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Takahashi Y, Nishinaka N, Furuya K, Ikeda T, Jinno T, Okawa A, Sakai T. Analysis of in vivo humeral rotation of reverse total shoulder arthroplasty patients during shoulder abduction on the scapular plane with a load. ARTHROPLASTY 2023; 5:51. [PMID: 37794512 PMCID: PMC10552275 DOI: 10.1186/s42836-023-00207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Few studies have investigated the kinematics after reverse total shoulder arthroplasty (RTSA). This study aimed to compare the shoulder kinematics in RTSA patients during shoulder abduction on the scapular plane with and without a load and yield information regarding the function of stabilizing the joints against gravity for the functional assessment of the shoulder after RTSA, which could lead to changes in postoperative rehabilitation treatment. METHODS Twenty RTSA patients (7 men, 13 women; mean age: 78.1 [64-90] years) were examined. First, active shoulder abduction in the scapular plane was captured using single-plane fluoroscopic X-ray images. Imaging was performed by stipulating that one shoulder abduction cycle should be completed in 6 s. Two trials were conducted: one under a load equivalent to 2% of body weight and one without a load. Next, a three-dimensional (3D) model of each humeral and scapular component was matched to the silhouette of the fluoroscopic image to estimate the 3D dynamics. By using the 3D dynamic model obtained, the kinematics of the glenosphere and humeral implant were calculated relative to the shoulder abduction angle on the scapular plane and were compared between groups with and without a load. A one-way analysis of variance and a post hoc paired t-test with a statistical significance level of 0.05 were performed. RESULTS The humeral internal rotation decreased with a load at shoulder abduction between 40° and 90° on the scapular plane (P < 0.01, effect size: 0.15). No significant differences in scapular upward rotation (P = 0.57, effect size: 0.022), external rotation (P = 0.83, effect size: 0.0083) and posterior tilting (P = 0.74, effect size: 0.013) were observed between groups with and without a load. The main effect was not observed with and without a load (P = 0.86, effect size: 0.0072). However, the scapulohumeral rhythm was significantly greater without a load during shoulder joint abduction between 40° and 60° on the scapular plane. CONCLUSION In RTSA patients, the glenohumeral joint was less internally rotated, and the scapulohumeral rhythm decreased under loaded conditions. It was stabilized against the load through the mechanical advantage of the deltoid muscle and other muscles.
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Affiliation(s)
- Yuji Takahashi
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
- Showa University School of Nursing and Rehabilitation Science, 1865 Tohkaichiba-Cho Midori-Ku, Yokohama, Kanagawa, 226-8555, Japan.
| | - Naoya Nishinaka
- Showa University Faculty of Health Care, 1865 Tohkaichiba-Cho Midori-Ku, Yokohama, Kanagawa, 226-8555, Japan
- Showa University Research Institute for Sport and Exercise Sciences, 2-1-1 Fujigaoka Aoba-Ku, Yokohama, Kanagawa, 227-8518, Japan
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-Ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Kanji Furuya
- Showa University Research Institute for Sport and Exercise Sciences, 2-1-1 Fujigaoka Aoba-Ku, Yokohama, Kanagawa, 227-8518, Japan
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-Ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Takashi Ikeda
- Showa University School of Nursing and Rehabilitation Science, 1865 Tohkaichiba-Cho Midori-Ku, Yokohama, Kanagawa, 226-8555, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Tomoko Sakai
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Yildiz TI, Kara D, Demirci S, Sevinç C, Ulusoy B, Eraslan L, Aksoy T, Huri G, Duzgun I. Recovery of the shoulder kinematics after reverse shoulder arthroplasty. Clin Biomech (Bristol, Avon) 2023; 107:106013. [PMID: 37267895 DOI: 10.1016/j.clinbiomech.2023.106013] [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: 06/16/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND There is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the changes in the scapulohumeral rhythm and shoulder kinematics over time after the reverse shoulder procedure. METHODS Nineteen patients with reverse shoulder arthroplasty (age: 65.8 ± 10.3 years) were included to the study. During arm elevation in the sagittal and scapular planes, operated shoulder kinematics (humerothoracic elevation, glenohumeral elevation, scapulohumeral rhythm, and scapular rotations) were assessed using an electromagnetic tracking system at the postoperative 3rd, 6th, and 18th months. Asymptomatic shoulder kinematics were also assessed at the postoperative 18th month. Shoulder function was assessed using The Disabilities of the Arm Shoulder and Hand score at the postoperative 3rd, 6th, and 18th months. FINDINGS Maximum humerothoracic elevation increased from 98° to 109° over the postoperative period (p = 0.01). The scapulohumeral rhythm was similar on the operated and asymptomatic shoulders at the final follow-up (p = 0.11). Both the operated and asymptomatic shoulder demonstrated similar scapular kinematics at the postoperative 18th month (p > 0.05). The Disabilities of the Arm Shoulder and Hand score decreased over time in the postoperative period (p < 0.05). INTERPRETATION Shoulder kinematics may be improved after reverse shoulder arthroplasty in the postoperative period. Focusing on scapular stabilization and deltoid muscle control in the postoperative rehabilitation program may enhance the shoulder kinematics and upper extremity function.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Afyonkarahisar Saglik Bilimleri University, Institution of Health Science, Turkey.
