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Antunes M, Quental C, Folgado J, Ângelo AC, de Campos Azevedo C. Influence of the rotator cuff tear pattern in shoulder stability after arthroscopic superior capsule reconstruction: a computational analysis. J ISAKOS 2024; 9:296-301. [PMID: 38307208 DOI: 10.1016/j.jisako.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES To assess the ability of the arthroscopic superior capsule reconstruction (SCR) in restoring glenohumeral stability in the presence of different preoperative patterns of irreparable rotator cuff tears (RCTs). METHODS A computational musculoskeletal (MSK) model of the upper limb was used to simulate isolated SCR and to estimate the stability of the shoulder. Four patterns of preoperative irreparable RCTs were modeled: Supraspinatus (SSP); SSP + Subscapularis (SSC); SSP + Infraspinatus (ISP); and SSP + SSC + ISP. The muscles involved in the irreparable RCT were removed from the MSK model to simulate an irreparable full-thickness tear. In the MSK model, the muscle and joint forces were estimated for a set of upper limb positions, from four types of motions (abduction in the frontal plane, forward flexion in the sagittal plane, reaching behind the back, and combing the hair) collected in a biomechanics laboratory, through inverse dynamic analysis. The stability of the shoulder was estimated based on the tangential and compressive components of the glenohumeral joint reaction force. The comparison of pre- and post-operative conditions, for the four patterns of irreparable RCTs, with the healthy condition, was performed using ANOVA and Tukey's tests (statistical level of p < 0.05). RESULTS In the setting of an isolated irreparable SSP tear, SCR statistically significantly improved stability compared with the preoperative condition (p < 0.001). For the irreparable SSP + SSC pattern, a statistically significant loss in stability was observed (p < 0.001) when SCR was applied. For the irreparable SSP + ISP and SSP + SSC + ISP patterns, the postoperative condition increased shoulder stability, compared to the preoperative condition; however, the improvement was not statistically significantly different. CONCLUSION Isolated SCR for irreparable RCTs extending beyond the SSP does not statistically significantly improve the stability of the glenohumeral joint. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Madalena Antunes
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal.
| | - Carlos Quental
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal.
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal.
| | - Ana Catarina Ângelo
- Hospital CUF Tejo, Av. 24 de Julho 171 A, 1350-352, Lisbon, Portugal; Hospital dos SAMS de Lisboa, Lisbon, Portugal.
| | - Clara de Campos Azevedo
- Hospital CUF Tejo, Av. 24 de Julho 171 A, 1350-352, Lisbon, Portugal; Hospital dos SAMS de Lisboa, Lisbon, Portugal.
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Chang CY, Weng YH, Chang CH, Yang JL, Chen PT, Lin JJ. Neuromuscular electrical stimulation of humeral adductors in subjects with rotator cuff tear. Arch Orthop Trauma Surg 2024; 144:2039-2046. [PMID: 38613614 DOI: 10.1007/s00402-024-05316-3] [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: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION In symptomatic patients with rotator cuff tear, MRI and radiographic studies have ascribed the pain symptom to insufficient humeral head depression during arm elevations. The arm adductors such as the teres major and pectoralis major may contribute to depression of the humerus head during arm elevations. Researchers have demonstrated that neuromuscular electrical stimulation (NMES) of the serratus anterior and lower trapezius can control scapular motions and improve acromiohumeral distance. It is unknown, however, if adductor neuromuscular training could help patients with rotator cuff tear. MATERIALS AND METHODS A cross-sectional study of NMES of the teres major and pectoralis major was conducted on 30 symptomatic subjects with rotator cuff tear. We measured the acromiohumeral distance by ultrasonography and scapular kinematics during arm elevation with a three-dimensional motion tracking system. RESULTS The acromiohumeral distance significantly increased during NMES of the teres major (0.73 mm, p < 0.001). However, the distance significantly decreased with NMES of the pectoralis major (0.78 mm, p < 0.001). Additionally, scapular upward rotation was greater during NMES of the teres major than during NMES of the pectoralis major (3.4°, p < 0.001). Scapular external rotation decreased significantly more during NMES of the pectoralis major than during NMES of the teres major (1.6°, p = 0.003). CONCLUSIONS NMES of the teres major can increase acromiohumeral distance and scapular upward rotation during arm elevation. However, the decreased upward and external rotation of the scapula during arm elevation with NMES of the pectoralis major may be associated with subacromial impingement.
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Affiliation(s)
- Che-Yuan Chang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Rm. 327, 3F., No. 17, Xuzhou Rd. Zhongzheng Dist, Taichung, Taipei City, 100, Taiwan
| | - Yi Hsuan Weng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsun Chang
- Department of Orthopedic Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Lan Yang
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Tsun Chen
- School of Physical Therapy, Master Program in Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Walford SL, Rankin JW, Mulroy SJ, Neptune RR. Differences in Glenohumeral Joint Contact Forces Between Recovery Hand Patterns During Wheelchair Propulsion With and Without Shoulder Muscle Weakness: A Simulation Study. J Biomech Eng 2024; 146:041005. [PMID: 38270963 PMCID: PMC10983712 DOI: 10.1115/1.4064590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
The majority of manual wheelchair users (MWCU) develop shoulder pain or injuries, which is often caused by impingement. Because propulsion mechanics are influenced by the recovery hand pattern used, the pattern may affect shoulder loading and susceptibility to injury. Shoulder muscle weakness is also correlated with shoulder pain, but how shoulder loading changes with specific muscle group weakness is unknown. Musculoskeletal modeling and simulation were used to compare glenohumeral joint contact forces (GJCFs) across hand patterns and determine how GJCFs vary when primary shoulder muscle groups are weakened. Experimental data were analyzed to classify individuals into four hand pattern groups. A representative musculoskeletal model was then developed for each group and simulations generated to portray baseline strength and six muscle weakness conditions. Three-dimensional GJCF peaks and impulses were compared across hand patterns and muscle weakness conditions. The semicircular pattern consistently had lower shear (anterior-posterior and superior-inferior) GJCFs compared to other patterns. The double-loop pattern had the highest superior GJCFs, while the single-loop pattern had the highest anterior and posterior GJCFs. These results suggest that using the semicircular pattern may be less susceptible to shoulder injuries such as subacromial impingement. Weakening the internal rotators and external rotators resulted in the greatest increases in shear GJCFs and decreases in compressive GJCF, likely due to decreased force from rotator cuff muscles. These findings suggest that strengthening specific muscle groups, especially the rotator cuff, is critical for decreasing the risk of shoulder overuse injuries.
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Affiliation(s)
- Shelby L. Walford
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712-1591
| | - Jeffery W. Rankin
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242; Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242
| | - Sara J. Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242; Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242
| | - Richard R. Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712-1591
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Mattar LT, Mahboobin AB, Popchak AJ, Anderst WJ, Musahl V, Irrgang JJ, Debski RE. Individuals with rotator cuff tears unsuccessfully treated with exercise therapy have less inferiorly oriented net muscle forces during scapular plane abduction. J Biomech 2024; 162:111859. [PMID: 37989027 PMCID: PMC10843663 DOI: 10.1016/j.jbiomech.2023.111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
Exercise therapy for individuals with rotator cuff tears fails in approximately 25.0 % of cases. One reason for failure of exercise therapy may be the inability to strengthen and balance the muscle forces crossing the glenohumeral joint that act to center the humeral head on the glenoid. The objective of the current study was to compare the magnitude and orientation of the net muscle force pre- and post-exercise therapy between subjects successfully and unsuccessfully (e.g. eventually underwent surgery) treated with a 12-week individualized exercise therapy program. Twelve computational musculoskeletal models (n = 6 successful, n = 6 unsuccessful) were developed in OpenSim (v4.0) that incorporated subject specific tear characteristics, muscle peak isometric force, in-vivo kinematics and bony morphology. The models were driven with experimental kinematics and the magnitude and orientation of the net muscle force was determined during scapular plane abduction at pre- and post-exercise therapy timepoints. Subjects unsuccessfully treated had less inferiorly oriented net muscle forces pre- and post-exercise therapy compared to subjects successfully treated (p = 0.039 & 0.045, respectively). No differences were observed in the magnitude of the net muscle force (p > 0.05). The current study developed novel computational musculoskeletal models with subject specific inputs capable of distinguishing between subjects successfully and unsuccessfully treated with exercise therapy. A less inferiorly oriented net muscle force in subjects unsuccessfully treated may increase the risk of superior migration leading to impingement. Adjustments to exercise therapy programs may be warranted to avoid surgery in subjects at risk of unsuccessful treatment.
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Affiliation(s)
- Luke T Mattar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Arash B Mahboobin
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - William J Anderst
- Biodynamics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - James J Irrgang
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States.
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Belli I, Joshi S, Prendergast JM, Beck I, Della Santina C, Peternel L, Seth A. Does enforcing glenohumeral joint stability matter? A new rapid muscle redundancy solver highlights the importance of non-superficial shoulder muscles. PLoS One 2023; 18:e0295003. [PMID: 38033021 PMCID: PMC10688910 DOI: 10.1371/journal.pone.0295003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
The complexity of the human shoulder girdle enables the large mobility of the upper extremity, but also introduces instability of the glenohumeral (GH) joint. Shoulder movements are generated by coordinating large superficial and deeper stabilizing muscles spanning numerous degrees-of-freedom. How shoulder muscles are coordinated to stabilize the movement of the GH joint remains widely unknown. Musculoskeletal simulations are powerful tools to gain insights into the actions of individual muscles and particularly of those that are difficult to measure. In this study, we analyze how enforcement of GH joint stability in a musculoskeletal model affects the estimates of individual muscle activity during shoulder movements. To estimate both muscle activity and GH stability from recorded shoulder movements, we developed a Rapid Muscle Redundancy (RMR) solver to include constraints on joint reaction forces (JRFs) from a musculoskeletal model. The RMR solver yields muscle activations and joint forces by minimizing the weighted sum of squared-activations, while matching experimental motion. We implemented three new features: first, computed muscle forces include active and passive fiber contributions; second, muscle activation rates are enforced to be physiological, and third, JRFs are efficiently formulated as linear functions of activations. Muscle activity from the RMR solver without GH stability was not different from the computed muscle control (CMC) algorithm and electromyography of superficial muscles. The efficiency of the solver enabled us to test over 3600 trials sampled within the uncertainty of the experimental movements to test the differences in muscle activity with and without GH joint stability enforced. We found that enforcing GH stability significantly increases the estimated activity of the rotator cuff muscles but not of most superficial muscles. Therefore, a comparison of shoulder model muscle activity to EMG measurements of superficial muscles alone is insufficient to validate the activity of rotator cuff muscles estimated from musculoskeletal models.
