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Costa E Silva Cabral AL, Marques JDP, Dionisio VC. Scapular dyskinesis and overhead athletes: A systematic review of electromyography studies. J Bodyw Mov Ther 2024; 39:606-614. [PMID: 38876694 DOI: 10.1016/j.jbmt.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Understanding how the main scapular muscles behave in overhead athletes with scapular dyskinesis (SD). DESIGN Systematic Review. SETTING Electronic searches were performed in Pubmed (MedLine), Embase, CINAHL, and SPORTDiscus databases. PARTICIPANTS Overhead athletes with SD. MAIN OUTCOME MEASURES Electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior (SA). RESULTS Eight studies were included in this review. The UT activity showed a tended to increase its activity mainly during tasks over 90° compared to 45°. SA activity had similar behavior, mainly during isometric tasks. The MT also increased its activity mainly in tasks with overhead angulations when compared to lower angulations. The LT activation tended to decrease its EMG activity at angulations below 60° in overhead athletes with SD. CONCLUSIONS The EMG behaviour of UT and SA for non-athletes appears to differ from what has already been described in the literature. The MT seems to be the most neglected muscle for scapular stabilization in overhead athletes with SD. The decrease in LT activity suggests that this may have implications for the performance of these athletes.
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Affiliation(s)
- Ana Luiza Costa E Silva Cabral
- Federal University of Uberlândia, Faculty of Physical Education and Physiotherapy (FAEFI), Laboratory of Neuromechanics and Physiotherapy (LANEF), Brazil.
| | - Júlia de Paula Marques
- Federal University of Uberlândia, Faculty of Physical Education and Physiotherapy (FAEFI), Laboratory of Neuromechanics and Physiotherapy (LANEF), Brazil
| | - Valdeci Carlos Dionisio
- Federal University of Uberlândia, Faculty of Physical Education and Physiotherapy (FAEFI), Laboratory of Neuromechanics and Physiotherapy (LANEF), Brazil
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Tazawa T, Yasui M, Otsuka S, Hatayama N, Naito M, Ohshima S, Yokota H. Development of a musculoskeletal shoulder model considering anatomic joint structures and soft-tissue deformation for dynamic simulation. Anat Sci Int 2024; 99:278-289. [PMID: 38698275 DOI: 10.1007/s12565-024-00773-7] [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: 11/27/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
The shoulder joint has a high degree of freedom and an extremely complex and unstable kinematic mechanism. Coordinated contraction of the rotator cuff muscles that stop around the humeral head and the deltoid muscles and the extensibility of soft tissues, such as the joint capsule, labrum, and ligaments, contribute to shoulder-joint stability. Understanding the mechanics of shoulder-joint movement, including soft-tissue characteristics, is important for disease prevention and the development of a device for disease treatment. This study aimed to create a musculoskeletal shoulder model to represent the realistic behavior of joint movement and soft-tissue deformation as a dynamic simulation using a rigid-body model for bones and a soft-body model for soft tissues via a spring-damper-mass system. To reproduce the muscle-contraction properties of organisms, we used a muscle-expansion representation and Hill's mechanical muscle model. Shoulder motion, including the movement of the center of rotation in joints, was reproduced, and the strain in the joint capsule during dynamic shoulder movement was quantified. Furthermore, we investigated narrowing of the acromiohumeral distance in several situations to induce tissue damage due to rotator cuff impingement at the anterior-subacromial border during shoulder abduction. Given that the model can analyze exercises under disease conditions, such as muscle and tendon injuries and impingement syndrome, the proposed model is expected to help elucidate disease mechanisms and develop treatment guidelines.
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Affiliation(s)
- Taku Tazawa
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan
- ASAHI INTECC CO., LTD., Aichi, Japan
| | - Masaya Yasui
- Department of Judo Seifuku and Health Sciences, Tokoha University, 1230 Miyakodacho, Kita-ku, Hamamatsu-shi, Shizuoka, Japan
| | - Shun Otsuka
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Naoyuki Hatayama
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, Japan
| | - Shigemichi Ohshima
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan
| | - Hiroki Yokota
- Department of Mechanical Engineering, Meijo University, 1-501 Shiogamaguchi, Tempaku-Ku, Nagoya-Shi, Aichi, Japan.
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Lopiz Y, Rodríguez-González A, Martín-Albarrán S, Herzog R, García-Fernández C, Marco F. Neuropathy of the suprascapular and axillary nerves in rotator cuff arthropathy: a prospective electrodiagnostic study. INTERNATIONAL ORTHOPAEDICS 2024; 48:1285-1294. [PMID: 38478022 PMCID: PMC11001664 DOI: 10.1007/s00264-024-06130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes. METHODS Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up. RESULTS Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27). CONCLUSIONS The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, , 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain.
- Department of Surgery, Complutense University, Madrid, Spain.
| | - Alberto Rodríguez-González
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, , 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain
| | | | - Raul Herzog
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, , 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, , 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, , 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain
- Department of Surgery, Complutense University, Madrid, Spain
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Marc T, Morana C. Effectiveness of a joint mobilizations protocol for shoulder subacromial pain syndrome: A pilot study. J Bodyw Mov Ther 2024; 38:574-582. [PMID: 38763611 DOI: 10.1016/j.jbmt.2024.03.072] [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: 10/13/2022] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Subacromial pain syndrome (SPS) is the most frequent shoulder pathology. The aims of this prospective randomized study were to evaluate the effects of some specific shoulder joint mobilizations ("spin correction"), and the effectiveness of a rehabilitation program, named Shoulder Global Concept, in SPS patients. METHODS 45 patients with SPS were randomly assigned to two groups, to benefit from a different first session of mobilizations: the experimental group received all specific mobilizations, while the control group received the same program but without the spin correction mobilizations. The second session was identical for both groups, with all specific mobilizations. Before and after the first two sessions, range of motion (ROM) in flexion, abduction, external and internal rotations, pain and functional status with Constant score and Quick Dash were evaluated. Evaluation was repeated with 24 patients after 11 rehabilitation sessions. Rehabilitation with Shoulder Global Concept included 13 mobilizations aiming at improving the ROM with passive and active-assisted mobilizations, static stretching, and muscle strengthening. RESULTS All ROM were improved at the end of the first session for both groups, but significantly more in the experimental group for glenohumeral (GH) abduction and external rotation (p < 0.05). Functional scores, pain and strength were significantly improved after 11 rehabilitation sessions with the Shoulder Global Concept. CONCLUSION This manual therapy method was able to improve shoulder mobility in one session. The additional joint mobilizations (spin correction) specifically increased GH abduction and external rotation. Rehabilitation of SPS with Shoulder Global Concept allowed to improve functional capacity and decrease pain.
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Affiliation(s)
- Thierry Marc
- Centre de Rééducation Spécialisé, Montpellier, France
| | - Claire Morana
- Centre de Rééducation Spécialisé, Montpellier, France.
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Paksoy A, Akgün D, Gebauer H, Karczewski D, Lacheta L, Tokish JM, Chamberlain A, Moroder P. The latissimus dorsi creates a dynamic track for the inferior angle of the scapula during arm abduction in humans. J Orthop Surg Res 2024; 19:193. [PMID: 38504340 PMCID: PMC10953177 DOI: 10.1186/s13018-024-04659-2] [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: 01/17/2024] [Accepted: 03/02/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The importance of several scapulothoracic muscles, including trapezius and serratus anterior, in maintaining physiological scapula kinematics has been highlighted in the past. However, the relationship between the scapula and the latissimus dorsi muscle remains unclear. Our clinical surgical observation is that the latissimus dorsi does not directly attach but rather runs superficial to the inferior angle of the scapula. Based on this observation, we hypothesise that the latissimus dorsi creates a dynamic track on which the scapula glides under the muscle belly during elevation of the arm, creating the latissimus-scapula overlap (LSO). METHODS All consecutive patients who had a whole-body computed tomography scan (CT) in case of polytrauma evaluation between 2018 and 2021, with complete depiction of the scapula and latissimus dorsi muscle, were analysed. 150 shoulders in 90 patients with arms up were matched according to their age (within five years), gender, and affected side with 150 shoulders in 88 patients with arms down. Patients with pathologies of the upper extremities or thorax that potentially could alter LSO measurements were excluded. LSO was calculated as a ratio of the measured area of the latissimus dorsi projection on the scapula and the total scapula area. RESULTS The mean age of the 178 patients (48 females; 13 males) was 60 years. The arms-up group showed a significantly higher LSO than the arms-down group (19.9 ± 6.3% vs. 2.7 ± 2.2%; p < 0.0001). In the arms-up group, approximately one fifth of the scapula was overlapped inferiorly by the muscle belly of the latissimus dorsi, contrary to the almost non-existing LSO in the arms-down group. CONCLUSION With arms up, humans show a significantly higher LSO in comparison to arms down indicating that the latissimus dorsi indeed creates a dynamic track on which the scapula is forced to travel during abduction of the arm. This finding of increased LSO during the elevation of the arm warrants further consideration of the role of the latissimus dorsi in scapula kinematics and potentially scapular dyskinesis. LEVEL OF EVIDENCE Level two diagnostic study.
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Affiliation(s)
- Alp Paksoy
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany.
| | - Doruk Akgün
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Henry Gebauer
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Charité University Hospital, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Lucca Lacheta
- University Hospital rechts der Isar, Technical University Munich, German, Germany
| | | | - Aaron Chamberlain
- Center for Advanced Medicine Orthopedic Surgery Center, St. Louis, MO, USA
- Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, MO, USA
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Malmberg C, Andreasen KR, Bencke J, Kjær BH, Hølmich P, Barfod KW. Biomechanical and neuromuscular characteristics in patients with traumatic anterior shoulder instability undergoing arthroscopic Bankart repair: a clinical prospective cohort study protocol. BMJ Open 2024; 14:e078376. [PMID: 38431300 PMCID: PMC10910411 DOI: 10.1136/bmjopen-2023-078376] [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: 07/31/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Traumatic shoulder dislocation is a common shoulder injury, especially among the young and active population. More than 95% of dislocations are anterior, in which the humeral head is forced beyond the anterior glenoid rim. The injury leads to increased joint laxity and recurrence rates are high. There is evidence that the shoulder biomechanics and neuromuscular control change following dislocation, but the existing literature is scarce, and it remains to be established if and how these parameters are useful in the clinical setting. The aim of this exploratory prospective cohort study is to investigate biomechanical and neuromuscular outcomes in patients with traumatic anterior shoulder instability undergoing arthroscopic Bankart repair, to test the hypothesis that examinations of these characteristics are applicable in the clinical setting to assess shoulder instability. METHODS AND ANALYSIS This is a prospective multicentre cohort study with repeated measures of 30 patients undergoing arthroscopic Bankart repair. With carefully selected and completely non-invasive examination methods, we will investigate biomechanical and neuromuscular outcomes in the affected shoulders once presurgically and twice post surgically at 6 and 12 months. Patients' contralateral shoulders are investigated once to establish a preinjury level. ETHICS AND DISSEMINATION The study was approved by the Capital Region Ethics Committee (journal-no: H-21027799) and the Capital Region Knowledge Center for Data Reviews (journal-no: P-2021-842) before patient recruitment began. The study results will be published in international peer-reviewed journals, online and in other relevant media, presented at medical conventions and disseminated to clinicians and patients as appropriate. TRIAL REGISTRATION NUMBER NCT05250388.