| | - Dilara Kara
- Hacettepe University, Institution of Health Science, Turkey
| | - Serdar Demirci
- Balikesir University, Institution of Health Science, Turkey
| | - Ceyda Sevinç
- Hacettepe University, Institution of Health Science, Turkey
| | - Burak Ulusoy
- Cankiri University, Institution of Health Science, Turkey
| | - Leyla Eraslan
- Hacettepe University, Institution of Health Science, Turkey
| | - Taha Aksoy
- Hacettepe University, Institution of Health Science, Turkey
| | - Gazi Huri
- Hacettepe University, Institution of Health Science, Turkey
| | - Irem Duzgun
- Hacettepe University, Institution of Health Science, Turkey
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Knighton TW, Chalmers PN, Sulkar HJ, Aliaj K, Tashjian RZ, Henninger HB. Anatomic total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study. J Shoulder Elbow Surg 2022; 31:2023-2033. [PMID: 35550434 PMCID: PMC9481675 DOI: 10.1016/j.jse.2022.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although typically favorable in outcome, anatomic total shoulder arthroplasty (aTSA) can require long-term revision. The most common cause for revision is glenoid loosening, which may result from eccentric cyclic forces and joint translations. "Rocking" of the glenoid component may be exacerbated by the joint geometry, such as glenoid inclination and version. Restoration of premorbid glenoid inclination may be preferable, although laboratory and computational models indicate that both superior inclination and inferior inclination have benefits. This discrepancy may arise because previous studies were limited by a lack of physiological conditions to test inclination. Therefore, a cadaveric shoulder simulator with 3-dimensional human motion was used to study joint contact and muscle forces with isolated changes in glenoid inclination. METHODS Eight human cadaveric shoulders were tested before and after aTSA. Scapular-plane abduction kinematics from human subjects were used to drive a cadaveric shoulder simulator with 3-dimensional scapulothoracic and glenohumeral motion. Glenoid inclination was varied from -10° to +20°, whereas compressive, superior-inferior shear, and anterior-posterior shear forces were collected with a 6-df load cell during motion. Outputs also included muscle forces of the deltoid and rotator cuff. Data were evaluated with statistical parametric mapping repeated-measures analysis of variance and t tests. RESULTS Inferior glenoid inclination (-10°) reduced both compressive and superior-inferior shear forces vs. neutral 0° inclination by up to 40%, and even more when compared with superior inclination (P < .001). Superior inclinations (+10° and +20°) tended to increase deltoid and rotator cuff forces vs. neutral 0° inclination or inferior inclination, on the order of 20%-40% (P ≤ .045). All force metrics except anterior-posterior shear were lowest for inferior inclination. Most aTSA muscle forces for neutral 0° inclination were not significantly different from native shoulders and decreased 45% and 15% in the posterior deltoid and supraspinatus, respectively (P ≤ .003). Joint translations were similar to prior reports in aTSA patients and did not differ between any inclinations or compared with native shoulders. Joint reaction forces were similar to those observed in human subjects with instrumented aTSA implants, providing confidence in the relative magnitude of our results. CONCLUSIONS Inferior inclination reduces overall forces in the shoulder. Superior inclinations increase the muscle effort required for the shoulder to achieve similar motion, thus increasing the forces exerted on the glenoid component. These results suggest that a preference toward aTSA glenoid components in inferior inclination may reduce the likelihood of glenoid loosening by reducing excessive muscle and joint contact forces.