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Affiliation(s)
- Italo Belli
- Cognitive Robotics Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
- Biomechanical Engineering Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
| | - Sagar Joshi
- Cognitive Robotics Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
- Biomechanical Engineering Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
| | - J. Micah Prendergast
- Cognitive Robotics Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
| | - Irene Beck
- Biomechanical Engineering Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
| | - Cosimo Della Santina
- Cognitive Robotics Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
- Robotics and Mechatronics Department, German Aerospace Center (DLR), Munich, Germany
| | - Luka Peternel
- Cognitive Robotics Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
| | - Ajay Seth
- Biomechanical Engineering Department, Technische Universiteit Delft, Delft, Zuid Holland, The Netherlands
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Pataky J, Engle L, Seelam V, Khandare S, Moore ZM, Armstrong AD, Vidt ME. Movement compensation is driven by the deltoid and teres minor muscles following severe rotator cuff tear. Clin Biomech (Bristol, Avon) 2022; 100:105799. [PMID: 36265254 DOI: 10.1016/j.clinbiomech.2022.105799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tears are common in older adults, negatively affecting function. Previous simulation-based studies reported more posterior and superior oriented glenohumeral loading with increased cuff tear severity and task performance, although corresponding muscle compensation strategies are unclear. Our objective is to determine how shoulder muscle forces change with increased rotator cuff tear severity during functional task performance. METHODS Eight musculoskeletal models of increasing tear severity were developed to represent no rotator cuff tear to massive three-tendon tears. Simulations were performed using each combination of model and kinematics for five functional tasks. Individual muscle forces were averaged for each task and tear severity, then normalized by the sum of the muscle forces across the shoulder. Forces were compared across tear severity and muscle. FINDINGS For muscle force contribution, interactions between tear severity and muscle and a main effect of muscle were seen for all tasks (P < 0.0001). Middle deltoid increased force contribution by >10% in the greatest tear severity model compared to no cuff tear model for all tasks (all P < 0.0001). Teres minor contribution increased by 7.7%, 5.6%, and 11% in the greatest tear severity model compared to the no cuff tear model for forward reach, axilla wash, and upward reach 105° tasks, respectively (all P < 0.0001). INTERPRETATION Functional tasks elicit compensatory responses from uninjured muscles following severe cuff tears, notably in middle deltoid and teres minor, leading to posterior-superior glenohumeral loading. The muscles are potential targets for strengthening to avoid injury from sustained increased muscle force.
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Affiliation(s)
- Joshua Pataky
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Lyndsay Engle
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Vijitha Seelam
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Sujata Khandare
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Zoe M Moore
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - April D Armstrong
- Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Meghan E Vidt
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA; Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA.
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Gurnani N, Willems WJ, van Deurzen DFP, Weening AA, Bouwer J, Janssen TWJ, Veeger DHEJ. Shoulder kinematics and muscle activity following latissimus dorsi transfer for massive irreparable posterosuperior rotator cuff tears in shoulders with pseudoparalysis. J Shoulder Elbow Surg 2022; 31:1357-1367. [PMID: 35172211 DOI: 10.1016/j.jse.2022.01.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the thoracohumeral (TH) and glenohumeral (GH) motion with muscle activity after latissimus dorsi transfer (LDT) in a shoulder with a massive irreparable posterosuperior rotator cuff tear (MIRT) and pseudoparalysis compared with the asymptomatic contralateral shoulder (ACS). METHODS We recruited and evaluated 13 patients after LDT in a shoulder with preoperative clinical pseudoparalysis and an MIRT on magnetic resonance imaging, with a minimum follow-up period of 1 year, and with a Hamada stage of 3 or less. Three-dimensional electromagnetic tracking was used to assess shoulder active range of motion in both the LDT shoulder and the ACS. The maximal active elevation of the shoulder (MAES) was assessed and consisted of forward flexion, scapular abduction, and abduction in the coronal plane. Maximal active internal rotation and external rotation were assessed separately. Surface electromyography (EMG) was performed to track activation of the latissimus dorsi (LD) and deltoid muscles during shoulder motion. EMG was scaled to its maximal isometric voluntary contraction recorded in specified strength tests. RESULTS In MAES, TH motion of the LDT shoulder was not significantly different from that of the ACS (F1,12 = 1.174, P = .300) but the GH contribution was significantly lower in the LDT shoulder for all motions (F1,12 = 11.230, P = .006). External rotation was significantly greater in the ACS (26° ± 10° in LDT shoulder vs. 42° ± 11° in ACS, P < .001). The LD percentage EMG maximum showed no significant difference between the LDT shoulder and ACS during MAES (F1,11 = 0.005, P = .946). During maximal active external rotation of the shoulder, the LDT shoulder showed a higher percentage EMG maximum than the ACS (3.0% ± 2.9% for LDT shoulder vs. 1.2% ± 2.0% for ACS, P = .006). CONCLUSIONS TH motion improved after LDT in an MIRT with pseudoparalysis and was not different from the ACS except for external rotation. However, GH motion was significantly lower after LDT than in the ACS in active-elevation range of motion. The LD was active after LDT but not more than in the ACS except for active external rotation, which we did not consider relevant as the activity did not rise above 3% EMG maximum. The favorable clinical results of LDT do not seem to be related to a change in LD activation and might be explained by its effect in preventing proximal migration of the humeral head in active elevation.
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Affiliation(s)
- Navin Gurnani
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.
| | - W Jaap Willems
- Department of Orthopaedic Surgery, DC Expert Centre, Amsterdam, the Netherlands
| | | | - Alexander A Weening
- Department of Orthopaedic Surgery, Diakonesse Hospital, Utrecht, the Netherlands
| | - Joran Bouwer
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Thomas W J Janssen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - DirkJan H E J Veeger
- Faculty of Behavioural and Movement Sciences, Delft University of Technology, Delft, the Netherlands
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Péan F, Favre P, Goksel O. Computational analysis of subscapularis tears and pectoralis major transfers on muscular activity. Clin Biomech (Bristol, Avon) 2022; 92:105541. [PMID: 34999390 DOI: 10.1016/j.clinbiomech.2021.105541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pectoralis major is the most common muscle transfer procedure to restore joint function after subscapularis tears. Limited information is available on how the neuromuscular system adjusts to the new configuration, which could explain the mixed outcomes of the procedure. The purpose of this study is to assess how muscles activation patterns change after pectoralis major transfers and report their biomechanical implications. METHODS We compare how muscle activation change with subscapularis tears and after its treatment by pectoralis major transfers of the clavicular, sternal, or both these segments, during three activities of daily living and a computational musculoskeletal model of the shoulder. FINDINGS Our results indicate that subscapularis tears require a compensatory activation of the supraspinatus and is accompanied by a reduced co-contraction of the infraspinatus, both of which can be partially recovered after transfer. Furthermore, although the pectoralis major acts asynchronously to the subscapularis before the transfer, its activation pattern changes significantly after the transfer. INTERPRETATION The capability of a transferred muscle segment to activate similarly to the intact subscapularis is found to be dependent on the given motion. Differences in the activation patterns between intact subscapularis and the segments of pectoralis major may explain the difficulty in adapting psycho-motor patterns during the rehabilitation period. Thereby, rehabilitation programs could benefit from targeted training on specific motion and biofeedback programs. Finally, the condition of the anterior deltoid should be considered to improve joint function.
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Affiliation(s)
- Fabien Péan
- Computer-assisted Applications in Medicine, ETH Zurich, Switzerland
| | | | - Orcun Goksel
- Computer-assisted Applications in Medicine, ETH Zurich, Switzerland; Department of Information Technology, Uppsala University, Sweden.
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Overbeek CL, Kolk A, de Witte PB, Nagels J, Nelissen RGHH, de Groot JH. Pain does not explain reduced teres major co-contraction during abduction in patients with Subacromial Pain Syndrome. Clin Biomech (Bristol, Avon) 2022; 91:105548. [PMID: 34952267 DOI: 10.1016/j.clinbiomech.2021.105548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with Subacromial Pain Syndrome show reduced co-contraction of the teres major during abduction. Consequent insufficient humeral depressor function may contribute to painful irritation of subacromial tissues and offers a potential target for therapy. A crucial gap in knowledge is whether the degree of teres major co-contraction in these patients is influenced by pain itself. To gain insight into this matter, we assessed whether relief of subacromial pain with local analgesics leads to increased adductor co-contraction in 34 patients with subacromial pain. METHODS In a single-arm interventional study with 34 patients, electromyographic activity of the latissimus dorsi, pectoralis major, teres major and deltoid was assessed during isometric force tasks in 24 directions before and after subacromial Lidocaine injection. Co-contraction was quantified using the activation ratio; range [-1 (sole antagonistic activation, i.e. co-contraction) to 1 (sole agonistic activation)]. FINDINGS There were no changes in activation ratio of the teres major after the intervention (Z-score: -0.6, p = 0.569). The activation ratio of the latissimus dorsi increased to 0.38 (quartiles: 0.13-0.76), indicating decreased co-contraction (Z-score: -2.0, p = 0.045). INTERPRETATION Subacromial analgesics led to a decrease in co-contraction of the latissimus dorsi, whereas no change in the degree of teres major co-contraction was observed. This study shows that decreased teres major co-contraction in patients with subacromial pain, likely is not the consequence of pain itself, opening a window for physical therapy with training of teres major co-contraction to reduce subacromial irritation and pain. LEVEL OF EVIDENCE Level II treatment study.
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Affiliation(s)
- Celeste L Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands.