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Affiliation(s)
- Catarina Malmberg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristine Rask Andreasen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jesper Bencke
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Institute of Sports Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Per Hølmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - K W Barfod
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Croci E, Hess H, Warmuth F, Künzler M, Börlin S, Baumgartner D, Müller AM, Gerber K, Mündermann A. Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence. Eur Radiol 2024; 34:270-278. [PMID: 37566272 DOI: 10.1007/s00330-023-10082-8] [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: 03/07/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Patients with rotator cuff tears present often with glenohumeral joint instability. Assessing anatomic angles and shoulder kinematics from fluoroscopy requires labelling of specific landmarks in each image. This study aimed to develop an artificial intelligence model for automatic landmark detection from fluoroscopic images for motion tracking of the scapula and humeral head. MATERIALS AND METHODS Fluoroscopic images were acquired for both shoulders of 25 participants (N = 12 patients with unilateral rotator cuff tear, 6 men, mean (standard deviation) age: 63.7 ± 9.7 years; 13 asymptomatic subjects, 7 men, 58.2 ± 8.9 years) during a 30° arm abduction and adduction movement in the scapular plane with and without handheld weights of 2 and 4 kg. A 3D full-resolution convolutional neural network (nnU-Net) was trained to automatically locate five landmarks (glenohumeral joint centre, humeral shaft, inferior and superior edges of the glenoid and most lateral point of the acromion) and a calibration sphere. RESULTS The nnU-Net was trained with ground-truth data from 6021 fluoroscopic images of 40 shoulders and tested with 1925 fluoroscopic images of 10 shoulders. The automatic landmark detection algorithm achieved an accuracy above inter-rater variability and slightly below intra-rater variability. All landmarks and the calibration sphere were located within 1.5 mm, except the humeral landmark within 9.6 mm, but differences in abduction angles were within 1°. CONCLUSION The proposed algorithm detects the desired landmarks on fluoroscopic images with sufficient accuracy and can therefore be applied to automatically assess shoulder motion, scapular rotation or glenohumeral translation in the scapular plane. CLINICAL RELEVANCE STATEMENT This nnU-net algorithm facilitates efficient and objective identification and tracking of anatomical landmarks on fluoroscopic images necessary for measuring clinically relevant anatomical configuration (e.g. critical shoulder angle) and enables investigation of dynamic glenohumeral joint stability in pathological shoulders. KEY POINTS • Anatomical configuration and glenohumeral joint stability are often a concern after rotator cuff tears. • Artificial intelligence applied to fluoroscopic images helps to identify and track anatomical landmarks during dynamic movements. • The developed automatic landmark detection algorithm optimised the labelling procedures and is suitable for clinical application.
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Affiliation(s)
- Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Hanspeter Hess
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Fabian Warmuth
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Marina Künzler
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Sean Börlin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andreas Marc Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Kate Gerber
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Malmberg C, Andreasen KR, Bencke J, Hölmich P, Barfod KW. Anterior-posterior glenohumeral translation in shoulders with traumatic anterior instability: a systematic review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:477-493. [PMID: 37928995 PMCID: PMC10625004 DOI: 10.1016/j.xrrt.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Reports of glenohumeral translation in shoulders with traumatic anterior instability have been presented. The aim of this systematic review was to investigate anterior-posterior translation in shoulders with traumatic anterior instability. Methods This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies including patients aged ≥15 years with previous traumatic anterior shoulder dislocation or subluxation were included. The outcome was anterior-posterior glenohumeral translation. A search of PubMed, Embase, and Cochrane library was performed on July 17, 2022. Two reviewers individually screened titles and abstracts, reviewed full text, extracted data, and performed quality assessment. Results Twenty studies (582 unstable shoulders in total) of varying quality were included. There was a lack of standardization and unity across studies. Radiography, ultrasound, computed tomography, magnetic resonance imaging, motion tracking, instrumentation, and manual testing were used to assess the glenohumeral translation. The glenohumeral translation in unstable shoulders ranged from 0.0 ± 0.8 mm to 11.6 ± 3.7 mm, as measured during various motion tasks, arm positions, and application of external force. The glenohumeral translation was larger or more anteriorly directed in unstable shoulders than in stable when contralateral healthy shoulders or a healthy control group were included in the studies. Several studies found that the humeral head was more anteriorly located on the glenoid in the unstable shoulders. Conclusion This systematic review provides an overview of the current literature on glenohumeral translation in traumatic anterior shoulder instability. It was not able to identify a threshold for abnormal translation in unstable shoulders, due to the heterogeneity of data. The review supports that not only the range of translation but also the direction hereof as well as the location of the humeral head on the glenoid seem to be part of the pathophysiology. Technical development and increased attention to research methodology in recent years may provide more knowledge and clarity on this topic in the future.
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Affiliation(s)
- Catarina Malmberg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Kristine Rask Andreasen
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Jesper Bencke
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
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Tabatabaei A, Shahsaheb S, Seyyedi A, Salehi R, Pezeshk AF, Blandford L. Observational assessment for determining shoulder fault movements before and after corrective education in participants with chronic shoulder pain: Concurrent validity study. J Hand Ther 2023:S0894-1130(23)00134-5. [PMID: 37858502 DOI: 10.1016/j.jht.2023.09.008] [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: 02/09/2023] [Revised: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Movement faults (MF), described as the alteration of joint position and motion, are an important factor associated with developing shoulder pathologies. However, determining or predicting the exact MF in participants with shoulder pain is limited by the absence of clinical tools and poor validity. PURPOSE The aim of the study was to determine the validity of using observational assessment to MFs or controlling MFs in subjects with chronic shoulder pain during shoulder elevation and external rotation. STUDY DESIGN Concurrent validity study METHODS: Twenty-seven people with chronic shoulder pain were examined. The index test represented three observational assessments of MF during shoulder external rotation, elevation in the frontal plane, and elevation in the sagittal plane. Three-dimensional motion analysis represented the reference test. The movements of both shoulder joints were evaluated simultaneously, and the index and reference tests were performed concurrently. RESULTS The sensitivity and specificity of observational detection were good to excellent (Se: 77.5%, Sp: 81.5%) for MF and excellent (Se: 85.7%, Sp: 100%) for controlling MF. The positive and negative predictive value was (PPV: 93.9, NPV: 57.1) for MF and (PPV: 100%, NPV: 82.8%) for controlling MF. The result of the positive and negative likelihood ratio was (PLR: 5.4, NLR: 0.26) for MF and (PLR: 0, NLR: 0.18) for controlling MF. CONCLUSIONS The results revealed that the validity of the observational detection approach for identifying MFs was good to excellent. Moreover, the accuracy of this approach in detecting the control of MFs after patient education was excellent. There was good to excellent accuracy in most MFs once classified by their motion trajectories, except for scapula anterior tilt during glenohumeral joint external rotation or elevation.
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Affiliation(s)
- Abbas Tabatabaei
- Mobility and Falls Lab, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahab Shahsaheb
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aisan Seyyedi
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Farjad Pezeshk
- Associate Professor in Sport Biomechanics, Faculty of Sport Sciences, University of Birjand, Birjand, Iran
| | - Lincoln Blandford
- Faculty of Sport, Allied Health, and Performance Science, St Mary's University, Twickenham, UK; Comera Movement Science, Bristol, UK
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Khandare S, Vidt ME. Development of a more biofidelic musculoskeletal model with humeral head translation and glenohumeral ligaments. Comput Methods Biomech Biomed Engin 2023; 26:1549-1556. [PMID: 36165581 DOI: 10.1080/10255842.2022.2127319] [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: 05/25/2022] [Revised: 08/30/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
Computational musculoskeletal modeling is useful for understanding upper extremity biomechanics, especially when in vivo tests are unfeasible. A musculoskeletal model of the upper limb with increased biofidelity was developed by including humeral head translation (HHT) and ligaments. The model was validated and ligament contribution and effect of shoulder (thoracohumeral) elevation on HHT was evaluated. Humerus translated superiorly with increased elevation, with translations closely matching (avg. difference 2.83 mm) previous in vitro studies. HHT and ligament inclusion in the model will improve biomechanical predictions of upper extremity movements and study of conditions, like subacromial impingement, rotator cuff tear, or shoulder instability.
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Affiliation(s)
- Sujata Khandare
- Biomedical Engineering, Pennsylvania State University, University Park, 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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11
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Burton W, Crespo IR, Andreassen T, Pryhoda M, Jensen A, Myers C, Shelburne K, Banks S, Rullkoetter P. Fully automatic tracking of native glenohumeral kinematics from stereo-radiography. Comput Biol Med 2023; 163:107189. [PMID: 37393783 DOI: 10.1016/j.compbiomed.2023.107189] [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: 05/08/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
The current work introduces a system for fully automatic tracking of native glenohumeral kinematics in stereo-radiography sequences. The proposed method first applies convolutional neural networks to obtain segmentation and semantic key point predictions in biplanar radiograph frames. Preliminary bone pose estimates are computed by solving a non-convex optimization problem with semidefinite relaxations to register digitized bone landmarks to semantic key points. Initial poses are then refined by registering computed tomography-based digitally reconstructed radiographs to captured scenes, which are masked by segmentation maps to isolate the shoulder joint. A particular neural net architecture which exploits subject-specific geometry is also introduced to improve segmentation predictions and increase robustness of subsequent pose estimates. The method is evaluated by comparing predicted glenohumeral kinematics to manually tracked values from 17 trials capturing 4 dynamic activities. Median orientation differences between predicted and ground truth poses were 1.7∘ and 8.6∘ for the scapula and humerus, respectively. Joint-level kinematics differences were less than 2∘ in 65%, 13%, and 63% of frames for XYZ orientation DoFs based on Euler angle decompositions. Automation of kinematic tracking can increase scalability of tracking workflows in research, clinical, or surgical applications.
