of S-shaped acromion and 1.3% clock-shaped TSO. CONCLUSION The age group between 25-40 years had the most uniform distribution of data. There is a high morphological variability present in an asymptomatic population, which should be considered in the clinical assessment such as shoulder impingement syndrome.
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Affiliation(s)
- Uriel Alfaro-Gomez
- Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Aguirre Pequeño s/n, Col. Mitras Centro, CP. 64460, Monterrey, Nuevo León, Mexico
| | - Luis Donaldo Fuentes-Ramirez
- Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Aguirre Pequeño s/n, Col. Mitras Centro, CP. 64460, Monterrey, Nuevo León, Mexico
| | - Karla Ivonne Chavez-Blanco
- Department of Radiology and Diagnostic Imaging, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo Leon, Mexico
| | - Jose Felix Vilchez-Cavazos
- Department of Traumatology and Orthopedics, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo Leon, Mexico
| | - Matthew J Zdilla
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA.,Department of Graduate Health Sciences, West Liberty University, West Liberty, WV, USA.,Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Rodrigo E Elizondo-Omana
- Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Aguirre Pequeño s/n, Col. Mitras Centro, CP. 64460, Monterrey, Nuevo León, Mexico
| | - Jesus Dante Guerra-Leal
- Department of Radiology and Diagnostic Imaging, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo Leon, Mexico
| | - Guillermo Elizondo-Riojas
- Department of Radiology and Diagnostic Imaging, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo Leon, Mexico
| | - Ricardo Pinales-Razo
- Department of Radiology and Diagnostic Imaging, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Nuevo Leon, Mexico
| | - Santos Guzman-Lopez
- Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Aguirre Pequeño s/n, Col. Mitras Centro, CP. 64460, Monterrey, Nuevo León, Mexico
| | - Alejandro Quiroga-Garza
- Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Ave. Madero y Dr. Aguirre Pequeño s/n, Col. Mitras Centro, CP. 64460, Monterrey, Nuevo León, Mexico.
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Mulla DM, Hodder JN, Maly MR, Lyons JL, Keir PJ. Glenohumeral stabilizing roles of the scapulohumeral muscles: Implications of muscle geometry. J Biomech 2020; 100:109589. [PMID: 31911053 DOI: 10.1016/j.jbiomech.2019.109589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
Dynamic stability provided by muscles is integral for function and integrity of the glenohumeral joint. Although the high degree of inter-individual variation that exists in musculoskeletal geometry is associated with shoulder injuries, there is limited research associating the effects of muscle geometry on the potential stabilizing capacities of shoulder muscles. The purpose of this investigation was to evaluate the stabilizing functions of the scapulohumeral muscles using computational modeling and to quantify the sensitivity of muscle stabilizing roles to changes in muscle geometry. Muscle stability ratios in the superior/inferior and anterior/posterior directions were computed as the ratio between the muscle's shear components relative to compression throughout arm elevation in the scapular plane. Muscle attachment locations on the clavicle, scapula, and humerus were iteratively adjusted using Monte Carlo simulations. Consistent with previous experimental studies, the rotator cuff muscles were identified as the primary stabilizers of the glenohumeral joint; whereas the deltoids and coracobrachialis have a strong potential for superiorly translating the humerus at low elevation angles. Variations in the stability ratios due to altered muscle geometry were muscle- and angle-specific. In general, the highest variation was observed for the subscapularis and deltoids (at low elevation angles), while the remaining rotator cuff muscles largely maintained their capacity to provide compressive stabilizing forces at the glenohumeral joint. Changes in muscle stability ratios may affect dynamic stability of the humerus that could differentially predispose individuals to greater risk for injury.
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Affiliation(s)
- Daanish M Mulla
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Joanne N Hodder
- Faculty of Applied Health & Community Studies, Sheridan College, Brampton, ON, Canada
| | - Monica R Maly
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada; Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - James L Lyons
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Peter J Keir
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
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Mulla DM, Hodder JN, Maly MR, Lyons JL, Keir PJ. Modeling the effects of musculoskeletal geometry on scapulohumeral muscle moment arms and lines of action. Comput Methods Biomech Biomed Engin 2019; 22:1311-1322. [DOI: 10.1080/10255842.2019.1661392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Daanish M. Mulla
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Joanne N. Hodder
- Faculty of Applied Health and Community Studies, Sheridan College, Brampton, ON, Canada
| | - Monica R. Maly
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - James L. Lyons
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Peter J. Keir
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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Pepe M, Kocadal O, Gunes Z, Calisal E, Aksahin E, Aktekin CN. Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:419-422. [PMID: 30268741 PMCID: PMC6318497 DOI: 10.1016/j.aott.2018.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/12/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
Abstract
Objective The aim of this study was to evaluate the effect of the rotator cuff tear repair on subacromial space volume. Methods We retrospectively identified 21 eligible patients (5 males and 16 females; mean age: 56.4 (range; 46–71) years) who had shoulder arthroscopy for unilateral full-thickness small to medium rotator cuff tear and normal controlateral shoulder joint. The mean follow-up time was 16.1 (range; 12–25) months. Preoperative and postoperative 1 year bilateral shoulder MRIs and Constant scores were reviewed. Subacromial volume was calculated by using Osirix software. Pre-, postoperative and healthy side (contralateral control group) subacromial volumes were recorded. Paired sample and t-tests were used to compare the pre- and postoperative groups. Independent sample t-tests were used to compare the healthy and pre- and postoperative groups. The correlation between the changes in the subacromial volume and the shoulder Constant score were analyzed using Pearson correlation analyses. Results The mean subacromial volume of the preoperative group was 2.95 cm3 (range; 1.53–4.23) and the postoperative group was 3.59 cm3 (range; 2.12–4.84). The volume increase was statistically significant (p < 0.05). The mean subacromial volume of the control group was 3.93 cm3 (range; 2.77–5.03), and the difference between the preoperative group and the control group was statistically significant. There was no significant difference found between the postoperative group and the control group (p = 0.156). There was no significant correlation found between the volume and the constant score changes (r = 0.170, p = 0.515). Conclusion The subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm and the surgical repair increases the subacromial volume significantly. Level of evidence Level IV; Diagnostic Study.
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Affiliation(s)
- Murad Pepe
- Department of Orthopaedics and Traumatology, University of Amasya, Amasya, Turkey.
| | - Onur Kocadal
- Department of Orthopaedics and Traumatology, University of Yeditepe, Istanbul, Turkey
| | - Zafer Gunes
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emre Calisal
- Department of Orthopaedics and Traumatology, University of Amasya, Amasya, Turkey
| | - Ertugrul Aksahin
- Orthopaedics and Traumatology, Medical Park Hospital, Ankara, Turkey
| | - Cem Nuri Aktekin
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
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A probabilistic orthopaedic population model to predict fatigue-related subacromial geometric variability. J Biomech 2016; 49:543-9. [DOI: 10.1016/j.jbiomech.2015.12.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/13/2015] [Accepted: 12/28/2015] [Indexed: 11/20/2022]
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