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands
| | - Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands
| | - Jurriaan H de Groot
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands
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Shoulder Positioning during Superior Capsular Reconstruction: Computational Analysis of Graft Integrity and Shoulder Stability. BIOLOGY 2021; 10:biology10121263. [PMID: 34943178 PMCID: PMC8698921 DOI: 10.3390/biology10121263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023]
Abstract
Simple Summary In arthroscopic superior capsular reconstruction (ASCR) in irreparable rotator cuff tears (IRCTs), a graft is positioned and fixed between the superior rim of the glenoid and the humeral supraspinatus footprint. The fixation of the graft aims to restore the stability and improve the kinematics of the shoulder. The shoulder position during fixation of the graft may be a key factor impacting the outcome of ASCR; however, biomechanical evidence is lacking, as most studies addressing ASCR have been conducted in cadavers. In this study, graft strain and glenohumeral joint reaction force, estimated using a 3-D musculoskeletal model of the upper limb, were used to evaluate graft integrity and shoulder stability, respectively. The results suggest that ASCR significantly improved shoulder stability compared to the preoperative condition; however, the shoulder positions of fixation associated with the greatest improvements were also associated with the highest risk of compromising the integrity of the graft due to high strains. This study provides new and important information regarding the role of shoulder positioning during fixation of the graft. Abstract The shoulder position during fixation of the graft may be a key factor impacting the outcome of arthroscopic superior capsular reconstruction (ASCR) in irreparable rotator cuff tears (IRCTs). However, biomechanical evidence regarding this effect is lacking. The aim of this study was to evaluate the influence of the shoulder position during fixation of the graft on shoulder stability and graft tear risk in ASCR. A 3-D musculoskeletal model of the upper limb was modified to account for the fixation of the graft in ASCR, assuming a full-thickness tear of the supraspinatus tendon. The concomitant tenotomy of the long head of the biceps (LHB) tendon was also studied. The biomechanical parameters evaluated included the strain of the graft and the glenohumeral joint reaction force (GH JRF), which were used to evaluate graft integrity and shoulder stability, respectively. Fixation of the graft considering abduction angles greater than 15° resulted in a high risk for graft tearing when the arm was adducted to the side of the trunk. For abduction angles below 15°, the mean shoulder stability improved significantly, ranging between 6% and 20% (p < 0.001), compared with that in the preoperative condition. The concomitant tenotomy of the LHB tendon resulted in loss of stability when compared to ASCR with an intact LHB tendon. The position of the shoulder during fixation of the graft has a significant effect on shoulder stability and graft tear risk after ASCR in IRCTs. This study provides new and important information regarding the role of shoulder positioning during fixation of the graft.
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Péan F, Favre P, Goksel O. Influence of rotator cuff integrity on loading and kinematics before and after reverse shoulder arthroplasty. J Biomech 2021; 129:110778. [PMID: 34670177 DOI: 10.1016/j.jbiomech.2021.110778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 08/16/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Reverse Shoulder Arthroplasty has become a very common procedure for shoulder joint replacement, even for scenarios where an anatomical reconstruction would traditionally be used. Our hypothesis is that implanting a reverse prosthesis with a functional rotator cuff may lead to higher joint reaction force (JRF) and have a negative impact on the prosthesis. Available motion capture data during anterior flexion was input to a finite-element musculoskeletal shoulder model, and muscle activations were computed using inverse dynamics. Simulations were carried out for the intact joint as well as for various types of rotator cuff tears: superior (supraspinatus), superior-anterior (supraspinatus and subscapularis), and superior-posterior (supraspinatus, infraspinatus and teres minor). Each rotator cuff tear condition was repeated after shifting the humerus and the glenohumeral joint center of rotation to represent the effect of a reverse prosthesis. Changes in compressive, shear, and total JRF were analyzed. The model compared favorably to in vivo JRF measurements, and existing clinical and biomechanical knowledge. Implanting a reverse prosthesis with a functional rotator cuff or with an isolated supraspinatus tear led to more than 2 times higher compressive JRF than with massive rotator cuff tears (superior-anterior or superior-posterior), while the shear force remained comparable. The total JRF increased more than 1.5 times. While a lower shear to compressive ratio may reduce the risk of glenosphere loosening, higher JRF might increase the risk for other failure modes such as fracture or polyethylene wear of the reverse prosthesis.
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Affiliation(s)
- Fabien Péan
- Computer-assisted Applications in Medicine (CAiM), ETH Zurich, Switzerland
| | | | - Orcun Goksel
- Computer-assisted Applications in Medicine (CAiM), ETH Zurich, Switzerland.
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Pataky J, Seelam V, Engle L, Khandare S, Armstrong AD, Vidt ME. Glenohumeral joint loading is impacted by rotator cuff tear severity during functional task performance. Clin Biomech (Bristol, Avon) 2021; 90:105494. [PMID: 34634580 DOI: 10.1016/j.clinbiomech.2021.105494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tear is a common musculoskeletal injury, negatively affecting shoulder function. Rotator cuff tear severity ranges from small to massive tears, but it is unclear how tear severity affects glenohumeral joint loading and how changes contribute to secondary injury. This study's objective was to determine how glenohumeral joint contact force changes with tear severity during functional task performance using computational models. METHODS Eight models of increasing tear severity were developed, ranging from no rotator cuff tear to massive three-tendon tears. Simulations were performed using models representing increasing tear severity and kinematics for five functional tasks (n = 720 simulations). For each task, magnitude and orientation of peak resultant joint contact force for each tear severity was identified, then compared to the no rotator cuff tear model. FINDINGS For all tasks, compared to the no rotator cuff tear model, joint contact force magnitude decreased 9.5% on average with infraspinatus involvement, then plateaued at 20.8% average decrease with subscapularis involvement. Projected orientation of peak joint contact force vector was located more superior in the glenoid with increased tear severity, with significant changes (p < 0.0003) for all tasks with infraspinatus involvement. INTERPRETATION Decreased magnitude and superior orientation of joint contact force suggest fewer intact muscles contribute to force distribution across the joint, although more work is needed characterizing associated compensation strategies. All force vectors remained oriented within the glenoid rim for all tasks and models, suggesting the system prioritizes joint stability. This work identifies how joint contact force changes with rotator cuff tear severity.
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Affiliation(s)
- Joshua Pataky
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Vijitha Seelam
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Lyndsay Engle
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Sujata Khandare
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - April D Armstrong
- Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Meghan E Vidt
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA; Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA.
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Viswanath A, Bale S, Trail I. Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review. J Clin Orthop Trauma 2021; 17:267-272. [PMID: 33936948 PMCID: PMC8079458 DOI: 10.1016/j.jcot.2021.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Indications for reverse total shoulder arthroplasty (RTSA) have expanded over recent years. Whilst cuff tear arthropathy is an accepted indication, the results of its use in those without arthritis is not clear. The aim of this article is to review the literature on RTSA for massive rotator cuff tears without associated arthritis. METHODS A systematic review search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to find all studies with clinical outcomes on RTSA performed for massive irreparable rotator cuff tears (MIRCT) without arthritis. RESULTS Of the 160 studies produced by the search, a detailed analysis found 11 articles to be included in this review. There was variability in the implant style used and the outcome measures utilised, but all studies found improvement in the outcome following RTSA. Many studies advised judicious use following high complication rates, and caution was advised in those patients with pre-operatively preserved active forward elevation. CONCLUSION The available evidence suggests that RTSA is a reliable option in older patients with persistent pain and lack of function following MIRCT even without arthritis. However, as outcomes are not significantly worse following failed rotator cuff repair, joint preserving options in the younger age group should be carefully considered in light of the relatively high complication rate associated with RTSA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Aparna Viswanath
- Dept of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom,Upper Limb Unit, Dept of Orthopaedics, Wrightington Wigan and Leigh NHS Foundation Trust, Hall Lane, Appley Bridge, Lancashire, WN6 9EP, United Kingdom,Corresponding author. 29 Brook Road, Brentwood, CM14 4PT, United Kingdom.
| | - Steve Bale
- Upper Limb Unit, Dept of Orthopaedics, Wrightington Wigan and Leigh NHS Foundation Trust, Hall Lane, Appley Bridge, Lancashire, WN6 9EP, United Kingdom
| | - Ian Trail
- Upper Limb Unit, Dept of Orthopaedics, Wrightington Wigan and Leigh NHS Foundation Trust, Hall Lane, Appley Bridge, Lancashire, WN6 9EP, United Kingdom
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Veen EJD, Koorevaar CT, Verdonschot KHM, Sluijter TE, de Groot T, van der Hoeven JH, Diercks RL, Stevens M. Compensatory Movement Patterns Are Based on Abnormal Activity of the Biceps Brachii and Posterior Deltoid Muscles in Patients with Symptomatic Rotator Cuff Tears. Clin Orthop Relat Res 2021; 479:378-388. [PMID: 33177479 PMCID: PMC7899608 DOI: 10.1097/corr.0000000000001555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/12/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Abnormal movement patterns due to compensatory mechanisms have been reported in patients with rotator cuff tears. The long head of the biceps tendon may especially be overactive and a source of pain and could induce abnormal muscle activation in these patients. It is still unknown why some patients with a rotator cuff tear develop complaints and others do not. QUESTIONS/PURPOSES (1) Which shoulder muscles show a different activation pattern on electromyography (EMG) while performing the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) in patients with a symptomatic rotator cuff tear compared with age-matched controls with an intact rotator cuff? (2) Which shoulder muscles are coactivated on EMG while performing the FIT-HaNSA? METHODS This comparative study included two groups of people aged 50 years and older: a group of patients with chronic symptomatic rotator cuff tears (confirmed by MRI or ultrasound with the exclusion of Patte stage 3 and massive rotator cuff tears) and a control group of volunteers without shoulder conditions. Starting January 2019, 12 patients with a chronic rotator cuff tear were consecutively recruited at the outpatient orthopaedic clinic. Eleven age-matched controls (randomly recruited by posters in the hospital) were included after assuring the absence of shoulder complaints and an intact rotator cuff on ultrasound imaging. The upper limb was examined using the FIT-HaNSA (score: 0 [worst] to 300 seconds [best]), shoulder-specific instruments, health-related quality of life, and EMG recordings of 10 shoulder girdle muscles while performing a tailored FIT-HaNSA. RESULTS EMG (normalized root mean square amplitudes) revealed hyperactivity of the posterior deltoid and biceps brachii muscles during the upward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 111% ± 6% versus 102% ± 10%, mean difference -9 [95% confidence interval -17 to -1]; p = 0.03; biceps brachii: 118% ± 7% versus 111% ± 6%, mean difference -7 [95% CI -13 to 0]; p = 0.04), and there was decreased activity during the downward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 89% ± 6% versus 98% ± 10%, mean difference 9 [95% CI 1 to 17]; p = 0.03; biceps brachii: 82% ± 7% versus 89% ± 6%, mean difference 7 [95% CI 0 to 14]; p = 0.03). The posterior deltoid functioned less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than in the control group. CONCLUSION Patients with a symptomatic rotator cuff tear show compensatory movement patterns based on abnormal activity of the biceps brachii and posterior deltoid muscles when compared with age-matched controls. The posterior deltoid functions less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than the control group. CLINICAL RELEVANCE This study supports the potential benefit of addressing the long head biceps tendon in the treatment of patients with a symptomatic rotator cuff tear. Moreover, clinicians might use these findings for conservative treatment; the posterior deltoid can be specifically trained to help compensate for the deficient rotator cuff.