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Affiliation(s)
- William Burton
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA.
| | - Ignacio Rivero Crespo
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA
| | - Thor Andreassen
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA
| | - Moira Pryhoda
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA
| | - Andrew Jensen
- Department of Mechanical and Aerospace Engineering, University of Florida, 939 Center Dr., Gainesville, FL, 32611, USA
| | - Casey Myers
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA
| | - Kevin Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA
| | - Scott Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, 939 Center Dr., Gainesville, FL, 32611, USA
| | - Paul Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA
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12
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Croci E, Warmuth F, Baum C, Kovacs BK, Nüesch C, Baumgartner D, Müller AM, Mündermann A. Load-induced increase in muscle activity during 30° abduction in patients with rotator cuff tears and control subjects. J Orthop Traumatol 2023; 24:41. [PMID: 37542140 PMCID: PMC10403481 DOI: 10.1186/s10195-023-00720-8] [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: 05/04/2023] [Accepted: 07/20/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Rotator cuff muscles stabilise the glenohumeral joint and contribute to the initial abduction phase with other shoulder muscles. This study aimed to determine if the load-induced increase in shoulder muscle activity during a 30° abduction test is influenced by asymptomatic or symptomatic rotator cuff pathologies. MATERIALS AND METHODS Twenty-five patients with unilateral rotator cuff tears (age, 64.3 ± 10.2 years), 25 older control subjects (55.4 ± 8.2 years) and 25 younger control subjects (26.1 ± 2.3 years) participated in this study. Participants performed a bilateral 30° arm abduction and adduction movement in the scapular plane with handheld weights (0-4 kg). Activity of the deltoid, infraspinatus, biceps brachii, pectoralis major, latissimus dorsi and upper trapezius muscles was analysed at maximum abduction angle after normalisation to maximum voluntary contraction. Shoulders were classified into rotator cuff tendinopathy, asymptomatic and symptomatic rotator cuff tears, and healthy based on magnetic resonance images. A linear mixed model (loads, shoulder types) with random effects (shoulder identification) was applied to the log-transformed muscle activities. RESULTS Muscle activity increased with increasing load in all muscles and shoulder types (P < 0.001), and 1-kg increments in additional weights were significant (P < 0.001). Significant effects of rotator cuff pathologies were found for all muscles analysed (P < 0.05). In all muscles, activity was at least 20% higher in symptomatic rotator cuff tears than in healthy shoulders (P < 0.001). Symptomatic rotator cuff tears showed 20-32% higher posterior deltoid (P < 0.05) and 19-25% higher pectoralis major (P < 0.01) activity when compared with asymptomatic tears. CONCLUSIONS Rotator cuff pathologies are associated with greater relative activity of shoulder muscles, even with low levels of additional load. Therefore, the inclusion of loaded shoulder tests in the diagnosis and rehabilitation of rotator cuff pathologies can provide important insight into the functional status of shoulders and can be used to guide treatment decisions. LEVEL OF EVIDENCE Level 2. TRIAL REGISTRATION Ethical approval was obtained from the regional ethics committee (Ethics Committee Northwest Switzerland EKNZ 2021-00182), and the study was registered at clinicaltrials.gov on 29 March 2021 (trial registration number NCT04819724, https://clinicaltrials.gov/ct2/show/NCT04819724 ).
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Affiliation(s)
- Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Fabian Warmuth
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Cornelia Baum
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Corina Nüesch
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andreas Marc Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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13
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Horowitz EH, Aibinder WR. Shoulder Impingement Syndrome. Phys Med Rehabil Clin N Am 2023; 34:311-334. [PMID: 37003655 DOI: 10.1016/j.pmr.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder impingement is the most common diagnosis for shoulder pain. Shoulder impingement syndrome has been scrutinized as a misleading "umbrella" term, due to its vague and nonspecific context. It is better subcategorized into subacromial, internal, and subcoracoid impingement. The evaluation and treatment algorithm for each is grossly similar. A thorough history, focused physical examination, and standard radiographs are the first steps. Advanced imaging with MRI or ultrasound may be useful. The mainstay of treatment includes physical therapy, anti-inflammatory medications, and injections. Surgical treatment is reserved for refractory cases, and includes decompression, debridement, and/or repair of injured structures.
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Affiliation(s)
- Evan H Horowitz
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY 11203, USA. https://twitter.com/EvanHorowitzMD
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA.
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14
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Leung T, Eckers F, Nüesch C, Aghlmandi S, Kovacs BK, Genter J, Baumgartner D, Müller AM, Mündermann A. Load-Induced Glenohumeral Translation After Rotator Cuff Tears: Protocol for an In Vivo Study. JMIR Res Protoc 2022; 11:e43769. [PMID: 36563028 PMCID: PMC9823567 DOI: 10.2196/43769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Rotator cuff tears are a common shoulder injury, but they sometimes remain undiagnosed, as symptoms can be limited. Altered shoulder biomechanics can lead to secondary damage and degeneration. In biomechanical analyses, the shoulder (ie, the glenohumeral joint) is normally idealized as a ball-and-socket joint, even though a translation is often observed clinically. To date, no conclusive changes in glenohumeral translation have been reported in patients with rotator cuff tears, and it is unknown how an additional handheld weight that is comparable to those used during daily activities will affect glenohumeral translations in patients with rotator cuff tears. OBJECTIVE This study aims to assess the load-induced glenohumeral translation (liTr) in patients with rotator cuff tears and its association with the load-induced changes in muscle activation (liMA). METHODS Patients and asymptomatic controls will be recruited. Participants will fill out health questionnaires and perform 30° arm abduction and adduction trials, during which they will hold different handheld weights of a maximum of 4 kg while motion capture and electromyographic data are collected. In addition, fluoroscopic images of the shoulders will be taken for the same movements. Isometric shoulder muscle strength for abduction and rotation will be assessed with a dynamometer. Finally, shoulder magnetic resonance images will be acquired to assess muscle status and injury presence. The dose-response relationship between additional weight, liTr, and liMA will be evaluated. RESULTS Recruitment and data collection began in May 2021, and they will last until the recruitment target is achieved. Data collection is expected to be completed by the end of 2022. As of November 2022, data processing and analysis are in progress, and the first results are expected to be submitted for publication in 2023. CONCLUSIONS This study will aid our understanding of biological variations in liTr, the influence of disease pathology on liTr, the potential compensation of rotator cuff tears by muscle activation and size, and the association between liTr and patient outcomes. The outcomes will be relevant for diagnosis, treatment, and rehabilitation planning in patients with rotator cuff tears. TRIAL REGISTRATION ClinicalTrials.gov NCT04819724; https://clinicaltrials.gov/ct2/show/NCT04819724. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43769.
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Affiliation(s)
| | - Franziska Eckers
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Soheila Aghlmandi
- Meta-Research Centre, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | | | - Jeremy Genter
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Daniel Baumgartner
- Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andreas Marc Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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15
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Ernstbrunner L, Francis-Pester FW, Fox A, Wieser K, Ackland DC. Patients with recurrent anterior shoulder instability exhibit altered glenohumeral and scapulothoracic joint kinematics during upper limb movement: A prospective comparative study. Clin Biomech (Bristol, Avon) 2022; 100:105775. [PMID: 36242953 DOI: 10.1016/j.clinbiomech.2022.105775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered shoulder kinematics in patients with recurrent anterior shoulder instability remains poorly understood. This prospective study aimed to quantify in vivo glenohumeral and scapulothoracic joint kinematics and joint-contact positions in patients with shoulder instability and healthy controls. METHODS Twenty patients with recurrent anterior shoulder instability (mean 28 years) and five patients without shoulder pathology (mean 39 years) were scanned using open CT in six static upper limb positions including 90° of abduction, combined abduction and external rotation, 90° of flexion, lift-off position (i.e. reaching behind the back) and the neutral shoulder with external rotation. Image datasets were digitally reconstructed to quantify shoulder joint kinematics and glenohumeral translation. FINDINGS At 90° of abduction, instability patients demonstrated significantly less glenohumeral abduction and a reciprocal increase in upward scapulothoracic rotation compared to controls (mean difference: 13.3°, p = 0.038). With the shoulder in combined abduction and external rotation, instability patients showed a significant increase in glenohumeral rotation and a reciprocal decrease in scapulothoracic rotation compared to controls (mean difference: 5.0°, p = 0.042). There were no significant differences in humeral head translation in the sagittal plane (anterior-posterior axis) for all motions tested (p > 0.05). INTERPRETATION Scapulothoracic and glenohumeral kinematics are significantly different between patients with recurrent anterior shoulder instability and those with a healthy shoulder. Instability patients compensate for reduced glenohumeral function during abduction by increasing scapular rotation. With the shoulder in combined abduction and external rotation position, greater glenohumeral joint angles without significantly increased humeral head translation suggest altered neuromuscular control in the unstable shoulder.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
| | | | - Aaron Fox
- Centre for Sport Research, Deakin University, Waurn Ponds, Geelong, Australia
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
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16
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Makhija M, Sethi J, Kataria C, Singh H, Phadke V. Fluoroscopic measurements of the glenohumeral joint position and space in true anteroposterior and axillary views – a reliability study. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Two-dimensional (2D) fluoroscopy has been used in shoulder pathologies to estimate the humeral head position (HHP) in the true anteroposterior (AP) view. However, there is a lack of evidence regarding the reliability estimating it in the axillary view and in measuring the shoulder joint space width (JSW). True AP view images (n=36) of subjects with adhesive capsulitis were taken in supine in multiple arm abduction positions. The axillary view images (n=48) were taken in supine and prone in 75° of abduction. The HHP was assessed in the glenoid reference frame. The position and radius of the humeral head along with the superior, inferior, anterior, posterior, and middle JSWs were measured in each image. All the images were coded and randomly presented twice to a physiotherapist at a gap of 48-72 h for intra-rater reliability and to 2 therapists and an orthopaedic surgeon for inter-rater reliability. Reliability was expressed using intraclass correlation coefficients (ICC) and standard error of measurement (SEM). In both the views, inter-rater, and intra-rater reliability was excellent for the radius of the humeral head (inter-rater – 0.95-0.97 and intra-rater -0.98)], moderate (ICC: 0.70 and 0.76), and excellent (ICC: 0.89 and 0.93) for HHP. The reliability for JSWs was moderate to good (ICC: 0.66-0.82) for inter-rater and good to excellent (ICC: 0.75-0.95) for intra-rater analysis. The SEM for HHP and JSWs were <0.4 mm for intra-rater analysis, and <0.7 mm for inter-rater reliability in both views. The study demonstrated that the glenohumeral arthrokinematic parameters can be measured with good to excellent levels of reliability when using 2 D fluoroscopy. The study is part of a clinical trial (Clinical Trial Registry India: CTRI/2018/12/016657).
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Affiliation(s)
- M. Makhija
- Amity Institute of Physiotherapy, Amity University Campus, Sector-125, Noida 201301, Uttar Pradesh, India
| | - J. Sethi
- Amity Institute of Physiotherapy, Amity University Campus, Sector-125, Noida 201301, Uttar Pradesh, India
| | - C. Kataria
- Indian Spinal Injuries Centre-Institute of Rehabilitation Sciences, Sector-C, Vasant Kunj, New Delhi 110070, India
| | - H. Singh
- Orthopedics Department, Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, New Delhi 110070, India
| | - V. Phadke
- Research Department, Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, New Delhi 110070, India
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17
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Mattar LT, Popchak AJ, Anderst WJ, Musahl V, Irrgang JJ, Debski RE. Associations between range of motion, strength, tear size, patient-reported outcomes, and glenohumeral kinematics in individuals with symptomatic isolated supraspinatus tears. J Shoulder Elbow Surg 2022; 31:1261-1271. [PMID: 35091074 PMCID: PMC9484487 DOI: 10.1016/j.jse.2021.12.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical failure associated with nonoperative treatment of rotator cuff tears may be due to inadequate characterization of the individual's functional impairments. Clinically, restricted passive range of motion (ROM) (restrictions imply capsular tightness), limitations in muscle strength, and larger rotator cuff tears are hypothesized to be related to altered glenohumeral kinematics. Understanding these relationships, as well as the relationship between glenohumeral kinematics and patient-reported outcomes (PROs) prior to exercise therapy, may help characterize functional impairments in individuals with rotator cuff tears. The objectives of the study were to describe the baseline presentation of individuals with an isolated supraspinatus tear, including passive ROM, rotator cuff muscle strength, tear size, PROs, and glenohumeral kinematics, and to determine associations among these variables. METHODS One hundred one individuals with symptomatic isolated supraspinatus tears were recruited for the study and underwent assessments of passive glenohumeral ROM, isometric muscle strength, and ultrasonography to assess anterior-posterior tear size. Glenohumeral kinematics during scapular-plane abduction were measured using biplane radiography. Furthermore, PROs including the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Rotator Cuff Index (WORC) score were collected. RESULTS Individuals presented with decreased ROM, external rotation weakness compared with the uninvolved side, and pain and disability as measured by the ASES and WORC scores. These findings were not associated with glenohumeral kinematics, with the exception of a weak positive association between glenohumeral contact path lengths and WORC scores (ρ = 0.25, P = .03). Tear size was 11.7 ± 5.7 mm, and maximum anterior translation, superior translation, and contact path length were 3.0% ± 3.8% of glenoid width, 3.5% ± 3.8% of glenoid height, and 38.2% ± 20.7% of glenoid size, respectively. CONCLUSION Individuals with a symptomatic isolated supraspinatus tear presented with decreased ROM, external rotation weakness, and pain and disability as measured by the ASES and WORC scores. However, no abnormal kinematics associated with these limitations were observed. Thus, given that the tear is isolated to the supraspinatus tendon and no capsular restrictions are present, normal function of the glenohumeral joint may be possible during scapular-plane abduction.