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Affiliation(s)
- Tyler W Knighton
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Hema J Sulkar
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Klevis Aliaj
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
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Gonzalez FF, Fonseca R, Leporace G, Pitta R, Giordano MN, Chahla J, Metsavaht L. Three-dimensional kinematic evaluation of scapulohumeral rhythm after reverse shoulder arthroplasty: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:8-16. [PMID: 37588296 PMCID: PMC10426534 DOI: 10.1016/j.xrrt.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The movement of the arm relative to the trunk results from 3-dimensional (3D) coordinated movements of the glenohumeral (GH) and scapulothoracic (ST) joints and dictates the scapulohumeral rhythm (SHR). Alterations in SHR increase joint overload and may lead to low functional scores, pain, and failures in patients undergoing reverse total shoulder arthroplasty (RSA). The goal of this systematic review and meta-analysis was to examine 3D SHR kinematics after RSA and compare it to that of asymptomatic shoulders. Methods A systematic review and meta-analysis of articles in English were performed using PubMed, Embase, Cochrane Library, and SciELO. Additional studies were identified by searching bibliographies. Search terms included "Reverse shoulder arthroplasty", "3D", and "scapula". It was selected cross-sectional studies that reported SHR with 3D motion analysis systems in patients who underwent RSA and asymptomatic controls. Two authors independently performed the extraction of articles using predefined data fields, including study quality indicators. Results Data from four studies were included in quantitative analysis, totaling 48 shoulders with RSA and 63 asymptomatic shoulders. Pooled analyses were based on random-effects model (DerSimonian-Laird). A statistically smaller SHR ratio was observed in the RSA group than that in the control group (P < .00001), meaning a greater contribution of ST joint in relation to GH joint for arm elevation. The standardized mean difference was -1.16 (95% confidence interval: -1.64, -0.67). A sensitivity analysis with three more studies that had imputed data on control group did not change the direction of the effect. The standardized mean difference on sensitivity analysis was -0.60 (P = .03; 95% confidence interval: -1.13, -0.06). It was detected as "not important heterogeneity" within the comparison (I2: 22%). Chi-square was not statistically significant (Chi2: 3.85), and I2 was 22%. Tau2 was not zero (Tau2: 0.05). Sensitivity analysis showed an I2 of 74%, which might represent substantial heterogeneity, Chi-square was not statistically significant (Chi2: 23.01), and Tau2 was not zero (Tau2: 0.37). Conclusion This study found that RSA shoulders have an increased contribution of ST joint during arm elevation, compared with asymptomatic shoulders. More movement in ST joint in proportion to GH joint increases GH joint contact forces, which could lead to component loosening or other complications. Further studies should address the clinical implications of this kinematic finding.