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Affiliation(s)
- Egbert J D Veen
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cornelis T Koorevaar
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen H M Verdonschot
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim E Sluijter
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tom de Groot
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes H van der Hoeven
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald L Diercks
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- E. J. D. Veen, K. H. M. Verdonschot, T. E. Sluijter, T. de Groot, R. L. Diercks, M. Stevens, Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- C. T. Koorevaar, Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
- K. H. M. Verdonschot, Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- J. H. van der Hoeven, Department of Neurology and Neurophysiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sarshari E, Mancuso M, Terrier A, Farron A, Mullhaupt P, Pioletti D. Muscle co-contraction in an upper limb musculoskeletal model: EMG-assisted vs. standard load-sharing. Comput Methods Biomech Biomed Engin 2020; 24:137-150. [DOI: 10.1080/10255842.2020.1814755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ehsan Sarshari
- Automatic Control Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Matteo Mancuso
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Alain Farron
- Service of Orthopaedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, Switzerland
| | - Philippe Mullhaupt
- Automatic Control Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dominique Pioletti
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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16
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Lawrence RL, Ruder MC, Zauel R, Bey MJ. Instantaneous helical axis estimation of glenohumeral kinematics: The impact of rotator cuff pathology. J Biomech 2020; 109:109924. [PMID: 32807327 PMCID: PMC7443981 DOI: 10.1016/j.jbiomech.2020.109924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/02/2020] [Accepted: 06/21/2020] [Indexed: 11/16/2022]
Abstract
The rotator cuff is theorized to contribute to force couples required to produce glenohumeral kinematics. Impairment in these force couples would theoretically result in impaired ball-and-socket kinematics. Although less frequently used than traditional kinematic descriptors (e.g., Euler angles, joint translations), helical axes are capable of identifying alterations in ball-and-socket kinematics by quantifying the variability (i.e., dispersion) in axis orientation and position during motion. Consequently, assessing glenohumeral helical dispersion may provide indirect evidence of rotator cuff function. The purpose of this exploratory study was to determine the extent to which rotator cuff pathology is associated with alterations in ball-and-socket kinematics. Fifty-one participants were classified into one of five groups based on an assessment of the supraspinatus using diagnostic imaging: asymptomatic healthy, asymptomatic tendinosis, asymptomatic partial-thickness tear, asymptomatic full-thickness tear, symptomatic full-thickness tear. Glenohumeral kinematics were quantified during coronal plane abduction using a biplane x-ray system and described using instantaneous helical axes. The degree to which glenohumeral motion coincided with ball-and-socket kinematics was described using the angular and positional dispersion about the optimal helical axis and pivot, respectively. No statistically significant difference was observed between groups in angular dispersion. However, symptomatic individuals with a full-thickness supraspinatus tear had significantly more positional dispersion than asymptomatic individuals with a healthy supraspinatus or tendinosis. These findings suggest that symptomatic individuals with a full-thickness supraspinatus tear exhibit impaired ball-and-socket kinematics, which is believed to be associated with a disruption of the glenohumeral force couples.
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Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA.
| | - Matthew C Ruder
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA
| | - Roger Zauel
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, 6135 Woodward Avenue, Detroit, MI 48202, USA
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McFarland DC, Brynildsen AG, Saul KR. Sensitivity of Neuromechanical Predictions to Choice of Glenohumeral Stability Modeling Approach. J Appl Biomech 2020; 36:249-258. [PMID: 32369767 DOI: 10.1123/jab.2019-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 02/05/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022]
Abstract
Most upper-extremity musculoskeletal models represent the glenohumeral joint with an inherently stable ball-and-socket, but the physiological joint requires active muscle coordination for stability. The authors evaluated sensitivity of common predicted outcomes (instability, net glenohumeral reaction force, and rotator cuff activations) to different implementations of active stabilizing mechanisms (constraining net joint reaction direction and incorporating normalized surface electromyography [EMG]). Both EMG and reaction force constraints successfully reduced joint instability. For flexion, incorporating any normalized surface EMG data reduced predicted instability by 54.8%, whereas incorporating any force constraint reduced predicted instability by 43.1%. Other outcomes were sensitive to EMG constraints, but not to force constraints. For flexion, incorporating normalized surface EMG data increased predicted magnitudes of joint reaction force and rotator cuff activations by 28.7% and 88.4%, respectively. Force constraints had no influence on these predicted outcomes for all tasks evaluated. More restrictive EMG constraints also tended to overconstrain the model, making it challenging to accurately track input kinematics. Therefore, force constraints may be a more robust choice when representing stability.
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18
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Surface-based modeling of muscles: Functional simulation of the shoulder. Med Eng Phys 2020; 82:1-12. [PMID: 32709260 DOI: 10.1016/j.medengphy.2020.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/03/2020] [Accepted: 04/30/2020] [Indexed: 12/25/2022]
Abstract
Musculoskeletal simulations are an essential tool for studying functional implications of pathologies and of potential surgical outcomes, e.g., for the complex shoulder anatomy. Most shoulder models rely on line-segment approximation of muscles with potential limitations. Comprehensive shoulder models based on continuum-mechanics are scarce due to their complexity in both modeling and computation. In this paper, we present a surface-based modeling approach for muscles, which simplifies the modeling process and is efficient for computation. We propose to use surface geometries for modeling muscles, and devise an automatic approach to generate such models, given the locations of the origin and insertion of tendons. The surfaces are expressed as higher-order tensor B-splines, which ensure smoothness of the geometrical representation. They are simulated as membrane elements within a finite element simulation. This is demonstrated on a comprehensive model of the upper limb, where muscle activations needed to perform desired motions are obtained by using inverse dynamics. In synthetic examples, we demonstrate our proposed surface elements both to be easy to customize (e.g., with spatially varying material properties) and to be substantially (up to 12 times) faster in simulation compared to their volumetric counterpart. With our presented automatic approach of muscle wrapping around bones, the humeral head is exemplified to be wrapped physiologically consistently with surface elements. Our functional simulation is shown to successfully replicate a tracked shoulder motion during activities of daily living. We demonstrate surface-based models to be a numerically stable and computationally efficient compromise between line-segment and volumetric models, enabling anatomical correctness, subject-specific customization, and fast simulations, for a comprehensive simulation of musculoskeletal motion.
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19
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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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Li H, Yoon SH, Lee D, Chung H. Relation between preoperative electromyographic activity of the deltoid and upper trapezius muscle and clinical results in patients treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:195-201. [PMID: 31420222 DOI: 10.1016/j.jse.2019.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND If patients susceptible to poor clinical outcomes could be predicted before reverse shoulder arthroplasty (RSA), it would help to set reasonable postsurgical patient expectations in the preoperative setting. Our hypothesis was that the preoperative electromyographic (EMG) activity of the deltoid and upper trapezius muscles would be correlated with clinical outcomes of patients undergoing RSA. METHODS EMG activity of the deltoid and upper trapezius muscles was measured in 25 patients scheduled to undergo RSA during 3 motions: shrugging, forward flexion, and abduction. Their postoperative clinical results were assessed prospectively during regular outpatient visits, including strength, active range of motion (ROM), pain, and functional scores. The correlations between the preoperative EMG activities and clinical results were analyzed. RESULTS Postoperative shoulder strength after RSA was increased in patients with greater preoperative EMG activity of the middle deltoid and upper trapezius. Preoperative EMG activity of the anterior or middle deltoid muscle was associated with active ROM in flexion or abduction, whereas EMG activity of the posterior deltoid was associated with active ROM in external rotation. CONCLUSIONS Shoulder strength after RSA was positively correlated with preoperative EMG activity of the deltoid and upper trapezius. Active ROM after RSA was positively correlated with preoperative EMG activity of the deltoid. Therefore, preoperative EMG measurements of the deltoid and upper trapezius may predict clinical outcomes after RSA.
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Affiliation(s)
- HongRi Li
- Department of Orthopedic Surgery, Ajou University Graduate School of Medicine, Suwon, Republic of Korea; Department of Orthopedic Surgery, Yanbian University Medical School, Yanbian, China
| | - Seung-Hyun Yoon
- Department of Rehabilitation and Physical Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Doohyung Lee
- Department of Orthopedic Surgery, Ajou University Graduate School of Medicine, Suwon, Republic of Korea; Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Heewoong Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
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Overbeek CL, Kolk A, de Groot JH, de Witte PB, Gademan MGJ, Nelissen RGHH, Nagels J. Middle-aged adults cocontract with arm ADductors during arm ABduction, while young adults do not. Adaptations to preserve pain-free function? J Electromyogr Kinesiol 2019; 49:102351. [PMID: 31473453 DOI: 10.1016/j.jelekin.2019.102351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/30/2019] [Accepted: 08/20/2019] [Indexed: 02/04/2023] Open
Abstract
Middle-aged individuals cocontract with adductor muscles during abduction. This may be crucial for counteracting deltoid forces, depressing the humerus and ensuring free passage of subacromial tissues underneath the acromion during abduction. We questioned whether adductor co-contraction is always present, or develops during ageing, in which case it may explain the age-related character of common shoulder conditions such as Subacromial Pain Syndrome. In a cross-sectional analysis with electromyography (EMG), activation patterns of the latissimus dorsi, teres major, pectoralis major and deltoid muscle were assessed during isometric force tasks in 60 asymptomatic individuals between 21 and 60 years old. Cocontraction was expressed as the degree of antagonistic activation relative to the same muscle's degree of agonistic activation, resulting in an activation ratio between -1 and 1, where lower values indicate more cocontraction. Using linear regression analyses, we found age-related decreases in the activation ratio of the latissimus dorsi (regression estimate: -0.004, 95% CI: -0.007 to 0.0, p-value: 0.042) and teres major (regression estimate: -0.013, 95% CI: -0.019 to -0.008, p-value: <0.001). In contrast to young individuals, middle-aged individuals showed a high degree of adductor cocontraction during abduction. This may indicate that during ageing, alterations in activation patterns are required for preserving pain-free shoulder function.