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Affiliation(s)
- Luke T. Mattar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam J. Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J. Anderst
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - James J. Irrgang
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E. Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA,Reprint requests: Richard E. Debski, PhD, Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Dr, Pittsburgh, PA 15219, USA. (R.E. Debski)
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18
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Reliability of the Fluoroscopic Assessment of Load-Induced Glenohumeral Translation during a 30° Shoulder Abduction Test. BIOMECHANICS 2022; 2:255-263. [PMID: 35677586 PMCID: PMC7612827 DOI: 10.3390/biomechanics2020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rotator cuff tears are often linked to superior translational instability, but a thorough understanding of glenohumeral motion is lacking. This study aimed to assess the reliability of fluoroscopically measured glenohumeral translation during a shoulder abduction test. Ten patients with rotator cuff tears participated in this study. Fluoroscopic images were acquired during 30° abduction and adduction in the scapular plane with and without handheld weights of 2 kg and 4 kg. Images were labelled by two raters, and inferior–superior glenohumeral translation was calculated. During abduction, glenohumeral translation (mean (standard deviation)) ranged from 3.3 (2.2) mm for 0 kg to 4.1 (1.8) mm for 4 kg, and from 2.3 (1.5) mm for 0 kg to 3.8 (2.2) mm for 4 kg for the asymptomatic and symptomatic sides, respectively. For the translation range, moderate to good interrater (intra-class correlation coefficient ICC [95% confidence interval (CI)]; abduction: 0.803 [0.691; 0.877]; adduction: 0.705 [0.551; 0.813]) and intrarater reliabilities (ICC [95% CI]; abduction: 0.817 [0.712; 0.887]; adduction: 0.688 [0.529; 0.801]) were found. Differences in the translation range between the repeated measurements were not statistically significant (mean difference, interrater: abduction, −0.1 mm, p = 0.686; adduction, −0.1 mm, p = 0.466; intrarater: abduction 0.0 mm, p = 0.888; adduction, 0.2 mm, p = 0.275). This method is suitable for measuring inferior–superior glenohumeral translation in the scapular plane.
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19
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Mozingo JD, Akbari-Shandiz M, Van Straaten MG, Murthy NS, Schueler BA, Holmes DR, McCollough CH, Zhao KD. Comparison of glenohumeral joint kinematics between manual wheelchair tasks and implications on the subacromial space: A biplane fluoroscopy study. J Electromyogr Kinesiol 2022; 62:102350. [PMID: 31481296 PMCID: PMC7036020 DOI: 10.1016/j.jelekin.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/12/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023] Open
Abstract
Scapula and humerus motion associated with common manual wheelchair tasks is hypothesized to reduce the subacromial space. However, previous work relied on either marker-based motion capture for kinematic measures, which is prone to skin-motion artifact; or ultrasound imaging for arthrokinematic measures, which are 2D and acquired in statically-held positions. The aim of this study was to use a fluoroscopy-based approach to accurately quantify glenohumeral kinematics during manual wheelchair use, and compare tasks for a subset of parameters theorized to be associated with mechanical impingement. Biplane images of the dominant shoulder were acquired during scapular plane elevation, propulsion, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury. A computed tomography scan of the shoulder was obtained, and model-based tracking was used to quantify six-degree-of-freedom glenohumeral kinematics. Axial rotation and superior/inferior and anterior/posterior humeral head positions were characterized for full activity cycles and compared between tasks. The change in the subacromial space was also determined for the period of each task defined by maximal change in the aforementioned parameters. Propulsion, sideways lean, and weight-relief raise, but not scapular plane elevation, were marked by mean internal rotation (8.1°, 10.8°, 14.7°, -49.2° respectively). On average, the humeral head was most superiorly positioned during the weight-relief raise (1.6 ± 0.9 mm), but not significantly different from the sideways lean (0.8 ± 1.1 mm) (p = 0.191), and much of the task was characterized by inferior translation. Scaption was the only task without a defined period of superior translation on average. Pairwise comparisons revealed no significant differences between tasks for anterior/posterior position (task means range: 0.1-1.7 mm), but each task exhibited defined periods of anterior translation. There was not a consistent trend across tasks between internal rotation, superior translation, and anterior translation with reductions in the subacromial space. Further research is warranted to determine the likelihood of mechanical impingement during these tasks based on the measured task kinematics and reductions in the subacromial space.
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Affiliation(s)
- Joseph D. Mozingo
- Biomedical Engineering and Physiology Graduate Program,
Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN,
USA,Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
| | | | | | | | | | - David R. Holmes
- Department of Physiology and Biomedical Engineering, Mayo
Clinic, Rochester, MN, USA
| | | | - Kristin D. Zhao
- Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
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20
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Ludewig PM, Saini G, Hellem A, Kahnert EK, Rezvanifar SC, Braman JP, Staker JL. Changing our Diagnostic Paradigm Part II: Movement System Diagnostic Classification. Int J Sports Phys Ther 2022; 17:7-17. [PMID: 35024204 PMCID: PMC8720248 DOI: 10.26603/001c.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/28/2021] [Indexed: 12/30/2022] Open
Abstract
Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.
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Affiliation(s)
- Paula M Ludewig
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Gaura Saini
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science
| | - Aaron Hellem
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Emily K Kahnert
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science; Orofacial Pain & Dental Sleep Medicine Clinic, University of Minnesota School of Dentistry
| | - S Cyrus Rezvanifar
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | | | - Justin L Staker
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
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21
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Barcia AM, Makovicka JL, Spenciner DB, Chamberlain AM, Jacofsky MC, Gabriel SM, Moroder P, von Rechenberg B, Sengun MZ, Tokish JM. Scapular motion in the presence of rotator cuff tears: a systematic review. J Shoulder Elbow Surg 2021; 30:1679-1692. [PMID: 33540119 DOI: 10.1016/j.jse.2020.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears (RCTs) remain a significant source of pain and disability in the shoulder. Although much work has been done in the study of the effects of rotator cuff tears on glenohumeral joint motion, much less has been done in understanding the effect of rotator cuff tearing on scapular motion or activation. It remains unknown whether scapular dyskinesis is causative or adaptive. The purpose of this study was to systematically review the literature to determine the relationship between rotator cuff tear presence and size on scapular motion, and if rotator cuff repair restored normal motion. METHODS A systematic review using PRISMA guidelines was accomplished to include all studies with biomechanical or clinical outcomes of scapular motion in the presence of RCTs. Studies were excluded if they involved shoulder arthroplasty, rotator cuff tendinopathy, or shoulder impingement without an RCT. From 530 initial references, 42 manuscripts were selected for full review and cross referenced. All studies were evaluated for inclusion and exclusion criteria. RESULTS Sixteen studies including 335 rotator cuff tears were included in the final review. There were several findings of interest in the literature. First, although all studies demonstrated scapular dyskinesis, they did not report a consistent pattern of motion in the presence of an RCT. In general, scapular posterior tilt was decreased, and scapular upward rotation was increased, especially in large tears, but the literature was unclear as to whether this was a result of the RCT or an adaptive attempt to maintain elevation. Larger RCTs resulted in more pronounced scapular dysfunction, but there was significant variability within studies. Further, dyskinesis was confounded by pain with more abnormal movement in symptomatic vs. asymptomatic RCTs, the latter of which were not different from normal healthy controls. Four studies addressed the effect of RCT on scapular mechanics and found that repair consistently improved it compared to the normal side, but the time to normalization varied between 5 months and 2 years. CONCLUSION Scapular motion is abnormal in the presence of an RCT, but the literature is inconsistent regarding a universally affected variable or consistent degree of scapular dysfunction in this setting. Furthermore, it remains unknown which changes are adaptive vs. pathologic. Understanding the relationship between rotator cuff tearing and scapular dyskinesis will require better biomechanical models that consider scapular dyskinesis in their design.
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Affiliation(s)
| | | | | | - David B Spenciner
- DePuy Synthes Mitek Sports Medicine, Raynham, MA, USA; Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO, USA
| | - Marc C Jacofsky
- Musculoskeletal Orthopedic Research and Education (MORE) Foundation, Phoenix, AZ, USA
| | | | | | | | | | - John M Tokish
- Department of Orthopedics, Mayo Clinic, Phoenix, AZ, USA.
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22
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Haque A, Modi A. Interposition grafting for irreparable rotator cuff tears: Systematic review and specialist practice report. J Clin Orthop Trauma 2021; 17:218-222. [PMID: 33868918 PMCID: PMC8047223 DOI: 10.1016/j.jcot.2021.02.022] [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: 01/26/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 02/06/2023] Open
Abstract
The treatment of symptomatic irreparable rotator cuff tears poses significant challenges to both patients and shoulder surgeons. Although reverse shoulder arthroplasty provides reliably good outcomes in the elderly, it is not a good option in younger patients. Various surgical techniques have been proposed for the treatment of irreparable rotator cuff tears; however, no gold standard currently exists. Interposition grafting is used when the rotator cuff cannot be fully repaired onto its footprint, and the remaining defect is bridged with either an allograft, autograft, xenograft or a synthetic graft. This review aims to present the literature on the use of various interposition grafts and techniques to treat large or massive irreparable rotator cuff tears and provide a specialist practice report.