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Affiliation(s)
- Felipe F. Gonzalez
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil
- Post Graduation Program of Clinical Radiology, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
| | - Raphael Fonseca
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
| | - Gustavo Leporace
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil
- Post Graduation Program of Clinical Radiology, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
| | - Rafael Pitta
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
| | - Marcos N. Giordano
- Department of Orthopedic Surgery, Galeão Air Force Hospital (Hospital de Força Aérea do Galeão), Rio de Janeiro, Brazil
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Leonardo Metsavaht
- Brazil Institute of Health Technologies (Instituto Brasil de Tecnologias da Saúde), Rio de Janeiro, Brazil
- Post Graduation Program of Clinical Radiology, Federal University of São Paulo (Universidade Federal de São Paulo), São Paulo, Brazil
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Zaferiou AM, Knowlton CB, Jang SH, Saltzman BM, Verma NN, Forsythe B, Nicholson GP, Romeo AA. Scapular and humeral elevation coordination patterns used before vs. after Reverse Total Shoulder Arthroplasty. J Biomech 2021; 125:110550. [PMID: 34198022 DOI: 10.1016/j.jbiomech.2021.110550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/16/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to compare scapulohumeral coordination used before and after Reverse Total Shoulder Arthroplasty (RTSA) during the ascent phase of scapular plane arm elevation tasks performed with varied shoulder rotations (neutral, external rotation, and internal rotation). We expected that after RTSA, participants would decrease scapulothoracic upward rotation angular displacement and increase the scapulohumeral rhythm (SHR) vs. before RTSA. 11 RTSA patients (12 shoulders) participated in this study before and after RTSA while optical motion capture measured kinematics of the humerus and scapula relative to the thorax. Angular kinematics were compared pre vs. post-RTSA within-participant using One Dimensional Statistical Parametric Mapping (SPM) t-tests (α = 0.05) and across-participants, using paired t-tests (α = 0.05) adjusted for multiple comparisons. As a group, during arm elevation with neutral rotation, the mean (SD) SHR pre-RTSA was 1.5 (0.5) and increased to 1.7 (0.3) post-RTSA, though, not significantly (p = 0.182). In contrast, during arm elevation with external rotation, the mean (SD) SHR pre-RTSA was 1.3 (0.4) and significantly increased (p = 0.018) post-RTSA to 1.7 (0.3). Likewise, during arm elevation with internal rotation, the mean (SD) SHR pre-RTSA was 1.2 (0.3) and significantly increased (p < 0.001) post-RTSA to 1.7 (0.2). In addition to these and other group trends, participant-specific patterns were uncovered through SPM analyses - with some participants significantly increasing and others significantly decreasing scapulothoracic angular displacements across humerothoracic elevation ranges. Both before and after RTSA, scapulohumeral rhythm ratios were within the range of those previously reported in post-RTSA patients and were smaller than those used by healthy populations.
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Affiliation(s)
- Antonia M Zaferiou
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | | | - Suk-Hwan Jang
- Inje University Seoul Paik Hospital, Seoul, South Korea
| | - Bryan M Saltzman
- Orthocarolina Sports Medicine Center, Charlotte, NC, USA; Atrium Health Musculoskeletal Institute (MSKI), Charlotte, NC, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Friesenbichler B, Grassi A, Grobet C, Audigé L, Wirth B. Is limited shoulder abduction associated with poor scapulothoracic mobility after reverse shoulder arthroplasty? Arch Orthop Trauma Surg 2021; 141:587-591. [PMID: 32296967 DOI: 10.1007/s00402-020-03445-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The contribution of the glenohumeral joint to shoulder abduction is acknowledged as an important factor for reverse total shoulder arthroplasty (RTSA) patients. In contrast, the degree of scapulothoracic joint contribution and its relation to RTSA patients with poor to excellent shoulder abduction are unclear. MATERIALS AND METHODS Twenty-three selectively recruited patients (74 ± 7 years, 11 males) with shoulder abduction ranging from poor to excellent at least 6 months after primary, unilateral RTSA participated in this study. Individual scapulothoracic and glenohumeral contributions at maximum shoulder abduction in the scapular plane were measured using 3D motion capture and correlations between scapulothoracic and glenohumeral contributions to shoulder abduction were assessed. Multiple regression analysis was used to determine the influence of age, body mass index, follow-up period, abduction strength and passive glenohumeral mobility on scapulothoracic and glenohumeral function. RESULTS Maximum shoulder abduction (range 48°-140°) was not significantly correlated with the scapulothoracic contribution (range 39°-75°, r = 0.40, p = 0.06), but there was a strong and significant correlation with the glenohumeral contribution (range - 9°-83°, r = 0.91, p < 0.001). Abduction strength was strongly associated with glenohumeral (p = 0.006) but not scapulothoracic (p = 0.34) joint contributions. CONCLUSIONS Limited shoulder abduction is not associated with insufficient scapulothoracic mobility, which rather provides a basic level of function for RTSA patients. Good to excellent shoulder abduction could only be achieved by increasing the glenohumeral contribution that was associated with postoperative abduction strength.