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Affiliation(s)
- Celeste L Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H de Groot
- Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands; Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands
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Altered Cocontraction Patterns of Humeral Head Depressors in Patients with Subacromial Pain Syndrome: A Cross-sectional Electromyography Analysis. Clin Orthop Relat Res 2019; 477:1862-1868. [PMID: 31107319 PMCID: PMC7000021 DOI: 10.1097/corr.0000000000000745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In approximately 29% to 34% of all patients with subacromial pain syndrome (SAPS) there is no anatomic explanation for symptoms, and behavioral aspects and/or central pain mechanisms may play a more important role than previously assumed. A possible behavioral explanation for pain in patients with SAPS is insufficient active depression of the humerus during abduction by the adductor muscles. Although the adductor muscles, specifically the teres major, have the most important contribution to depression of the humerus during abduction, these muscles have not been well studied in patients with SAPS. QUESTIONS/PURPOSES Do patients with SAPS have altered contraction patterns of the arm adductors during abduction compared with asymptomatic people? METHODS SAPS was defined as nonspecific shoulder pain lasting for longer than 3 months that could not be explained by specific conditions such as calcific tendinitis, full-thickness rotator cuff tears, or symptomatic acromioclavicular arthritis, as assessed with clinical examination, radiographs, and magnetic resonance arthrography. Of 85 patients with SAPS who met the prespecified inclusion criteria, 40 were eligible and agreed to participate in this study. Thirty asymptomatic spouses of patients with musculoskeletal complaints, aged 35 to 60 years, were included; the SAPS and control groups were not different with respect to age, sex, and hand dominance. With electromyography, we assessed the contraction patterns of selected muscles that directly act on the position of the humerus relative to the scapula (the latissimus dorsi, teres major, pectoralis major, and deltoid muscles). Cocontraction was quantified through the activation ratio ([AR]; range, -1 to 1). The AR indicates the task-related degree of antagonist activation relative to the same muscle's degree of agonist activation, equaling 1 in case of sole agonist muscle activation and equaling -1 in case of sole antagonistic activation (cocontraction). We compared the AR between patients with SAPS and asymptomatic controls using linear mixed-model analyses. An effect size of 0.10 < AR < 0.20 was subjectively considered to be a modest effect size. RESULTS Patients with SAPS had a 0.11 higher AR of the teres major (95% CI, 0.01-0.21; p = 0.038), a 0.11 lower AR of the pectoralis major (95% CI, -0.18 to -0.04; p = 0.003), and a 0.12 lower AR of the deltoid muscle (95% CI, -0.17 to -0.06; p < 0.001) than control participants did. These differences were considered to be modest. With the numbers available, we found no difference in the AR of the latissimus dorsi between patients with SAPS and controls (difference = 0.05; 95% CI, -0.01 to 0.12; p = 0.120). CONCLUSIONS Patients with SAPS showed an altered adductor cocontraction pattern with reduced teres major activation during abduction. The consequent reduction of caudally directed forces on the humerus may lead to repetitive overloading of the subacromial tissues and perpetuate symptoms in patients with SAPS. Physical therapy programs are frequently effective in patients with SAPS, but targeted approaches are lacking. Clinicians and scientists may use the findings of this study to assess if actively training adductor cocontraction in patients with SAPS to unload the subacromial tissues is clinically effective. The efficacy of training protocols may be enhanced by using electromyography monitoring. LEVEL OF EVIDENCE Level II, prognostic study.
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Khandare S, Arce RA, Vidt ME. Muscle compensation strategies to maintain glenohumeral joint stability with increased rotator cuff tear severity: A simulation study. J Electromyogr Kinesiol 2019; 62:102335. [DOI: 10.1016/j.jelekin.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 11/26/2022] Open
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Fandridis E, Malahias MA, Plagou A, Orgiani A, Flaviis L, Castagna A. The grade of preoperative subscapularis muscle atrophy as a prognostic factor for postoperative retears: A double-center retrospective series. Orthop Rev (Pavia) 2019; 11:7909. [PMID: 31312418 PMCID: PMC6600844 DOI: 10.4081/or.2019.7909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to investigate whether subscapularis muscle atrophy is a negative prognostic factor leading to increased risk of retears in patients treated with an arthroscopic subscapularis tendon repair. We hypothesized that fatty infiltration of the subscapularis muscle deteriorates the clinical and sonographic outcome of the arthroscopic repair and inhibits reparability of the ruptured tendons. A double- center, multinational, retrospective, blind (in the follow-up) clinical study regarding 32 patients who underwent an arthroscopic subscapularis repair was conducted. Patients were divided into two groups according to the preoparative fatty infiltration grade of subscapularis muscle (group A: grade<II, group B: grade II or higher). Reparability was not influenced by the grade of preoperative fatty infiltration of subscapularis muscle. The preoperative MRI scans showed significantly higher grades of fatty infiltration (group B) in the subscapularis muscle of patients with clinical evidence of retear after the arthroscopic repair. Low grades of preoperative subscapularis muscle atrophy are significantly correlated with low clinical and sonographic retear’s rate after subscapularis arthroscopic repair, while high grades were a clear negative prognostic factor for the clinical outcome of the aforementioned patients.
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Affiliation(s)
| | | | | | | | - Luca Flaviis
- Private Radiological Office De Flaviis, Milan, Italy
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McFarland DC, McCain EM, Poppo MN, Saul K. Spatial Dependency of Glenohumeral Joint Stability during Dynamic Unimanual and Bimanual Pushing and Pulling. J Biomech Eng 2019; 141:2727818. [PMID: 30835272 DOI: 10.1115/1.4043035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 11/08/2022]
Abstract
Degenerative wear to the glenoid from repetitive loading can reduce effective concavity depth and lead to future instability. Workspace design should consider glenohumeral stability to prevent initial wear. While stability has been previously explored for activities of daily living including push-pull tasks, whether stability is spatially dependent is unexplored. We simulated bimanual and unimanual push-pull tasks to 4 horizontal targets (planes of elevation: 0º, 45º, 90º, and 135º) at 90º thoracohumeral elevation and 3 elevation targets (thoracohumeral elevations: 20º, 90º, 170º) at 90º plane of elevation. The 45º horizontal target was most stable regardless of exertion type and would be the ideal target placement when considering stability. This target is likely more stable because the applied load acts perpendicular to the glenoid, limiting shear force production. The 135º horizontal target was particularly unstable for unimanual pushing (143% less stable than the 45º target), and the applied force acts parallel to the glenoid, likely creating shear forces. Pushing was less stable than pulling (all targets except sagittal 170º for both task types and horizontal 45º for bimanual) (p<0.01), which is consistent with prior reports. For example, unimanual pushing at the 90º horizontal target was 197% less stable than unimanual pulling. There were limited stability benefits to task placement for pushing, and larger stability benefits may be seen from converting pushing to pulling rather than optimizing task layout. There was no difference in stability between bimanual and unimanual tasks, suggesting no stability benefit to bimanual operation.
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Affiliation(s)
| | - Emily M McCain
- North Carolina State University, 911 Oval Drive, Raleigh, NC 27606
| | - Michael N Poppo
- North Carolina State University, 911 Oval Drive, Raleigh, NC 27606
| | - Kate Saul
- North Carolina State University, 911 Oval Drive, Raleigh, NC 27606
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Patterns of muscle coordination during dynamic glenohumeral joint elevation: An EMG study. PLoS One 2019; 14:e0211800. [PMID: 30735521 PMCID: PMC6368381 DOI: 10.1371/journal.pone.0211800] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022] Open
Abstract
The shoulder relies heavily on coordinated muscle activity for normal function owing to its limited osseous constraint. However, previous studies have failed to examine the sophisticated interrelationship between all muscles. It is essential for these normal relationships to be defined as a basis for understanding pathology. Therefore, the primary aim of the study was to investigate shoulder inter-muscular coordination during different planes of shoulder elevation. Twenty healthy subjects were included. Electromyography was recorded from 14 shoulder girdle muscles as subjects performed shoulder flexion, scapula plane elevation, abduction and extension. Cross-correlation was used to examine the coordination between different muscles and muscle groups. Significantly higher coordination existed between the rotator cuff and deltoid muscle groups during the initial (Pearson Correlation Coefficient (PCC) = 0.79) and final (PCC = 0.74) stages of shoulder elevation compared to the mid-range (PCC = 0.34) (p = 0.020–0.035). Coordination between the deltoid and a functional adducting group comprising the latissimus dorsi and teres major was particularly high (PCC = 0.89) during early shoulder elevation. The destabilising force of the deltoid, during the initial stage of shoulder elevation, is balanced by the coordinated activity of the rotator cuff, latissimus dorsi and teres major. Stability requirements are lower during the mid-range of elevation. At the end-range of movement the demand for muscular stability again increases and higher coordination is seen between the deltoid and rotator cuff muscle groups. It is proposed that by appreciating the sophistication of normal shoulder function targeted evidence-based rehabilitation strategies for conditions such as subacromial impingement syndrome or shoulder instability can be developed.
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Vidt ME, Santago AC, Marsh AP, Hegedus EJ, Tuohy CJ, Poehling GG, Freehill MT, Miller ME, Saul KR. Modeling a rotator cuff tear: Individualized shoulder muscle forces influence glenohumeral joint contact force predictions. Clin Biomech (Bristol, Avon) 2018; 60:20-29. [PMID: 30308434 PMCID: PMC6252115 DOI: 10.1016/j.clinbiomech.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/31/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tears in older individuals may result in decreased muscle forces and changes to force distribution across the glenohumeral joint. Reduced muscle forces may impact functional task performance, altering glenohumeral joint contact forces, potentially contributing to instability or joint damage risk. Our objective was to evaluate the influence of rotator cuff muscle force distribution on glenohumeral joint contact force during functional pull and axilla wash tasks using individualized computational models. METHODS Fourteen older individuals (age 63.4 yrs. (SD 1.8)) were studied; 7 with rotator cuff tear, 7 matched controls. Muscle volume measurements were used to scale a nominal upper limb model's muscle forces to develop individualized models and perform dynamic simulations of movement tracking participant-derived kinematics. Peak resultant glenohumeral joint contact force, and direction and magnitude of force components were compared between groups using ANCOVA. FINDINGS Results show individualized muscle force distributions for rotator cuff tear participants had reduced peak resultant joint contact force for pull and axilla wash (P ≤ 0.0456), with smaller compressive components of peak resultant force for pull (P = 0.0248). Peak forces for pull were within the glenoid. For axilla wash, peak joint contact was directed near/outside the glenoid rim for three participants; predictions required individualized muscle forces since nominal muscle forces did not affect joint force location. INTERPRETATION Older adults with rotator cuff tear had smaller peak resultant and compressive forces, possibly indicating increased instability or secondary joint damage risk. Outcomes suggest predicted joint contact force following rotator cuff tear is sensitive to including individualized muscle forces.