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Affiliation(s)
- Aziz Haque
- Leicester Shoulder & Elbow Unit, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Amit Modi
- Leicester Shoulder & Elbow Unit, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
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23
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Schmitt M, Vogt L, Wilke J, Niederer D. Unilateral and bilateral training competitive archers differ in some potentially unhealthy neck-shoulder region movement behaviour characteristics. BMC Sports Sci Med Rehabil 2021; 13:44. [PMID: 33902697 PMCID: PMC8077866 DOI: 10.1186/s13102-021-00272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Excessive unilateral joint loads may lead to overuse disorders. Bilateral training in archery is only performed as a supportive coordination training and as a variation of typical exercise. However, a series of studies demonstrated a crossover transfer of training-induced motor skills to the contralateral side, especially in case of mainly unilateral skills. We compared the cervical spine and shoulder kinematics of unilateral and bilateral training archers. METHODS In this cross-sectional study, 25 (5 females, 48 ± 14 years) bilaterally training and 50 age-, sex- and level-matched (1:2; 47.3 ± 13.9 years) unilaterally training competitive archers were included. Cervical range of motion (RoM, all planes) and glenohumeral rotation were assessed with an ultrasound-based 3D motion analysis system. Upward rotation of the scapula during abduction and elevation of the arm were measured by means of a digital inclinometer and active shoulder mobility by means of an electronic caliper. All outcomes were compared between groups (unilaterally vs. bilaterally) and sides (pull-hand- vs. bow-hand-side). RESULTS Unilateral and bilateral archers showed no between group and no side-to-side-differences in either of the movement direction of the cervical spine. The unilateral archers had higher pull-arm-side total glenohumeral rotation than the bilateral archers (mean, 95% CI), (148°, 144-152° vs. 140°, 135°-145°). In particular, internal rotation (61°, 58-65° vs. 56°, 51-61°) and more upward rotation of the scapula at 45 degrees (12°, 11-14° vs. 8°, 6-10°), 90 degrees (34°, 31-36° vs. 28°, 24-32°), 135 degrees (56°, 53-59° vs. 49°, 46-53°), and maximal (68°, 65-70° vs. 62°, 59-65°) arm abduction differed. The bow- and pull-arm of the unilateral, but not of the bilateral archers, differed in the active mobility of the shoulder (22 cm, 20-24 cm vs. 18 cm, 16-20 cm). CONCLUSIONS Unilaterally training archers display no unphysiologic movement behaviour of the cervical spine, but show distinct shoulder asymmetris in the bow- and pull-arm-side when compared to bilateral archers in glenohumeral rotation, scapula rotation during arm abduction, and active mobility of the shoulder. These asymmetries in may exceed physiological performance-enhancing degrees. Bilateral training may seems appropriate in archery to prevent asymmetries.
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Affiliation(s)
- Mareike Schmitt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany
| | - Jan Wilke
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany
| | - Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Ginnheimer Landstraße 39, D-60487, Frankfurt am Main, Germany.
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24
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Jildeh TR, Ference DA, Abbas MJ, Jiang EX, Okoroha KR. Scapulothoracic Dyskinesis: A Concept Review. Curr Rev Musculoskelet Med 2021; 14:246-254. [PMID: 33822304 DOI: 10.1007/s12178-021-09705-8] [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] [Accepted: 03/24/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Scapulothoracic dyskinesis (SD) occurs when there is a noticeable disruption in typical position and motion of the scapula, which can result in debilitating pain. The purpose of this review is to describe the current knowledge regarding the diagnosis and management of scapulothoracic dyskinesis by providing an evidence-based overview of clinical exams and treatment modalities available for orthopedic surgeons and provide insight into which treatment modalities require further investigation. RECENT FINDINGS SD is highly prevalent in athletes, particularly those participating in overhead activities (e.g., baseball, tennis, and swimming) and can coexist with several shoulder pathologies. A holistic approach in the diagnosis of SD has been supported in the literature; however, it is important to recognize that diagnosis is currently limited to the absence of a quantitative SD clinical assessment. The main goal of the treatment of SD is to regain proper scapular positioning and dynamics. The standard of care for the management of SD is conservative interventions aimed at optimizing scapular kinematics. Surgical intervention is only considered in the presence of concomitant pathology requiring surgery. Due to the complexity of coordinated movement of the shoulder girdle, recent literature has begun to move away from the use of traditional orthopedic tests, in favor of a more system-based approach for the diagnosis of SD. We present a concise review of clinical exams and treatment modalities available for orthopedic surgeons in the management of SD.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Daisy A Ference
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Eric X Jiang
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Kelechi R Okoroha
- Mayo Clinic, Department of Orthopedic Surgery, 600 Hennepin Avenue, Suite 310, Minneapolis, MN, 55403, USA
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25
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Lawrence RL, Zauel R, Bey MJ. Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography. J Vis Exp 2021. [PMID: 33779606 DOI: 10.3791/62210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The shoulder is one of the human body's most complex joint systems, with motion occurring through the coordinated actions of four individual joints, multiple ligaments, and approximately 20 muscles. Unfortunately, shoulder pathologies (e.g., rotator cuff tears, joint dislocations, arthritis) are common, resulting in substantial pain, disability, and decreased quality of life. The specific etiology for many of these pathologic conditions is not fully understood, but it is generally accepted that shoulder pathology is often associated with altered joint motion. Unfortunately, measuring shoulder motion with the necessary level of accuracy to investigate motion-based hypotheses is not trivial. However, radiographic-based motion measurement techniques have provided the advancement necessary to investigate motion-based hypotheses and provide a mechanistic understanding of shoulder function. Thus, the purpose of this article is to describe the approaches for measuring shoulder motion using a custom biplanar videoradiography system. The specific objectives of this article are to describe the protocols to acquire biplanar videoradiographic images of the shoulder complex, acquire CT scans, develop 3D bone models, locate anatomical landmarks, track the position and orientation of the humerus, scapula, and torso from the biplanar radiographic images, and calculate the kinematic outcome measures. In addition, the article will describe special considerations unique to the shoulder when measuring joint kinematics using this approach.
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Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System
| | - Roger Zauel
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System;
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26
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Ravenscroft M, Barnes MW, Muench LN, Mazzocca AD, Berthold DP. Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft as a Surgical Solution for the Treatment of Massive Irreparable Rotator Cuff Tears. Arthrosc Tech 2021; 10:e877-e885. [PMID: 33738228 PMCID: PMC7953327 DOI: 10.1016/j.eats.2020.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/01/2020] [Indexed: 02/03/2023] Open
Abstract
Massive, irreparable rotator cuff tears in patients without severe signs of osteoarthritis remains a major challenge for orthopaedic surgeons. These can be a source of significant pain and functional loss occurring most commonly in a relatively frail, elderly patient population. A plethora of surgical techniques covering minimally invasive, arthroscopic techniques and open, salvage procedures have been described for this challenging patient cohort. Continuous evolvement of arthroscopic techniques has led to all-arthroscopic superior capsular reconstruction techniques using allografts, thereby reducing donor side morbidity along with decreased soft tissue dissection. However, conventional superior capsular reconstruction is noted to be a technically complex, time-consuming, and high-cost surgery, which may put this technique beyond the confidence of many shoulder surgeons. The subacromial balloon spacer has emerged as a potential solution in these patients, providing interposition between the humeral head and acromion. However, the subacromial balloon biodegrades rapidly and its effect is only temporary. Thus this technique article presents using an acellular human dermal allograft to reconstruct the bursal layer, which is normally interposed between the humeral head and the acromion. The proposed technique provides a permanent interposition graft preventing humeral acromial contact, which does not undergo rapid biodegradation. The surgical technique is technically feasible, both minimizing surgical time and therefore operative risk to the patient.
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Affiliation(s)
- Matt Ravenscroft
- Orthteam Centre, Manchester, England
- Address correspondence to Matt Ravenscroft, F.R.C.S., BMI Alexandra, Mill Lane, Cheadle, England SK8 2PX.
| | | | - Lukas N. Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Daniel P. Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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27
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28
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Kibler WB, Stone AV, Zacharias A, Grantham WJ, Sciascia AD. Management of Scapular Dyskinesis in Overhead Athletes. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Hermena S, Assaf A, Donaldson O. Systematic Review With Meta-Analysis: Are Muscle Transfers a Satisfactory Treatment Option to Restore Shoulder Abduction in Delayed Adult Brachial Plexus Injuries? Cureus 2021; 13:e12914. [PMID: 33643742 PMCID: PMC7885548 DOI: 10.7759/cureus.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Brachial plexus injuries usually result in significant upper limb disabilities and shoulder joint instability. Primary nerve reconstruction procedures are more effective if performed within six months from the injury. Secondary procedures, including muscle transfers, are usually indicated for delayed presentation (>6 months) or when the outcomes of primary procedures are unsatisfactory. A comprehensive systematic search of the MEDLINE, EMBASE, AMED, PubMed, and Cochrane databases was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data, including demographic information, time to surgery, the extent of brachial plexus injury, surgical techniques, follow-up duration, and functional outcomes were collected and tabulated. Meta-analysis was conducted using Review Manager (RevMan) 5.4 software ([Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Seven studies were eligible to be included in this review, with a total of 218 patients. The average patient age was 28.39 ± 3 years, with a mean time to surgery of 29.87 ± 18 months. Forty-six (46) patients (21.10%) were treated as delayed presentation and 172 patients (78.89%) had muscle transfer performed as a secondary procedure. The mean time at follow-up was 18.86 ± 13.5 months. Upper trapezius muscle transfer was the most common transferred muscle (100%) either in isolation (n=159, 72.93%) or in combination with lower trapezius transfer (n=59, 27.06%). The mean preoperative and postoperative shoulder abduction were 12.22 ± 10.09 degrees and 58.36 ± 32.33 degrees, respectively (p < 0.05). Meta-analysis shows a statistically significant difference (CI at 95%, p<0.05) favoring postoperative shoulder abduction. Muscle transfers especially upper trapezius transfer could be a satisfactory secondary procedure to restore shoulder abduction and enhance shoulder joint stability.
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Affiliation(s)
- Shady Hermena
- Trauma and Orthopaedic Department, Yeovil District Hospital NHS Foundation Trust, Yeovil, GBR
| | - Ali Assaf
- Trauma and Orthopaedic Department, Isle of Wight NHS Trust, Isle of Wight, GBR
| | - Oliver Donaldson
- Trauma and Orthopaedic Department, Yeovil District Hospital NHS Foundation Trust, Yeovil, GBR
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30
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Huang TS, Du WY, Lin JJ. Clinical Factors Related to Improved Scapular Control After a Scapular Conscious Control Program in Symptomatic Overhead Athletes: Secondary Analysis of a Randomized Controlled Trial. Orthop J Sports Med 2020; 8:2325967120964600. [PMID: 33294472 PMCID: PMC7708709 DOI: 10.1177/2325967120964600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Predictive variables associated with the effects of a scapular conscious
control program should be identified and used to guide rehabilitation
programs. Purpose: To determine whether potential factors are associated with the success of
scapular muscle balance with an early control program in patients with
subacromial pain and scapular dyskinesis. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 38 amateur overhead athletes with subacromial pain and medial
border prominence were recruited. They performed progressive conscious
control of scapular orientation during 45° and 90° of arm elevation.
Stepwise logistic regression and receiver operating characteristic curve
were used to determine the optimal cutoff point of related factors for
success or failure of the program. Potential factors including pain level
during activity, pain duration, anterior/posterior shoulder flexibility,
forward shoulder posture, posterior displacement of root of spine and
inferior angle, scapular kinematics, and muscle activation before conscious
control program were recorded as independent variables. Successful control
defined as decreases of the upper trapezius/serratus anterior ratio in 2
consecutive trials of the 90° program or failure in the program was used as
a dependent variable. Results: Having a posterior displacement of the inferior angle of the scapula of ≤16.4
mm and scapular posterior tipping during arm elevation of ≤3.3° (collected
before the control program) were associated with the success of the program
(R2 = 0.286; P < .05). Additionally,
participants with each or both variables present at baseline had
probabilities of success of 78% and 95%, respectively. Conclusion: The value of scapular posterior displacement and posterior tilt should be
considered before early scapular control program. Other factors related to
the success of the program should be found due to the limited variance
explained in the regression model.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Yu Du
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 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, National Taiwan University Hospital, Taipei, Taiwan
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31
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Schmalzl J, Jessen M, Gilbert F, Gerhardt C, Lehmann LJ. Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:517-524. [PMID: 33025159 DOI: 10.1007/s00590-020-02801-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment. METHODS Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum-collum-diaphyseal (CCD) angle were analyzed. RESULTS A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6-1.9; p < 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17-2.40; p = 0.0046) compared to those with advanced CTA. CONCLUSION In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.