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Affiliation(s)
| | - Andrea Grassi
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Cécile Grobet
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland.,Shoulder and Elbow Surgery Department, Schulthess Clinic, Zürich, Switzerland
| | - Laurent Audigé
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland.,Shoulder and Elbow Surgery Department, Schulthess Clinic, Zürich, Switzerland
| | - Barbara Wirth
- Shoulder and Elbow Surgery Department, Schulthess Clinic, Zürich, Switzerland
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Lang AE, Kim SY, Milosavljevic S, Dickerson CR. Estimating Muscle Forces for Breast Cancer Survivors During Functional Tasks. J Appl Biomech 2020; 36:408-415. [PMID: 32963123 DOI: 10.1123/jab.2020-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/21/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
Breast cancer survivors have known scapular kinematic alterations that may be related to the development of secondary morbidities. A measure of muscle activation would help understand the mechanisms behind potential harmful kinematics. The purpose of this study was to define muscle force strategies in breast cancer survivors. Shoulder muscle forces during 6 functional tasks were predicted for 25 breast cancer survivors (divided by impingement pain) and 25 controls using a modified Shoulder Loading Analysis Module. Maximum forces for each muscle were calculated, and 1-way analysis of variance (P < .05) was used to identify group differences. The differences between maximum predicted forces and maximum electromyography were compared with repeated-measures analysis of variance (P < .05) to evaluate the success of the model predictions. Average differences between force predictions and electromyography ranged from 7.3% to 31.6% but were within the range of previously accepted differences. Impingement related pain in breast cancer survivors is associated with increased force of select shoulder muscles. Both pectoralis major heads, upper trapezius, and supraspinatus peak forces were higher in the pain group across all tasks. These force prediction differences are also associated with potentially harmful kinematic strategies, providing a direction for possible rehabilitation strategies.
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Lang AE, Milosavljevic S, Dickerson CR, Kim SY. Examining assessment methods of scapular motion: Comparing results from planar elevations and functional task performance. Clin Biomech (Bristol, Avon) 2020; 80:105203. [PMID: 33127188 DOI: 10.1016/j.clinbiomech.2020.105203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scapular kinematics of breast cancer survivors are most often evaluated during arm elevation. However, known compensations exist during functional task performance. The purpose of this study was to determine if scapular kinematics of breast cancer survivors during arm elevation are related to scapular kinematics during functional task performance. METHODS Scapular kinematics of 25 non-cancer controls and 25 breast cancer survivors (split by presence of impingement pain) during arm elevation in 3 planes and 3 reaching and lifting functional tasks were measured. Scapular upward rotation and scapulohumeral rhythm (SHR) at 30° increments of arm elevation were calculated. Between-group differences of upward rotation during arm elevation were evaluated with one-way ANOVAs (p < 0.05). The association of upward rotation angle and SHR during arm elevation and functional tasks was tested with Pearson correlations (p < 0.05). FINDINGS Scapular upward rotation was reduced for the breast cancer survivor with pain at lower levels of arm elevation in each plane by up to 7.1° (p = .014 to 0.049). This is inconsistent with functional task results, in which upward rotation decrements occurred at higher levels of arm elevation. Upward rotation angles and SHR during arm elevation had an overall weak-to-moderate relationship (r = 0.003 to 0.970, p = .001 to 0.048) to values from functional tasks. Arm elevation during sagittal plane elevation demonstrated scapular upward rotation that was most closely associated to upward rotation during functional task performance. INTERPRETATION Inconsistent relationships suggests that clinical evaluations should adopt basic functional movements for scapular motion assessment to complement simple arm elevations.
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Affiliation(s)
- Angelica E Lang
- Department of Health Sciences, College of Medicine, University of Saskatchewan, Canada
| | - Stephan Milosavljevic
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Canada
| | - Clark R Dickerson
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Canada
| | - Soo Y Kim
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Canada.