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Affiliation(s)
- Meghan E Vidt
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Wake Forest Baptist Health, Biomedical Engineering, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Anthony C Santago
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Wake Forest Baptist Health, Biomedical Engineering, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC 27109, USA
| | - Eric J Hegedus
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC 27268, USA
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Katherine R Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Engineering Building 3, Campus Box 7910, 911 Oval Drive, Raleigh, NC 27695-7910, USA
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The presence of a rotator cuff tear interferes with age-dependent muscle atrophy of intact shoulder muscles. An MRI study with 3 years' follow-up. Hum Mov Sci 2018; 62:161-168. [PMID: 30384184 DOI: 10.1016/j.humov.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 11/23/2022]
Abstract
Rotator cuff muscle atrophy is frequently studied, but it is unknown whether redistribution of mechanical load in the presence of a rotator cuff tear influence muscle atrophy that is observed in patients. We hypothesized that in the presence of a supraspinatus tear, redistribution of mechanical load towards teres minor and deltoid slows down atrophy of these muscles over time. In this retrospective observational study of 129 patients, we measured the cross-sectional surface-areas on MRI of shoulder muscles in an intact rotator cuff (n = 92) and in a supraspinatus-tear group (n = 37) with a mean follow-up of 3 ± 1.8 years. Mixed models were applied to evaluate changes in surface-area of the rotator cuff and deltoid with adjustments for age, sex and follow-up time. In patients with an intact rotator cuff, the mean surface-area of the teres minor decreased 6 mm2/year (95% CI 0.7-11.1, P = 0.026) and the mean deltoid surface-area decreased 75 mm2/year (95% CI 24.5-124.8, P = 0.004). The presence of a rotator cuff tear was associated with less reduction of teres minor and deltoid surface-area in patients <50 years, with an effect of a tear of 22 mm2/year (95% CI 1.7-41.7, P = 0.034) and 250 mm2/year (95% CI 75.8-424.3, P = 0.006), respectively. Whereas the surface-area of teres minor and deltoid decrease over time in patient with an intact rotator cuff, the decline in surface-area of these muscles was substantially less in the presence of a rotator cuff tear. Our findings indicate that atrophy may be reduced if an increase in mechanical load is exerted onto the muscle.
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Increased co-contraction of arm adductors is associated with a favorable course in subacromial pain syndrome. J Shoulder Elbow Surg 2018; 27:1925-1931. [PMID: 30243903 DOI: 10.1016/j.jse.2018.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Enhancement of arm adductor activity during abduction (ie, adductor co-contraction), may be effective in the treatment of subacromial pain syndrome (SAPS). We assessed whether an increase of adductor co-contraction is associated with a favorable course of SAPS. METHODS At baseline and after nearly 4 years of follow-up, electromyography of the latissimus dorsi (LD), teres major (TM), pectoralis major, and deltoid muscle was obtained during isometric abduction and adduction tasks in 26 patients with SAPS. Changes in co-contraction were assessed with change in the activation ratio (ΔAR). The AR ranges between -1 and 1, where lower values indicate more co-contraction. Clinical course was determined from an anchor question (reduced, persistent, or increased complaints), the visual analog scale for pain (VAS), and the Western Ontario Rotator Cuff score (WORC). RESULTS In patients indicating persistent complaints (31%), the VAS and WORC remained stable. In patients who indicated reduced complaints (69%), the VAS reduced (z score, -3.4; P = .001) and WORC increased (z score, 3.6; P < .001). Unchanged ARs associated with complaints persistence, whereas decreased AR of the LD (ΔARLD, -0.21; 95% confidence interval [CI], -0.36 to -0.06) and TM (ΔARTM, -0.17; 95% CI, -0.34 to -0.00) coincided with reduced complaints. There was a significant between-group difference in ΔARLD (-0.35; 95% CI, -0.60 to 0.10) and ΔARTM (-0.36; 95% CI, -0.66 to -0.05). CONCLUSIONS Increased co-contraction of the LD and TM is associated with a favorable course of SAPS. This may be explained by widening of the subacromial space accomplished by adductor co-contraction.
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Bone mineralization changes of the glenoid in shoulders with symptomatic rotator cuff tear. INTERNATIONAL ORTHOPAEDICS 2018; 42:2639-2644. [PMID: 29876627 DOI: 10.1007/s00264-018-4004-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Computed tomography osteoabsorptiometry (CTO) is a method to analyze the stress distribution in joints by measuring the subchondral bone density. The purpose of this study was to evaluate the bone mineralization changes of the glenoid in shoulders with rotator cuff tears by CTO and to evaluate whether rotator cuff tears are associated with stress changes in the glenoid. METHODS In total, 32 patients, who were diagnosed with unilateral rotator cuff tears and underwent arthroscopic rotator cuff repair, were enrolled in this study. They underwent CT scanning of both shoulders pre-operatively and the glenoid was evaluated using CTO. Hounsfield units (HU) in seven areas of the glenoid were compared between the affected and unaffected sides. RESULTS The central area of the glenoid on the affected side had significantly lower HU than on the unaffected side among all patients. Focusing on the rotator cuff tear size and the subscapularis tendon, only patients with larger cuff tears or with subscapularis tendon tears showed significantly lower HU in the central area of the affected side. CONCLUSIONS This study showed a decrease in bone mineralization density in the central glenoid in shoulders with rotator cuff tear. This change was observed in the case of larger cuff tears and subscapularis tendon tears. Our results help clarify the changes in stress distribution in the shoulder joint caused by symptomatic rotator cuff tears.
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Understanding the Importance of the Teres Minor for Shoulder Function: Functional Anatomy and Pathology. J Am Acad Orthop Surg 2018; 26:150-161. [PMID: 29473831 DOI: 10.5435/jaaos-d-15-00258] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Although the teres minor is often overlooked in a normal shoulder, it becomes a key component in maintaining shoulder function when other rotator cuff tendons fail. The teres minor maintains a balanced glenohumeral joint and changes from an insignificant to the most significant external rotator in the presence of major rotator cuff pathology. The presence or absence of the teres minor provides prognostic information on the outcomes of reverse total shoulder arthroplasty and tendon transfers. Clinical tests include the Patte test, the Neer dropping sign, the external rotation lag sign, and the Hertel drop sign. Advanced imaging of the teres minor can be used for classification using the Walch system. Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of the patient with shoulder pathology. Appropriate clinical examination and imaging of the teres minor are important for preoperative stratification and postoperative expectations.
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Do subscapularis tears really result in superior humeral migration? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:109-114. [PMID: 29452896 PMCID: PMC6136318 DOI: 10.1016/j.aott.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/02/2017] [Accepted: 01/23/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to analyse the effect of subscapularis tear on superior humeral excursion (SHE) and acromiohumeral distance (AHD). The hypothesis was that subscapularis tears do not result in superior humeral excursion. METHODS Patients who underwent shoulder arthroscopy between August of 2011 and 2015 were reevaluated. Those with isolated Bankart lesion were used as control group and included in the Group 1, isolated full-thickness supraspinatus tear in the Group 2, isolated subscapularis tear in the Group 3, and combined subscapularis and supraspinatus tear in the Group 4. The mean SHE and AHD measurements on magnetic resonance imaging of these groups were compared to reveal any difference in superior humeral migration (SHM). RESULTS There were 30 patients in each group. The mean age of Group 1 (26.44 ± 8.34) was younger than the other 3 groups. The mean AHD and SHE were higher in Group 1 and 3 (Mean AHD: 12.89 ± 2.24 and 12.28 ± 1.9, respectively. Mean SHE: -3.2 ± 0.99 and -2.78 ± 0.64, respectively) than Group 2 and 4 (Mean AHD: 6.2 ± 1.78 and 6.16 ± 1.52, respectively. Mean SHE: 0.72 ± 0.65 and 1.24 ± 0.63, respectively). The AHD and SHE were strongly correlated with each other (Pearson correlation coefficient = 0.184). The inter-observer and intra-observer correlation of the measurements of SHE on MRI were excellent with intraclass correlation coefficient of 0.95 and 0.94, respectively. CONCLUSION Subscapularis tears do not lead to SHM and subacromial impingement. However, superior rotator cuff tears can still lead to SHM and subacromial impingement even when subscapularis tendon is intact. LEVEL OF EVIDENCE Level III, diagnostic study.
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Blache Y, Begon M, Michaud B, Desmoulins L, Allard P, Dal Maso F. Muscle function in glenohumeral joint stability during lifting task. PLoS One 2017; 12:e0189406. [PMID: 29244838 PMCID: PMC5731701 DOI: 10.1371/journal.pone.0189406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 11/26/2017] [Indexed: 11/23/2022] Open
Abstract
Ensuring glenohumeral stability during repetitive lifting tasks is a key factor to reduce the risk of shoulder injuries. Nevertheless, the literature reveals some lack concerning the assessment of the muscles that ensure glenohumeral stability during specific lifting tasks. Therefore, the purpose of this study was to assess the stabilization function of shoulder muscles during a lifting task. Kinematics and muscle electromyograms (n = 9) were recorded from 13 healthy adults during a bi-manual lifting task performed from the hip to the shoulder level. A generic upper-limb OpenSim model was implemented to simulate glenohumeral stability and instability by performing static optimizations with and without glenohumeral stability constraints. This procedure enabled to compute the level of shoulder muscle activity and forces in the two conditions. Without the stability constraint, the simulated movement was unstable during 74%±16% of the time. The force of the supraspinatus was significantly increased of 107% (p<0.002) when the glenohumeral stability constraint was implemented. The increased supraspinatus force led to greater compressive force (p<0.001) and smaller shear force (p<0.001), which contributed to improved glenohumeral stability. It was concluded that the supraspinatus may be the main contributor to glenohumeral stability during lifting task.
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Affiliation(s)
- Yoann Blache
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université Lyon 1, Université de Lyon, Lyon, France
- * E-mail:
| | - Mickaël Begon
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Benjamin Michaud
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Landry Desmoulins
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Paul Allard
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
| | - Fabien Dal Maso
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Québec, Canada
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Alizadehkhaiyat O, Roebuck MM, Makki AT, Frostick SP. Subacromial impingement syndrome: An electromyographic study of shoulder girdle muscle fatigue. J Electromyogr Kinesiol 2017; 38:136-142. [PMID: 29245114 DOI: 10.1016/j.jelekin.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022] Open
Abstract
Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the contributing factors to the development of subacromial impingement syndrome (SAIS). Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics of SAIS has not been reported. This study aimed to measure and compare fatigue progression within the shoulder girdle musculature of patients and healthy controls. 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital Anxiety and Depression Scale) were also assessed. The results were compared between patient and control groups according to the gender. Despite marked fatigue observed in the majority of muscles particularly during flexion and abduction at 90°, overall results indicated a lower tendency of fatigue progression in the impingement group across the tests (p < 0.05 - p < 0.001). Shoulder Strength, pain experience, and psychological status were significantly different between the two groups (P < .05). Lower tendency to fatigue progression in the impingement group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, which in turn lead to adaptations in motor programme to reduce muscle recruitment and activation. The significantly higher levels of pain experience and anxiety/depression in the impingement group further support this proposition.
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Affiliation(s)
- Omid Alizadehkhaiyat
- School of Health Sciences (Sport and Exercise Science), Liverpool Hope University, Liverpool, UK.
| | - Margaret M Roebuck
- Musculoskeletal Science Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ahmed T Makki
- Musculoskeletal Science Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Simon P Frostick
- Musculoskeletal Science Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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The effect of a rotator cuff tear and its size on three-dimensional shoulder motion. Clin Biomech (Bristol, Avon) 2017; 45:43-51. [PMID: 28477525 DOI: 10.1016/j.clinbiomech.2017.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo. METHODS In this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n=34), 2) an isolated supraspinatus tear (n=21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n=54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion. FINDINGS In the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p<0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p=0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p<0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p=0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation. INTERPRETATION The massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential.