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Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany. .,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
| | - Malik Jessen
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
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32
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Dyrna F, Berthold DP, Muench LN, Beitzel K, Kia C, Obopilwe E, Pauzenberger L, Adams CR, Cote MP, Scheiderer B, Mazzocca AD. Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction. Orthop J Sports Med 2020; 8:2325967120957424. [PMID: 33088839 PMCID: PMC7543188 DOI: 10.1177/2325967120957424] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff
tears has become more widely used recently; however, ideal tensioning of the
graft and the influence on joint kinematics remain unknown. Purpose/Hypothesis: The purpose of this study was to assess the effects of graft tensioning on
glenohumeral joint kinematics after SCR using a dermal allograft. The
hypothesis was that a graft fixed under tension would result in increased
glenohumeral abduction motion and decreased cumulative deltoid forces
compared with a nontensioned graft. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a dynamic
shoulder simulator. Each shoulder underwent the following 4 conditions: (1)
native, (2) simulated irreparable supraspinatus (SSP) tear, (3) SCR using a
nontensioned acellular dermal allograft, and (4) SCR using a graft tensioned
with 30 to 35 N. Mean values for maximum glenohumeral abduction and
cumulative deltoid forces were recorded. The critical shoulder angle (CSA)
was also assessed. Results: Native shoulders required a mean (±SE) deltoid force of 193.2 ± 45.1 N to
achieve maximum glenohumeral abduction (79.8° ± 5.8°). Compared with native
shoulders, abduction decreased after SSP tears by 32% (54.3° ± 13.7°;
P = .04), whereas cumulative deltoid forces increased
by 23% (252.1 ± 68.3 N; P = .04). The nontensioned SCR
showed no significant difference in shoulder abduction (54.1° ± 16.1°) and
required deltoid forces (277.8 ± 39.8 N) when compared with the SSP tear
state. In contrast, a tensioned graft led to significantly improved shoulder
abduction compared with the SSP tear state (P = .04)
although abduction and deltoid forces could not be restored to the native
state (P = .01). A positive correlation between CSA and
maximum abduction was found for the tensioned-graft SCR state
(r = 0.685; P = .02). Conclusion: SCR using a graft fixed under tension demonstrated a significant increase in
maximum shoulder abduction compared with a nontensioned graft; however,
abduction remained significantly less than the intact state. The
nontensioned SCR showed no significant improvement in glenohumeral
kinematics compared with the SSP tear state. Clinical Relevance: Because significant improvement in shoulder function after SCR may be
expected only when the graft is adequately tensioned, accurate graft
measurement and adequate tension of at least 30 N should be considered
during the surgical procedure. SCR with a tensioned graft may help maintain
sufficient acromiohumeral distance, improve clinical outcomes, and reduce
postoperative complications.
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Affiliation(s)
- Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lukas N Muench
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Knut Beitzel
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany.,Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | | | - Christopher R Adams
- Arthrex, Naples, Florida, USA.,Naples Community Hospital, Naples, Florida, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Bastian Scheiderer
- Department of Orthopaedic Sportsmedicine, Technical University, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Radial to Axillary Nerve Transfer Outcomes in Shoulder Abduction: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3096. [PMID: 33133948 PMCID: PMC7544396 DOI: 10.1097/gox.0000000000003096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
Background Brachial plexus and axillary nerve injuries often result in paralysis of the deltoid muscle. This can be functionally debilitating for patients and have a negative impact on their activities of daily living. In these settings, transferring the branch of the radial nerve innervating the triceps to the axillary nerve is a viable treatment option. Additional nerve transfers may be warranted. This study sought to determine the efficacy of nerve transfer procedures in the setting of brachial plexus and axillary nerve injuries and factors affecting clinical outcomes. Methods The U.S. National Library of Medicine's website "PubMed" was queried for "radial to axillary nerve transfer" and "brachial plexus nerve transfer." An initial review by two authors was performed to identify relevant articles followed by a third author validation utilizing inclusion and exclusion criteria. Individual patient outcomes were recorded and pooled for final analysis. Results Of the 80 patients, 66 (82.5%) had clinical improvement after surgical nerve transfer procedures. Significant difference in clinical improvement following nerve transfer procedures was correlated with patient age, mechanism of injury, brachial plexus vs isolated axillary nerve injuries, multiple nerve transfers vs single nerve transfers, and surgery within the first 7 months of injury. The branch of the radial nerve supplying the triceps long head showed improved clinical results compared with the branch of the radial nerve supplying the triceps medial head and anconeus. Conclusion Nerve transfers have been shown to be effective in restoring shoulder abduction in both isolated axillary nerve injuries and brachial plexus injuries.
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Huang TS, Chen WJ, Du WY, Lin JJ. Measurement of scapular prominence in symptomatic dyskinesis using a novel scapulometer: reliability and the relationship to shoulder dysfunction. J Shoulder Elbow Surg 2020; 29:1852-1858. [PMID: 32247722 DOI: 10.1016/j.jse.2020.01.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/23/2019] [Accepted: 01/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND No previous studies have investigated whether the extent of scapular dyskinesis is associated with shoulder dysfunction. This study aimed (1) to establish the reliability of a scapulometer in patients with shoulder pain and (2) to investigate the related factors associated with shoulder dysfunction. METHODS One hundred participants with symptomatic scapular dyskinesis were recruited. Twenty-one participants were involved in the reliability study to test the intrarater and inter-rater reliabilities of the scapulometer in patients with shoulder pain. After demographic data and self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) scores were recorded, all participants were measured with a scapulometer to determine the posterior displacement of the root of the spine (ROS) and the inferior angle (IFA) of the scapula from the thorax. Next, the participants performed 5 trials of bilateral scapular plane elevation for scapular kinematics and electromyographic (EMG) data collection. Stepwise multiple linear regressions were used to determine the relationships between self-reported FLEX-SF scores and potential factors. In addition to scapular displacement, pain level, scapular kinematics, and EMG data were included as independent variables. RESULTS The intrarater and inter-rater reliabilities of the scapulometer were excellent (intraclass correlation coefficient [ICC] = 0.93-0.97) and moderate to good (ICC = 0.74-0.81), respectively. The Bland-Altman plots showed no systematic bias between raters in the ROS and IFA measurements. Final stepwise multiple regression models showed that more ROS distance, higher serratus anterior activity, and lower pain level during arm elevation were associated with higher shoulder function (total R2 = 0.253). CONCLUSION The reliability of the scapulometer in patients with shoulder pain is moderate to excellent. Scapular dyskinesis may be a compensatory strategy to avoid shoulder pain and improve shoulder function.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Jou Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Yu Du
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 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, National Taiwan University Hospital, Taipei, Taiwan.
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Burnier M, Lafosse T. Pectoralis Major and Anterior Latissimus Dorsi Transfer for Subscapularis Tears. Curr Rev Musculoskelet Med 2020; 13:725-733. [PMID: 32833188 DOI: 10.1007/s12178-020-09674-4] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Irreparable subscapularis tears represent a challenging entity, especially when they occur in younger patients with high functional demands. Tendon transfers are one of the options considered for surgical management for this pathology. The purpose of this article is to review the surgical technique and outcome of the two most common tendon transfers considered for irreparable subscapularis tears: pectoralis major and latissimus dorsi. RECENT FINDINGS Transfer of the pectoralis major has been considered for decades the transfer of choice for irreparable subscapularis tears. Recently, a series with long-term follow-up (over 18 years) supported the reduction in pain and improvement in functional scores and patient satisfaction after pectoralis major transfer. However, the range of motion and the force in internal rotation were not maintained over time. Transfer of the latissimus dorsi to the lesser tuberosity has been recently described as an alternative with a sound biomechanical rationale and encouraging short-term results. Transfer of the pectoralis major and the transfer of latissimus dorsi to the lesser tuberosity are the two transfers most commonly considered for patients with irreparable subscapularis tears. Transfer of the pectoralis major has a much longer track record. Both procedures seem to improve outcomes. Comparative studies are needed to determine the relative indications of these two procedures.
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Affiliation(s)
- Marion Burnier
- Hand and Upper Extremity Surgical Institute, Clinique du Medipole, 17 avenue Condorcet, Villeurbanne, France.
| | - Thibault Lafosse
- Alps Surgery Institute: Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d'Annecy, Annecy, France
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The latissimus dorsi tendon functions as an external rotator after arthroscopic-assisted transfer for massive irreparable posterosuperior rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2020; 28:2367-2376. [PMID: 31811355 DOI: 10.1007/s00167-019-05819-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/27/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Latissimus dorsi tendon transfer is a surgical option for the treatment of massive irreparable posterosuperior rotator cuff tear. Whether a favourable clinical outcome is due to the latissimus dorsi muscle contraction rather than the passive tenodesis effect remains to be confirmed. The purpose of the current case-control study was to evaluate the shoulder kinematics and latissimus dorsi activation after latissimus dorsi tendon transfer. METHODS Eighteen patients suffering from irreparable rotator cuff tear that underwent latissimus dorsi tendon transfer and 18 healthy individuals were examined using a 3D kinematic tracking system and electromyography. Active maximal flexion-extension and abduction-adduction of the humerus were measured for the operated and the contralateral shoulder of the patients and the shoulder of healthy individuals to evaluate the range of motion (ROM) and scapulohumeral rhythm. Electromyographic comparison of isometric contraction between the latissimus dorsi of the operated and contralateral shoulder was carried out. RESULTS After arthroscopic-assisted latissimus dorsi tendon transfer, patients showed comparable flexion and abduction ROM to their asymptomatic contralateral shoulders and to the shoulders of healthy individuals. Significantly higher scapular ROM values were found between the latissimus dorsi tendon transfer side and the shoulders of healthy individuals. While performing external rotation with 0° shoulder abduction, a greater percentage of the electromyographic peak value (p = 0.047) and a higher latissimus dorsi internal/external rotation ratio (p = 0.004) were noted for the transferred muscle in comparison to the contralateral shoulder. CONCLUSION Although the arthroscopic-assisted latissimus dorsi tendon transfer failed to normalize scapulothoracic joint movements of patients, a functional latissimus flap and a shoulder ROM similar to the contralateral side or the shoulder of healthy individuals can be expected after this procedure in patients with massive irreparable posterosuperior rotator cuff tear. LEVEL OF EVIDENCE III.
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Kim D, Lee B, Yeom J, Cha J, Han J. Three-dimensional in vivo comparative analysis of the kinematics of normal shoulders and shoulders with massive rotator cuff tears with successful conservative treatment. Clin Biomech (Bristol, Avon) 2020; 75:104990. [PMID: 32222472 DOI: 10.1016/j.clinbiomech.2020.104990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study used in vivo three-dimensional to two-dimensional image registration techniques to compare the glenohumeral kinematics of shoulders with massive rotator cuff tears that were successfully treated conservatively and those of normal shoulders. METHODS Ten patients (age, 67.4 ± 3.63 years) with massive rotator cuff tears on one side and without contralateral tears were enrolled. We performed computed tomography and fluoroscopy on both shoulder joints and created three-dimensional bone models of the humerus and scapula using image registration techniques. We measured the humeral superoinferior translation, angle of humeral external rotation, scapular upward rotation, scapular anteroposterior tilt, and scapular external rotation of the torn shoulders with good range of motion after effective conservative treatment and compared these measurements to those of the contralateral normal shoulders. FINDINGS There was a significant difference in the initial position of the humeral head relative to the glenoid in the tear group; it was 2.0 mm higher than that in the normal group (p < .05). This difference disappeared in the range from 40° to full elevation. The scapular motion of the tear group was significantly more upwardly rotated than that of the normal group: by 9.9° at rest (p < .05) and by 11.6° at terminal elevation (p < .05). No significant differences were detected for humeral head external rotation, scapular anteroposterior tilt, and scapular external rotation between the two groups. INTERPRETATION Kinematics of shoulders with massive cuff tears could not be recovered completely even though the patients had no significant symptoms after successful conservative treatment.