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Scapulohumeral rhythm in patients after total shoulder arthroplasty compared to age-matched healthy individuals. Gait Posture 2020; 82:38-44. [PMID: 32882516 DOI: 10.1016/j.gaitpost.2020.08.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/21/2019] [Accepted: 08/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The coordination of the glenohumeral joint and the shoulder girdle has been known as scapulohumeral rhythm. The effects of anatomical total shoulder arthroplasty (aTSA) are still subject to research. Former studies showed a higher amount of scapula lateral rotation to compensate for reduced glenohumeral elevation. The purpose of the present study was to confirm this mechanism and examine additional effects on the sternoclavicular and acromioclavicular joints' kinematics. METHODS 3D motion analysis was used to examine 23 shoulders of 16 patients with a mean age of 71.2 (SD: 5.2) years with a mean follow up of 5.4 (SD: 2.1) years after aTSA and to compare kinematics and coordination to 22 shoulders of 11 healthy age-matched individuals with a mean age of 69.6 (SD: 5.3) years while performing elevation movement in frontal and sagittal plane. RESULTS The ratio of glenohumeral to shoulder girdle contribution was reduced compared to healthy individuals: Shoulder girdle contribution to elevation was 36.5% (SD: 8.1) in the aTSA group vs. 28.5% (SD: 8.2) in the control group in the sagittal plane and 38.1% (SD: 9.1) vs. 30.2% (SD: 7.1) in the frontal plane. Kinematics of the sternoclavicular and acromioclavicular joints showed significantly different patterns. CONCLUSION Patients after aTSA showed altered shoulder girdle kinematics and higher contribution of the shoulder girdle towards elevation. Whether this is a result of the surgery, of limited glenohumeral range of motion or due to the preoperative status remains unclear. Further investigation with a prospective study design is necessary.
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Spranz DM, Bruttel H, Eckerle JM, Wolf SI, Berrsche G, Maier MW. Variation of the glenohumeral and scapulothoracic motion in progressive severity of glenohumeral osteoarthritis. Orthop Traumatol Surg Res 2019; 105:1503-1507. [PMID: 31727587 DOI: 10.1016/j.otsr.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 05/21/2019] [Accepted: 07/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study is to investigate the variation of the glenohumeral and scapulothoracic motion in progressive severity of glenohumeral osteoarthritis using a 3-D-motion analysis. Moreover, the variation of the Constant Score is evaluated. HYPOTHESIS The hypothesis is that the motion of the scapulothoracic joint may partly compensate for the loss of the glenohumeral joint movement in patients with increasing severity of glenohumeral osteoarthritis. MATERIAL AND METHODS A total of 21 patients with primary osteoarthritis of the glenohumeral joint were clinically examined, divided in three groups (SP1-SP3) according to size of their caudal osteophyte. The contribution of the scapulothoracic (acromioclavicular and sternoclavicular) joint to the total arm (humerothoracical) elevation in sagittal and frontal plane was measured with 3D motion analysis and the Constant Score was evaluated. DISCUSSION In sagittal plane elevation (anteversion) the contribution of the scapulothoracic joint to the total elevation was while arm raising 32.7% (SD 8.0%) in Group SP1, 36.6% (SD 11.0%) in Group SP2 and 49.6% (SD 9.0%) in Group SP3 (p=0.002). The contribution of the scapulothoracic joint to the total elevation while arm lowering was 31.4% (SD 9.0%) in Group SP1, 39.0% (SD 13.0%) in Group SP2 and 49.7% (SD 12.0%) in Group SP3 (p=0.043). In frontal plane elevation (abduction) the contribution of the scapulothoracic joint was while arm raising 33.7% (SD 8.0%) in Group SP1, 34.0% (SD 10.0%) in Group SP2 and 42.3% (SD 9.0%) in Group SP3 (p=0.071). While arm lowering the contribution of the scapulothoracic joint was 30.8% (SD 10.0%) in Group SP1, 36.3% (SD 12.0%) in Group SP2 and 44.8% (SD 8.0%) in Group SP3 (p=0.022). The group SP1 achieved a Constant Score of 78.00 (SD 9.823) points. The group SP2 achieved a Constant Score of 53.57 (SD 13.92) and the group SP3 38.64 (SD 10.40). There is a significant difference between the three groups (p<0.001). Increasing severity of glenohumeral osteoarthritis leads to a reduced motion of the glenohumeral joint. Instead the magnitude of the scapulothoracic motion increases. LEVEL OF PROOF V, Case Series.