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Anastasopoulos PP, Alexiadis G, Spyridonos S, Fandridis E. Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears. Open Orthop J 2017; 11:77-94. [PMID: 28400877 PMCID: PMC5366394 DOI: 10.2174/1874325001711010077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/09/2016] [Accepted: 04/20/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome. METHODS Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported. RESULTS Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear. CONCLUSION Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component.
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Affiliation(s)
- Panagiotis P Anastasopoulos
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - George Alexiadis
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - Sarantis Spyridonos
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
| | - Emmanouil Fandridis
- Hand Surgery-Upper Limb and Microsurgery Department, KAT General Hospital, Nikis 2 Str, Kifisia 145-61, Athens, Greece
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Xu X, Lin JH, McGorry RW. An entropy-assisted musculoskeletal shoulder model. J Electromyogr Kinesiol 2017; 33:103-110. [PMID: 28232284 DOI: 10.1016/j.jelekin.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/19/2017] [Accepted: 01/26/2017] [Indexed: 11/17/2022] Open
Abstract
Optimization combined with a musculoskeletal shoulder model has been used to estimate mechanical loading of musculoskeletal elements around the shoulder. Traditionally, the objective function is to minimize the summation of the total activities of the muscles with forces, moments, and stability constraints. Such an objective function, however, tends to neglect the antagonist muscle co-contraction. In this study, an objective function including an entropy term is proposed to address muscle co-contractions. A musculoskeletal shoulder model is developed to apply the proposed objective function. To find the optimal weight for the entropy term, an experiment was conducted. In the experiment, participants generated various 3-D shoulder moments in six shoulder postures. The surface EMG of 8 shoulder muscles was measured and compared with the predicted muscle activities based on the proposed objective function using Bhattacharyya distance and concordance ratio under different weight of the entropy term. The results show that a small weight of the entropy term can improve the predictability of the model in terms of muscle activities. Such a result suggests that the concept of entropy could be helpful for further understanding the mechanism of muscle co-contractions as well as developing a shoulder biomechanical model with greater validity.
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Affiliation(s)
- Xu Xu
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA.
| | - Jia-Hua Lin
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, WA 98504, USA
| | - Raymond W McGorry
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA
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The morphometric anatomy of the delto-fulcral triangle: A 3D CT-based reconstruction study. J Orthop 2016; 14:62-67. [PMID: 27822004 DOI: 10.1016/j.jor.2016.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/16/2016] [Indexed: 11/21/2022] Open
Abstract
This study introduced the new delto-fulcral triangle (DFT), the first anatomical model of its kind. As seen from the orthopaedician's supraspinatus-outlet view, the antero-superior point of the coracoid process along with the lateral- and posterior-most acromial landmarks form the boundaries of the DFT. Since these osseous scapular landmarks accounted for both dynamic and static stabilisers of the glenohumeral joint, knowledge of the anatomical features of the DFT may prove beneficial to the orthopaedic surgeon. This study thus aimed to investigate the morphometry of the new DFT. The bony surfaces of one-hundred and sixty-nine (n = 169) normal and pathological (Omarthrosis and Cuff-Tear Arthropathy) shoulders from the hospital's CT scan database were reconstructed (Mimics®: Materialise, Leuven, Belgium). Statistical significance was observed between all three groups for Side 2 (LACPF: distance between most lateral and most posterior points of the acromion) and angles α (angle between sides 1 and 3) and β (angle between sides 1 and 2) of the DFT. It was postulated that although pathological cases present with a smaller lateral acromial distance (LACPF), their lateral acromion landmark is more posteriorly placed from the scapular plane than that of a normal case. As the aspects of the morphometric anatomy of the DFT presented with levels of statistical significance, it may provide a means to evaluate the anatomy of normal and pathological cases. Additionally, the three osseous scapular landmarks that create the DFT are clearly visualised and palpable, therefore they are easily reproducible from both X-ray images and CT scans.
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Hölscher T, Weber T, Lazarev I, Englert C, Dendorfer S. Influence of rotator cuff tears on glenohumeral stability during abduction tasks. J Orthop Res 2016; 34:1628-35. [PMID: 26756861 DOI: 10.1002/jor.23161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/04/2016] [Indexed: 02/04/2023]
Abstract
One of the main goals in reconstructing rotator cuff tears is the restoration of glenohumeral joint stability, which is subsequently of utmost importance in order to prevent degenerative damage such as superior labral anterior posterior (SLAP) lesion, arthrosis, and malfunction. The goal of the current study was to facilitate musculoskeletal models in order to estimate glenohumeral instability introduced by muscle weakness due to cuff lesions. Inverse dynamics simulations were used to compute joint reaction forces for several static abduction tasks with different muscle weakness. Results were compared with the existing literature in order to ensure the model validity. Further arm positions taken from activities of daily living, requiring the rotator cuff muscles were modeled and their contribution to joint kinetics computed. Weakness of the superior rotator cuff muscles (supraspinatus; infraspinatus) leads to a deviation of the joint reaction force to the cranial dorsal rim of the glenoid. Massive rotator cuff defects showed higher potential for glenohumeral instability in contrast to single muscle ruptures. The teres minor muscle seems to substitute lost joint torque during several simulated muscle tears to maintain joint stability. Joint instability increases with cuff tear size. Weakness of the upper part of the rotator cuff leads to a joint reaction force closer to the upper glenoid rim. This indicates the comorbidity of cuff tears with SLAP lesions. The teres minor is crucial for maintaining joint stability in case of massive cuff defects and should be uprated in clinical decision-making. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1628-1635, 2016.
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Affiliation(s)
- Thomas Hölscher
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Tim Weber
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Igor Lazarev
- Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
| | | | - Sebastian Dendorfer
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany.,Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
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Hillen RJ, Bolsterlee B, Veeger DHEJ. The biomechanical effect of clavicular shortening on shoulder muscle function, a simulation study. Clin Biomech (Bristol, Avon) 2016; 37:141-146. [PMID: 27467816 DOI: 10.1016/j.clinbiomech.2016.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malunion of the clavicle with shortening after mid shaft fractures can give rise to long-term residual complaints. The cause of these complaints is as yet unclear. METHODS In this study we analysed data of an earlier experimental cadaveric study on changes of shoulder biomechanics with progressive shortening of the clavicle. The data was used in a musculoskeletal computer model to examine the effect of clavicle shortening on muscle function, expressed as maximal muscle moments for abduction and internal rotation. FINDINGS Clavicle shortening results in changes of maximal muscle moments around the shoulder girdle. The mean values at 3.6cm of shortening of maximal muscle moment changes are 16% decreased around the sterno-clavicular joint decreased for both ab- and adduction, 37% increased around the acromion-clavicular joint for adduction and 32% decrease for internal rotation around the gleno-humeral joint in resting position. INTERPRETATION Shortening of the clavicle affects muscle function in the shoulder in a computer model. This may explain for the residual complaints after short malunion with shortening. LEVEL OF EVIDENCE Basic Science Study. Biomechanics. Cadaveric data and computer model.
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Affiliation(s)
- Robert J Hillen
- Waterland Ziekenhuis Purmerend, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands.
| | - Bart Bolsterlee
- Neuroscience Research Australia Margarete Ainsworth Building, Barker St Randwick, NSW 2031, Australia
| | - Dirkjan H E J Veeger
- Faculty Mechanical, Maritime and Materials Engineering, Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands; Department of Human Movement Sciences, Research institute MOVE, Vrije Universiteit Amsterdam, The Netherlands
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Three-dimensional shoulder kinematics normalize after rotator cuff repair. J Shoulder Elbow Surg 2016; 25:881-9. [PMID: 26803930 DOI: 10.1016/j.jse.2015.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/19/2015] [Accepted: 10/24/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with a rotator cuff (RC) tear often exhibit scapular dyskinesia with increased scapular lateral rotation and decreased glenohumeral elevation with arm abduction. We hypothesized that in patients with an RC tear, scapular lateral rotation, and thus glenohumeral elevation, will be restored to normal after RC repair. METHODS Shoulder kinematics were quantitatively analyzed in 26 patients with an electromagnetic tracking device (Flock of Birds) before and 1 year after RC repair in this observational case series. We focused on humeral range of motion and scapular kinematics during abduction. The asymptomatic contralateral shoulder was used as the control. Changes in scapular kinematics were associated with the gain in range of motion. Shoulder kinematics were analyzed using a linear mixed model. RESULTS Mean arm abduction and forward flexion improved after surgery by 20° (95% confidence interval [CI], 2.7°-36.5°; P = .025) and 13° (95% CI, 1.2°-36.5°; P = .044), respectively. Kinematic analyses showed decreases in mean scapular protraction (ie, internal rotation) and lateral rotation (ie, upward rotation) during abduction by 3° (95% CI, 0.0°-5.2°; P = .046) and 4° (95% CI, 1.6°-8.4°; P = .042), respectively. Glenohumeral elevation increased by 5° (95% CI, 0.6°-9.7°; P = .028) at 80°. Humeral range of motion increased when scapular lateral rotation decreased and posterior tilt increased. CONCLUSIONS Scapular kinematics normalize after RC repair toward a symmetrical scapular motion pattern as observed in the asymptomatic contralateral shoulder. The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles.
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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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Slowik JS, McNitt-Gray JL, Requejo PS, Mulroy SJ, Neptune RR. Compensatory strategies during manual wheelchair propulsion in response to weakness in individual muscle groups: A simulation study. Clin Biomech (Bristol, Avon) 2016; 33:34-41. [PMID: 26945719 PMCID: PMC4821704 DOI: 10.1016/j.clinbiomech.2016.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/06/2016] [Accepted: 02/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The considerable physical demand placed on the upper extremity during manual wheelchair propulsion is distributed among individual muscles. The strategy used to distribute the workload is likely influenced by the relative force-generating capacities of individual muscles, and some strategies may be associated with a higher injury risk than others. The objective of this study was to use forward dynamics simulations of manual wheelchair propulsion to identify compensatory strategies that can be used to overcome weakness in individual muscle groups and identify specific strategies that may increase injury risk. Identifying these strategies can provide rationale for the design of targeted rehabilitation programs aimed at preventing the development of pain and injury in manual wheelchair users. METHODS Muscle-actuated forward dynamics simulations of manual wheelchair propulsion were analyzed to identify compensatory strategies in response to individual muscle group weakness using individual muscle mechanical power and stress as measures of upper extremity demand. FINDINGS The simulation analyses found the upper extremity to be robust to weakness in any single muscle group as the remaining groups were able to compensate and restore normal propulsion mechanics. The rotator cuff muscles experienced relatively high muscle stress levels and exhibited compensatory relationships with the deltoid muscles. INTERPRETATION These results underline the importance of strengthening the rotator cuff muscles and supporting muscles whose contributions do not increase the potential for impingement (i.e., the thoracohumeral depressors) and minimize the risk of upper extremity injury in manual wheelchair users.