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Affiliation(s)
- Doosup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea.
| | - Bonggun Lee
- Department of Orthopedic Surgery, Hanyang University, Seoul, Republic of Korea.
| | - Junseop Yeom
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea
| | - Jaehack Cha
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea
| | - Jinyoung Han
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Republic of Korea
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Giuseppe LU, Laura RA, Berton A, Candela V, Massaroni C, Carnevale A, Stelitano G, Schena E, Nazarian A, DeAngelis J, Denaro V. Scapular Dyskinesis: From Basic Science to Ultimate Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082974. [PMID: 32344746 PMCID: PMC7215460 DOI: 10.3390/ijerph17082974] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023]
Abstract
Background: This study intends to summarize the causes, clinical examination, and treatments of scapular dyskinesis (SD) and to briefly investigate whether alteration can be managed by a precision rehabilitation protocol planned on the basis of features derived from clinical tests. Methods: We performed a comprehensive search of PubMed, Cochrane, CINAHL and EMBASE databases using various combinations of the keywords “Rotator cuff”, “Scapula”, “Scapular Dyskinesis”, “Shoulder”, “Biomechanics” and “Arthroscopy”. Results: SD incidence is growing in patients with shoulder pathologies, even if it is not a specific injury or directly related to a particular injury. SD can be caused by multiple factors or can be the trigger of shoulder-degenerative pathologies. In both cases, SD results in a protracted scapula with the arm at rest or in motion. Conclusions: A clinical evaluation of altered shoulder kinematics is still complicated. Limitations in observing scapular motion are mainly related to the anatomical position and function of the scapula itself and the absence of a tool for quantitative SD clinical assessment. High-quality clinical trials are needed to establish whether there is a possible correlation between SD patterns and the specific findings of shoulder pathologies with altered scapular kinematics.
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Affiliation(s)
- Longo Umile Giuseppe
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Correspondence: ; Tel.: +39-062-2541-1613; Fax: +39-0622-5411
| | - Risi Ambrogioni Laura
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Carlo Massaroni
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
| | - Emiliano Schena
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Joseph DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 20115, USA; (A.N.); (J.D.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria 200, 00128 Rome, Italy; (R.A.L.); (A.B.); (V.C.); (A.C.); (G.S.)
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Subacromial space outlet in female patients with multidirectional instability based on hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder measured by ultrasound. J Shoulder Elbow Surg 2020; 29:600-608. [PMID: 31629650 DOI: 10.1016/j.jse.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/03/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evaluate if there was a change in AHD with arm elevation within and between groups. METHODS Twenty-nine female patients with hEDS/HSD (aged 34 ± 12.9 years) and 20 healthy controls (aged 33 ± 10.8 years) participated in the study. The supraspinatus tendon (SST) thickness and AHD were measured using ultrasound. The interplay between the SST and the AHD was expressed as the occupation ratio (OcAHD), calculated as the SST thickness as a percentage of AHD. The measures were performed in the resting position and in subsequently 45° and 60° of active arm elevation in the scapular plane. RESULTS The main finding is that patients with hEDS/HSD have a larger subacromial space outlet compared with the controls when measured by ultrasound. Furthermore, in both groups, we found an increased OcAHD during active arm elevation compared with the resting position, which indicates that similar mechanisms occur for patients with hEDS/HSD and healthy controls. CONCLUSION Patients with hEDS/HSD have a larger available subacromial space outlet compared with healthy individuals. OcAHD increased during active arm elevation compared with the resting position in both groups. This knowledge is important when designing rehabilitation exercise programs for shoulder instability patients with abnormal glenohumeral biomechanics.
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Scheiderer B, Kia C, Obopilwe E, Johnson JD, Cote MP, Imhoff FB, Dyrna F, Beitzel K, Imhoff AB, Adams CR, Mazzocca AD, Morikawa D. Biomechanical Effect of Superior Capsule Reconstruction Using a 3-mm and 6-mm Thick Acellular Dermal Allograft in a Dynamic Shoulder Model. Arthroscopy 2020; 36:355-364. [PMID: 31791890 DOI: 10.1016/j.arthro.2019.08.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 08/01/2019] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically compare the effect of superior capsule reconstruction (SCR) using a 3- and 6-mm thick acellular dermal allograft for the treatment of irreparable rotator cuff tears. METHODS Eight fresh-frozen cadaveric shoulders were tested using a dynamic shoulder model. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), subacromial peak contact pressure (sPCP), and cumulative deltoid force (cDF) were compared among 4 conditions: (1) intact shoulder, (2) simulated irreparable rotator cuff tear (RCT), (3) SCR using a 3-mm-thick acellular dermal allograft, (4) SCR using a 6-mm-thick acellular dermal allograft. RESULTS Compared with the intact state, simulated irreparable RCTs significantly decreased MAA (P < .001), while significantly increasing ghST (P = .001), sPCP (P < .001), and cDF (P < .001). SCR with a 3-mm-thick graft significantly increased MAA (P = .01) and decreased ghST (P = .01) compared with the RCT state, however, showed similar sPCP and cDF. Compared with the torn state, SCR with a 6-mm-thick graft significantly increased MAA (P < .001) and significantly decreased ghST (P < .001), sPCP (P < .001), and cDF (P = .001). Using a 6-mm-thick graft demonstrated similar MAA, ghST, sPCP, and cDF compared with the intact state. When comparing the 3-mm to the 6-mm thick graft, significant differences were found in ghST (P = .03), sPCP (P < .001), and cDF (P = .02). CONCLUSIONS SCR with a 6-mm-thick acellular dermal allograft better restored normal glenohumeral joint position and forces compared with a 3-mm-thick graft for the treatment of irreparable RCTs. CLINICAL RELEVANCE Graft thickness may affect the clinical success following SCR with commercially available dermal allografts. Using a thicker (>3 mm) graft was able to biomechanically better restore native glenohumeral joint properties.
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Affiliation(s)
- Bastian Scheiderer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Jeremiah D Johnson
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Florian B Imhoff
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Felix Dyrna
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Christopher R Adams
- Department of Orthopaedic Surgery, Naples Community Hospital, Naples, Florida, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
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Huang TS, Ou HL, Lin JJ. Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis. J Hand Ther 2020; 32:345-352. [PMID: 29196161 DOI: 10.1016/j.jht.2017.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Crossover repeated-measure design. INTRODUCTION Scapular dyskinesis rehabilitation programs that focus on inhibiting upper trapezius (UT) and activating the lower trapezius (LT) may assist in restoring scapular movements. We hypothesized that taping may be able to normalize scapular movements and associated muscular recruitment. PURPOSE OF THE STUDY The purpose of this study was to investigate the immediate effects of kinesio taping over trapezius on scapular kinematics and muscular activation in different dyskinesis patterns. We expected that taping can improve scapular kinematics and muscular activation in subjects with dyskinesis. METHODS Fifty-four participants with inferior angle prominence (pattern I), medial border prominence (pattern II), and mixed pattern (pattern I + II) were recruited. Kinesio taping was applied over 3 parts of trapezius muscles, including UT, middle trapezius (MT), and LT. The scapular kinematics and electromyographic data of trapezius and serratus anterior were collected during scapular plane elevation without taping and after each taping application. RESULTS UT taping decreased UT activity (5%-7%; P = .001-.003) in 72% of participants with pattern II and pattern I + II dyskinesis, with increased posterior tipping (2.2°-2.5°; P = .003) in pattern II dyskinesis. MT taping increased UT activity (3%; P = .003) in 48% of participants with pattern II dyskinesis. DISCUSSION The taping over the trapezius muscle may help to restore coordinated scapular muscle balance and increased upward rotation of the scapula, especially in pattern II dyskinesis. Although no electromyography or kinematic difference was found with LT taping in each dyskinesis pattern, methods of applying LT taping need to be further investigated. CONCLUSION Reduced UT muscle activity and scapular posterior tipping are appropriate when applying taping over UT muscle in patterns II and I + II dyskinesis. Caution should be taken when applying taping over MT and LT muscles in terms of increased UT activity, especially in pattern II dyskinesis.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Ling Ou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Iwashita S, Sugamoto K, Hashiguchi H, Yoneda M, Takai S. Morphological evaluation of the scapula by three-dimensional computed tomography to elucidate shoulder joint function. Clin Anat 2019; 33:1069-1074. [PMID: 31883136 DOI: 10.1002/ca.23541] [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: 11/08/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION There are many variations of scapula morphology. Evaluation of scapula morphology is necessary to elucidate shoulder joint movement. We aimed to analyze the bone morphology of various parts constituting the scapula to identify certain conserved features among them. MATERIALS AND METHODS Thirty-one healthy individuals were the subjects. We created a scapular three-dimensional (3D) model using computed tomography (CT). X and Y axes were set on a glenoid surface. We measured the approximate plane of the upper and lower scapular bodies and scapular spine and the central axis of the coracoid and acromion. The anatomical position of the scapular spine, upper and lower bodies, coracoid, and acromion was measured. The positional relationship between the upper and lower bodies and scapular spine and the coracoid and acromion was evaluated. The average angle of the upper and lower scapular bodies and the scapular spine with respect to the XZ plane was calculated. The average angle of the coracoid and acromion with the X-axis on the XY plane and Z-axis on the YZ plane was calculated. RESULTS On the XY plane, approximate planes of the upper and lower part of the body and the scapular spine were significantly correlated to each inclination. On the XY plane, inclinations of the central axes of the coracoid and acromion were significantly correlated. CONCLUSIONS The findings revealed for the first time the correlation between the inclinations of the scapular body and scapular spine and the inclination angle between the coracoid and acromion.
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Affiliation(s)
- Satoshi Iwashita
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Surgery, Osaka University, Osaka, Japan
| | - Hiroshi Hashiguchi
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Minoru Yoneda
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW This review will outline scapular function in throwing, discuss scapular dyskinesis as an impairment of function that can be associated with throwing injuries and altered performance, and present an algorithm that encompasses guidelines for evaluation and can serve as a basis for treatment. RECENT FINDINGS Optimal scapular function is integral to optimal shoulder function. Multiple roles of the scapula in arm function and throwing have been identified while scapular dysfunction continues to be associated with various shoulder pathologies. Although scapular motion alterations may be common in overhead athletes, various reports have shown that identification and management of the alterations can result in improved rehabilitation and performance outcomes. Baseball throwing occurs as the result of integrated, multisegmented, sequential joint motion, and muscle activation within the kinetic chain. The scapula is a key component link within the chain through its function to maximize the scapulohumeral rhythm and efficient throwing mechanics. Evaluation and management beginning with the scapula can produce improved outcomes related to shoulder pathology in overhead athletes.