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Affiliation(s)
- David M Spranz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Hendrik Bruttel
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Jan M Eckerle
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Gregor Berrsche
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Michael W Maier
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
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Bruttel H, Spranz DM, Bülhoff M, Aljohani N, Wolf SI, Maier MW. Comparison of glenohumeral and humerothoracical range of motion in healthy controls, osteoarthritic patients and patients after total shoulder arthroplasty performing different activities of daily living. Gait Posture 2019; 71:20-25. [PMID: 31003208 DOI: 10.1016/j.gaitpost.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/19/2018] [Accepted: 04/05/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine how total shoulder arthroplasty improves performance of activities of daily living compared to patients with glenohumeral osteoarthritis and how they perform compared to healthy controls. METHODS Glenohumeral and humerothoracical elevation used by patients with primary osteoarthritis (12 participants, 16 shoulders), after total shoulder arthroplasty (16 participants, 24 shoulders) and healthy controls (11 participants, 22 shoulders) for four different activities of daily living were assessed using 3D motion analysis. Analysis of range of motion and angle time series was performed. RESULTS Range of motion used for activities of daily living was better in patients treated with anatomical total shoulder arthroplasty than in patients with primary glenohumeral osteoarthritis. Although it was still reduced compared to healthy individuals. Angle time series showed improved kinematics in patients with total shoulder arthroplasty compared to patients with glenohumeral osteoarthritis. Both glenohumeral and humerothoracical elevation kinematic time series were in almost all cases in between the control group's and the osteoarthritis group's. CONCLUSION Total shoulder arthroplasty improves performance of activities of daily living in patients with primary glenohumeral osteoarthritis but cannot restore the full range of Motion compared to healthy controls. A prospective study with pre- and postoperative examinations is necessary to understand to understand how preoperative status influences the postoperative results.
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Affiliation(s)
- Hendrik Bruttel
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - David M Spranz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Matthias Bülhoff
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Nasser Aljohani
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Michael W Maier
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
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Scaption kinematics of reverse shoulder arthroplasty do not change after the sixth postoperative month. Clin Biomech (Bristol, Avon) 2018; 58:1-6. [PMID: 30005421 DOI: 10.1016/j.clinbiomech.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/11/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Changes over time in shoulder kinematics and function after reverse shoulder arthroplasty have not been reported. The purpose of this study was to compare shoulder kinematics and function at 6 months and 1 year after reverse shoulder arthroplasty. METHODS Twenty patients with a mean age of 74 years (range, 63-91 years) were enrolled in this study. Fluoroscopic images during scapular plane elevation were recorded at the mean of 6 months (range, 5-8 months) and 14 months (range, 11-21 months). CT-derived glenosphere models and computer-aided design humeral implant models were matched with the silhouette of the implants in the fluoroscopic images using model-image registration techniques. Glenosphere and humeral implant kinematics during scaption were compared between the two time points. Patients were also clinically examined with active range of motion and Constant score, and postoperative improvement in shoulder function were assessed. RESULTS Active flexion and Constant score improved after surgery (p < 0.001 for both), but there was no significant improvement after six months. There was no significant improvement in active external rotation at either postoperative exam. There were no significant differences in glenosphere or humeral kinematics between six months and one year. INTERPRETATION There was no significant additional improvement in either shoulder kinematics during scapular plane elevation or function between the sixth and twelfth postoperative months. We can assess kinematics at six months after reverse shoulder arthroplasty to determine how the shoulder will move. Clinically, treatment in the first six postoperative months should be emphasized to achieve better surgical outcomes.
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Lefèvre-Colau MM, Nguyen C, Palazzo C, Srour F, Paris G, Vuillemin V, Poiraudeau S, Roby-Brami A, Roren A. Kinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain, and clinical implications. Ann Phys Rehabil Med 2018; 61:46-53. [PMID: 28987866 DOI: 10.1016/j.rehab.2017.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints. METHODS This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience. RESULTS For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation. CONCLUSION The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities.
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Affiliation(s)
- Marie-Martine Lefèvre-Colau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Christelle Nguyen
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Clemence Palazzo
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Frederic Srour
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Guillaume Paris
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Valerie Vuillemin
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Serge Poiraudeau
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Agnes Roby-Brami
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Alexandra Roren
- Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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