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Affiliation(s)
- Jonathan S. Slowik
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Jill L. McNitt-Gray
- Department of Biomedical Engineering, The University of Southern California, Los Angeles, CA, USA,Department of Biological Sciences, The University of Southern California, Los Angeles, CA, USA
| | - Philip S. Requejo
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA,Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Sara J. Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Richard R. Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
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de Vries W, Veeger H, Baten C, van der Helm F. Can shoulder joint reaction forces be estimated by neural networks? J Biomech 2016; 49:73-79. [DOI: 10.1016/j.jbiomech.2015.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 10/01/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
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Mechanical risk of rotator cuff repair failure during passive movements: A simulation-based study. Clin Biomech (Bristol, Avon) 2015; 30:1181-8. [PMID: 26320977 DOI: 10.1016/j.clinbiomech.2015.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite improvements in rotator cuff surgery techniques, re-tear rate remains above 20% and increases with tear severity. Mechanical stresses to failure of repaired tendons have been reported. While optimal immobilization postures were proposed to minimize this stress, post-operative rehabilitation protocols have never been assessed with respect to these values. Purpose was to use musculoskeletal simulation to predict when the stress in repaired tendons exceeds safety limits during passive movements. Hence, guidelines could be provided towards safer post-operative exercises. METHODS Sixteen healthy participants volunteered in passive three-dimensional shoulder range-of-motion and passive rehabilitation exercises assessment. Stress in all rotator cuff tendons was predicted during each movement by means of a musculoskeletal model using simulations with different type and size of tears. Safety stress thresholds were defined based on repaired tendon loads to failure reported in the literature and used to discriminate safe from unsafe ranges-of-motion. FINDINGS Increased tear size and multiple tendons tear decreased safe range-of-motion. Mostly, glenohumeral elevations below 38°, above 65°, or performed with the arm held in internal rotation cause excessive stresses in most types and sizes of injury during abduction, scaption or flexion. Larger safe amplitudes of elevation are found in scapular plane for supraspinatus alone, supraspinatus plus infraspinatus, and supraspinatus plus subscapularis tears. INTERPRETATION This study reinforces that passive early rehabilitation exercises could contribute to re-tear due to excessive stresses. Recommendations arising from this study, for instance to keep the arm externally rotated during elevation in case of supraspinatus or supraspinatus plus infraspinatus tear, could help prevent re-tear.
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Alizadehkhaiyat O, Hawkes DH, Kemp GJ, Frostick SP. Electromyographic Analysis of the Shoulder Girdle Musculature During External Rotation Exercises. Orthop J Sports Med 2015; 3:2325967115613988. [PMID: 26740950 PMCID: PMC4687830 DOI: 10.1177/2325967115613988] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Implementation of overhead activity, a key component of many professional sports, requires an effective and balanced activation of the shoulder girdle muscles, particularly during forceful external rotation (ER) motions. Purpose: To identify activation strategies of 16 shoulder girdle muscles/muscle segments during common shoulder ER exercises. Study Design: Descriptive laboratory study. Method: Thirty healthy subjects were included in this study, and 16 shoulder girdle muscles/muscle segments were investigated (surface electrode: anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; serratus anterior; teres major; upper and lower latissimus dorsi; and upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis, and rhomboid major) using a telemetric electromyography (EMG) system. Five ER exercises (standing ER at 0° and 90° of abduction, with underarm towel roll, prone ER at 90° of abduction, side-lying ER with underarm towel) were studied. Exercise EMG amplitudes were normalized to EMG at maximum ER force in a standard position. Univariate analysis of variance and post hoc analysis applied on EMG activity of each muscle were used to assess the main effect of the exercise condition. Results: Muscular activity differed significantly among the ER exercises (P < .05 to P < .001). The greatest activation for anterior and middle deltoid, supraspinatus, upper trapezius, and serratus anterior occurred during standing ER at 90° of abduction; for posterior deltoid, middle trapezius, and rhomboid during side-lying ER with underarm towel; for lower trapezius, upper and lower latissimus dorsi, subscapularis, and teres major during prone ER at 90° of abduction; and for the clavicular and sternal part of the pectoralis major during standing ER with underarm towel. Conclusion: Key glenohumeral and scapular muscles can be optimally activated during specific ER exercises, particularly in positions that stimulate athletic overhead motions. Clinical Relevance: These results enable sports medicine professionals to target specific muscles during shoulder rehabilitation protocols while minimizing the effect of others, providing a foundation for optimal evidence-based exercise prescription. They also provide information for tailored muscle training and injury prevention in overhead sports.
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Affiliation(s)
| | - David H Hawkes
- Musculoskeletal Science Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Graham J Kemp
- Department of Musculoskeletal Biology II, Institute of Ageing & Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Simon P Frostick
- Musculoskeletal Science Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Kolk A, Wolterbeek N, Auw Yang KG, Zijl JAC, Wessel RN. Predictors of disease-specific quality of life after arthroscopic rotator cuff repair. INTERNATIONAL ORTHOPAEDICS 2015; 40:323-9. [PMID: 26508496 DOI: 10.1007/s00264-015-2996-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/11/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE Disease-specific instruments of quality of life (QOL) are more sensitive to disease-specific changes. The purpose of this study is to identify prognostic factors for disease-specific QOL after all-arthroscopic rotator cuff (RC) repair using the Western Ontario Rotator Cuff Index (WORC). METHODS A total of 140 patients were evaluated after an RC repair with a mean follow-up of 22 ± 6.7 months. Evaluations included the WORC, EQ-5D and anchor questions. Preoperative patient demographics and radiologic characteristics were assessed to identify predictors of disease-specific QOL. RESULTS Most patients (81.4 %) were satisfied with their surgical result. Minor tear retraction (odds ratio [OR] 2.97, p = 0.030), male gender (OR 3.67, p = 0.003), no social benefits (OR 3.67, p = 0.042) and pre-surgical complaints for more than six months (OR 3.03, p = 0.021) were independent predictors for superior postoperative WORC score in multivariable analysis. None of these factors were predictive for a higher EQ-5D score. CONCLUSION These findings highlight the important impact of retraction on QOL after RC repair and underline the utility of disease-specific instruments. Future studies should focus on how these significant predictors can be used to improve decision making and to develop new treatment approaches.
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Affiliation(s)
- Arjen Kolk
- Department of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, PO box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, PO box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Kiem Gie Auw Yang
- Department of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, PO box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Jacco A C Zijl
- Department of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, PO box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Ronald N Wessel
- Department of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, PO box 2500, 3430 EM, Nieuwegein, The Netherlands.
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Henseler JF, Raz Y, Nagels J, van Zwet EW, Raz V, Nelissen RGHH. Multivariate analyses of rotator cuff pathologies in shoulder disability. PLoS One 2015; 10:e0118158. [PMID: 25710703 PMCID: PMC4339721 DOI: 10.1371/journal.pone.0118158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 01/05/2015] [Indexed: 12/28/2022] Open
Abstract
Background Disability of the shoulder joint is often caused by a tear in the rotator cuff (RC) muscles. Four RC muscles coordinate shoulder movement and stability, among them the supraspinatus and infraspinatus muscle which are predominantly torn. The contribution of each RC muscle to tear pathology is not fully understood. We hypothesized that muscle atrophy and fatty infiltration, features of RC muscle degeneration, are predictive of superior humeral head translation and shoulder functional disability. Methods Shoulder features, including RC muscle surface area and fatty infiltration, superior humeral translation and RC tear size were obtained from a consecutive series of Magnetic Resonance Imaging with arthrography (MRA). We investigated patients with superior (supraspinatus, n = 39) and posterosuperior (supraspinatus and infraspinatus, n = 30) RC tears, and patients with an intact RC (n = 52) as controls. The individual or combinatorial contribution of RC measures to superior humeral translation, as a sign of RC dysfunction, was investigated with univariate or multivariate models, respectively. Results Using the univariate model the infraspinatus surface area and fatty infiltration in both the supraspinatus and infraspinatus had a significant contribution to RC dysfunction. With the multivariate model, however, the infraspinatus surface area only affected superior humeral translation (p<0.001) and discriminated between superior and posterosuperior tears. In contrast neither tear size nor fatty infiltration of the supraspinatus or infraspinatus contributed to superior humeral translation. Conclusion Our study reveals that infraspinatus atrophy has the strongest contribution to RC tear pathologies. This suggests a pivotal role for the infraspinatus in preventing shoulder disability.
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Affiliation(s)
- Jan F. Henseler
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
- * E-mail:
| | - Yotam Raz
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
| | - Erik W. van Zwet
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Vered Raz
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300 RC Leiden, the Netherlands
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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
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Patel RJ, Choi D, Wright T, Gao Y. Nonconforming glenoid increases posterior glenohumeral translation after a total shoulder replacement. J Shoulder Elbow Surg 2014; 23:1831-1837. [PMID: 24939381 DOI: 10.1016/j.jse.2014.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The major complication in nonconforming total shoulder replacement (TSR) is glenoid loosening and is attributed to posteriorly directed humeral head translations. Whether the posterior translations observed clinically are induced by radial mismatch is unclear. The objective of our study was to explain the posterior glenohumeral translations observed clinically after TSR by determining the glenohumeral translation and contact force as a function of radial mismatch. We hypothesized that the posterior direction of glenohumeral translation during scaption would be related to the radial mismatch and that the joint contact force would increase as the radial mismatch increased. METHODS A 6-degrees-of-freedom computational model of the glenohumeral joint was developed. We determined the muscle forces, joint contact force, and glenohumeral translation for radial mismatches from 1 mm to 20 mm with the shoulder positioned from 20° to 60° of scaption. RESULTS As the radial mismatch increased, the contact location of the humeral head moved posteriorly and inferiorly. The middle deltoid force decreased by 3%, while the supraspinatus and infraspinatus muscle forces increased by 9% and 11%, respectively. The joint contact force remained relatively constant. CONCLUSIONS Increased posterior glenohumeral translations were observed with increased radial mismatch. Clinical observations of posterior translation may be attributed to the balancing forces of the middle deltoid, infraspinatus, and supraspinatus muscles. High radial mismatches may lead to eccentric posterior loading on the glenoid component, which could lead to implant loosening and failure.
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Affiliation(s)
- Radhika J Patel
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Daniel Choi
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Timothy Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Yingxin Gao
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA.
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