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Lawrence RL, Braman JP, Keefe DF, Ludewig PM. The Coupled Kinematics of Scapulothoracic Upward Rotation. Phys Ther 2019; 100:283-294. [PMID: 31696926 PMCID: PMC8204887 DOI: 10.1093/ptj/pzz165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/01/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Scapulothoracic upward rotation (UR) is an important shoulder complex motion allowing for a larger functional work space and improved glenohumeral muscle function. However, the kinematic mechanisms producing scapulothoracic UR remain unclear, limiting the understanding of normal and abnormal shoulder movements. OBJECTIVE The objective of this study was to identify the coupling relationships through which sternoclavicular and acromioclavicular joint motions contribute to scapulothoracic UR. DESIGN This was a cross-sectional observational study. METHODS Sixty participants were enrolled in this study; 30 had current shoulder pain, and 30 had no history of shoulder symptoms. Shoulder complex kinematics were quantified using single-plane fluoroscopy and 2D/3D shape matching and were described as finite helical displacements for 30-degree phases of humerothoracic elevation (30 degrees-60 degrees, 60 degrees-90 degrees, and 90 degrees-120 degrees). A coupling function was derived to estimate scapulothoracic UR from its component motions of acromioclavicular UR, sternoclavicular posterior rotation, and sternoclavicular elevation as a function of acromioclavicular internal rotation. The proportional contributions of each of the component motions were also calculated and compared between phases of humerothoracic elevation and groups. RESULTS Scapulothoracic UR displacement could be effectively predicted using the derived coupling function. During the 30- to 60-degree humerothoracic elevation phase, acromioclavicular UR accounted for 84.2% of scapulothoracic UR, whereas sternoclavicular posterior rotation and elevation each accounted for < 10%. During later phases, acromioclavicular UR and sternoclavicular posterior rotation each accounted for 32% to 42%, whereas sternoclavicular elevation accounted for < 11%. LIMITATIONS Error due to the tracking of sternoclavicular posterior rotation may have resulted in an underprediction of its proportional contribution and an overprediction of the proportional contribution of acromioclavicular UR. CONCLUSIONS Acromioclavicular UR and sternoclavicular posterior rotation are the predominant component motions of scapulothoracic UR. More research is needed to investigate how these coupling relationships are affected by muscle function and influenced by scapular dyskinesis.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, and Bone and Joint Center, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202 (USA),R.L. Lawrence, PT, PhD, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, and Bone and Joint Center, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202 (USA). Address all correspondence to Dr Lawrence at:
| | | | - Daniel F Keefe
- Department of Computer Science and Engineering, University of Minnesota
| | - Paula M Ludewig
- PhD, Department of Rehabilitation Medicine, University of Minnesota
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IJspeert J, Kerstens HCJW, Janssen RMJ, Geurts ACH, van Alfen N, Groothuis JT. Validity and reliability of serratus anterior hand held dynamometry. BMC Musculoskelet Disord 2019; 20:360. [PMID: 31391035 PMCID: PMC6686461 DOI: 10.1186/s12891-019-2741-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/25/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Strength testing of the serratus anterior muscle with hand held dynamometry (HDD) in supine subjects has low reproducibility, and is influenced by compensatory activity of other muscles like the pectoralis major and upper trapezius. Previously, two manual maximum voluntary isometric contraction tests of the serratus anterior muscle were reported that recruited optimal surface electromyography (sEMG) activity in a sitting position. We adapted three manual muscle tests to make them suitable for HHD and investigated their validity and reliability. METHODS Twenty-one healthy adults were examined by two assessors in one supine and two seated positions. Each test was repeated twice. Construct validity was determined by evaluating force production (assessed with HHD) in relation to sEMG of the serratus anterior, upper trapezius and pectoralis major muscles, comparing the three test positions. Intra- and interrater reliability were determined by calculating intra-class correlation coefficients (ICC) smallest detectable change (SDC) and standard error of measurement (SEM). RESULTS Serratus anterior muscle sEMG activity was most isolated in a seated position with the humerus in 90° anteflexion in the scapular plane. This resulted in the lowest measured force levels in this position with a mean force of 296 N (SEM 15.8 N). Intrarater reliability yielded an ICC of 0.658 (95% CI 0.325; 0.846) and an interrater reliability of 0.277 (95% CI -0.089;0.605). SDC was 127 Newton, SEM 45.8 Newton. CONCLUSION The results indicate that validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane. Intrarater reliability is moderate and interrater reliability of this procedure is poor. However the high SDC values make it difficult to use the measurement in repeated measurements.
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Affiliation(s)
- Jos IJspeert
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans C. J. W. Kerstens
- Department of paramedical studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renske M. J. Janssen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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Abstract
Asymptomatic rotator cuff tears (RCTs) are prevalent in the general population; they are positively associated with age and are common in the contralateral shoulder of individuals who are being treated for shoulder pain or a symptomatic RCT. Asymptomatic RCTs are likely to become symptomatic over time, corresponding with decreased patient-reported function, strength, and range of motion. Previous studies have largely reported inconsistent findings regarding patient-reported outcomes, strength, range of motion, and kinematics in individuals with asymptomatic RCTs. Future research would benefit from characterizing any functional alteration that is associated with asymptomatic rotator cuff pathology, including determining whether such alterations are detrimental or compensatory and understanding the mechanism by which an asymptomatic RCT becomes symptomatic.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan
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Turgut E, Yildiz TI, Eraslan LS, Demirci S, Huri G, Turhan E, Duzgun I. A three-dimensional scapular motion analysis in patients with arthroscopic anterior capsulolabral repair of the shoulder: The effect of scapular stabilization taping. J Orthop Sci 2019; 24:426-430. [PMID: 30538077 DOI: 10.1016/j.jos.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/27/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate the scapular kinematics during dynamic humeral movements in patients with arthroscopic anterior capsulolabral repair of the shoulder along with the potential biomechanical corrective effects of scapular stabilization taping. METHODS Twenty patients with unilateral traumatic anterior shoulder instability and arthroscopic anterior capsulolabral repair participated in the study. Dynamic shoulder kinematics were assessed during the scapular plane shoulder elevation for both the operated and non operated shoulders and also under two conditions: no-taping and taping. Statistical analysis to compare sides and conditions was performed with analysis of variance models. RESULTS The scapula was more internally rotated position in operated shoulders than in non operated shoulders. Furthermore, the scapula was less internally rotated and more downwardly rotated at 120° of elevation in the taping condition. CONCLUSIONS Operated shoulders demonstrated kinematics alterations when compared to non operated shoulders underwent arthroscopic anterior capsulolabral repair. Additionally, changes in the scapular orientation with the taping was very small but followed a pattern, which would be suggested to be an orientation that potentially produce more scapular stability and to increase stress on the inferior glenohumeral ligament.
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Affiliation(s)
- Elif Turgut
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Taha Ibrahim Yildiz
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Leyla Sümeyye Eraslan
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Serdar Demirci
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Irem Duzgun
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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Ueda Y, Tanaka H, Morioka S, Tachibana T, Hayashi T, Ichihashi N, Inui H, Nobuhara K. Comparison of scapular upward rotation during arm elevation in the scapular plane in healthy volunteers and patients with rotator cuff tears pre- and post-surgery. Clin Biomech (Bristol, Avon) 2019; 63:207-213. [PMID: 30933709 DOI: 10.1016/j.clinbiomech.2019.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/16/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Function loss caused by rotator cuff tears alters the scapular orientation, however, few prior studies have reported on scapular movements after rotator cuff repair. The purpose was to determine the scapular orientations before and after rotator cuff repair. METHODS We recruited 14 healthy controls, 10 small and six massive rotator cuff tear in patients. The scapular upward rotation during arm elevation was analyzed using fluoroscopic imaging. FINDINGS Before surgery, both rotator cuff groups demonstrated greater scapular upward rotation compared to healthy controls. Two months postoperation, the analyses showed significant differences between the patients with small rotator cuff tears and healthy controls at arm elevations of 90°, and between patients with both rotator cuff tear groups and healthy controls at arm elevations of 120°. At five months post-operation, significant differences still existed between the healthy controls and both rotator cuff groups. In regard to the temporal effects in the patients with small rotator cuff tears, the scapular upward rotation decreased significantly over time (2-5 months postoperation) at arm elevations of 120°. We did not identify a main effect owing to time in the patients with massive rotator cuff tears. INTERPRETATION In patients with small rotator cuff tears, scapular upward rotation was reduced over the period of 2-5 months postoperation, however, the patients with massive rotator cuff tears showed greater scapular upward rotation throughout the experimental period. The results suggested that the execution of the rehabilitation program should consider that the tear size could affect scapular motion.
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Affiliation(s)
- Yasuyuki Ueda
- Department of Rehabilitation, Nobuhara Hospital, 720 Haze, Issai-cho, Tatsuno-city, Hyogo, Japan; Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan.
| | - Hiroshi Tanaka
- Institute of Biomechanics, Nobuhara Hospital, 720 Haze, Issai-cho, Tatsuno-city, Hyogo, Japan
| | - Shigetoshi Morioka
- Department of Radiology, Nobuhara Hospital, 720 Haze, Issai-cho, Tatsuno-city, Hyogo, Japan
| | - Takashi Tachibana
- Department of Rehabilitation, Nobuhara Hospital, 720 Haze, Issai-cho, Tatsuno-city, Hyogo, Japan
| | - Toyohiko Hayashi
- Department of Biocybernetics, Faculty of Engineering, Niigata University, 8050, Ninomachi, Igarashi, Nishi-ku, Niigata-city, Niigata, Japan.
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan.
| | - Hiroaki Inui
- Institute of Biomechanics, Nobuhara Hospital, 720 Haze, Issai-cho, Tatsuno-city, Hyogo, Japan
| | - Katsuya Nobuhara
- Institute of Biomechanics, Nobuhara Hospital, 720 Haze, Issai-cho, Tatsuno-city, Hyogo, Japan
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Nascimento ATD, Claudio GK. Snapping scapula syndrome: arthroscopic surgical treatment. Rev Bras Ortop 2018; 53:728-732. [PMID: 30377607 PMCID: PMC6205250 DOI: 10.1016/j.rboe.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives To evaluate the results of patients undergoing arthroscopic surgical treatment for snapping scapula syndrome. Methods This is a retrospective study of 11 patients undergoing scapulothoracic arthroscopy for the treatment of snapping scapula syndrome. The study included patients with clinical diagnosis of snapping scapula syndrome who did not show pain improvement after at least six months of physical therapy. Patients were assessed using the DASH, UCLA, visual analogue pain assessment (VAS), and Short-Form 36 (SF36) scores. Results The mean age at surgery was 38.4 years (21–48). The mean duration of symptoms before surgery was 2.8 years (range 6 months to 6 years). The mean follow-up duration was 12 months (range: 6.4–28). The mean postoperative scores were: DASH, 7.8 points; VAS, 1.5 points, being ten cases (90%) of mild pain and one case (10%) of moderate pain; UCLA, 32; and SF-36, 79.47. Conclusions The arthroscopic approach for the treatment of snapping scapula syndrome presents excellent functional results.
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Affiliation(s)
- Alexandre Tadeu do Nascimento
- Grupo de Ombro e Cotovelo, Hospital Orthoservice, São José dos Campos, SP, Brazil.,Departamento Médico, Confederação Brasileira de Rugby, São Paulo, SP, Brazil
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Nascimento ATD, Claudio GK. Ressalto de escápula: tratamento cirúrgico artroscópico. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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