Three-Dimensional Shoulder Kinematics to Complete Activities of Daily Living

Monitoring Scapular Kinematics through Wearable Magneto-Inertial Measurement Units: State of the Art and New Frontiers

Monitoring shoulder kinematics, including the scapular segment, is of great relevance in the orthopaedic field. Among wearable systems, magneto-inertial measurement units (M-IMUs) represent a valid alternative for applications in unstructured environments. The aim of this systematic literature review is to report and describe the existing methods to estimate 3D scapular movements through wearable systems integrating M-IMUs. A comprehensive search of PubMed, IEEE Xplore, and Web of Science was performed, and results were included up to May 2023. A total of 14 articles was included. The results showed high heterogeneity among studies regarding calibration procedures, tasks executed, and the population. Two different techniques were described, i.e., with the x-axis aligned with the cranial edge of the scapular spine or positioned on the flat surface of the acromion with the x-axis perpendicular to the scapular spine. Sensor placement affected the scapular motion and, also, the kinematic output. Further studies should be conducted to establish a universal protocol that reduces the variability among studies. Establishing a protocol that can be carried out without difficulty or pain by patients with shoulder musculoskeletal disorders could be of great clinical relevance for patients and clinicians to monitor 3D scapular kinematics in unstructured settings or during common clinical practice.

Shoulder complex and trunk coordination of individuals with severe hemiparesis following a constraint-induced movement therapy protocol: A case series

INTRODUCTION

Constraint Induced Movement Therapy (CIMT) has been shown to be an effective rehabilitation technique in individuals with mild and moderate upper limb (UL) hemiparesis. The aim was to evaluate the effect the CIMT for improving paretic UL use and interjoint coordination with individuals in severe hemiparesis.

METHODS

Six individuals with severe chronic hemiparesis (mean age = 55 ± 16 years) received a UL CIMT intervention for 2 weeks. UL clinical assessments were conducted five times: two assessments at pre-intervention and then, one assessment at post-intervention and 1- and 3-month follow-up using the Graded Motor Activity Log GMAL) and the Graded Wolf Motor Function Test (GWMFT). Scapula, humerus and trunk coordination variability were assessed using the 3-D kinematics during arm elevation, combing hair, turning on the switch and grasp a washcloth. A paired t-test was used to check differences between coordination variability and a one-way ANOVA repeated measures was used to check differences between GMAL and GWMFT scores.

RESULTS

There were no differences in GMAL and GWMFT between the patient screening and the baseline data collection (p > 0.05). GMAL scores increased at post-intervention and at follow-ups (p < 0.02). GWMFT performance time score decreased at post-intervention and at 1-month follow-up (p < 0.04). Improvements in kinematic variability of the paretic UL at pre and post-intervention were observed in all tasks, except in the activity of turn on the light switch.

CONCLUSION

Following the CIMT protocol, improvements in GMAL and GWMFT scores may reflect improvements in paretic UL performance, in real-life environment. Improvements in kinematic variability may reflect an improving of UL interjoint coordination for individuals with chronic severe hemiparesis.

Assessing Smoothness of Arm Movements With Jerk: A Comparison of Laterality, Contraction Mode and Plane of Elevation. A Pilot Study

Measuring the quality of movement is a need and a challenge for clinicians. Jerk, defined as the quantity of acceleration variation, is a kinematic parameter used to assess the smoothness of movement. We aimed to assess and compare jerk metrics in asymptomatic participants for 3 important movement characteristics that are considered by clinicians during shoulder examination: dominant and non-dominant side, concentric and eccentric contraction mode, and arm elevation plane. In this pilot study, we measured jerk metrics by using Xsens^® inertial measurement units strapped to the wrists for 11 different active arm movements (ascending and lowering phases): 3 bilateral maximal arm elevations in sagittal, scapular and frontal plane; 2 unilateral functional movements (hair combing and low back washing); and 2 unilateral maximal arm elevations in sagittal and scapular plane, performed with both arms alternately, right arm first. Each arm movement was repeated 3 times successively and the whole procedure was performed 3 times on different days. The recorded time series was segmented with semi-supervised algorithms. Comparisons involved the Wilcoxon signed rank test (p < 0.05) with Bonferroni correction. We included 30 right-handed asymptomatic individuals [17 men, mean (SD) age 31.9 (11.4) years]. Right jerk was significantly less than left jerk for bilateral arm elevations in all planes (all p < 0.05) and for functional movement (p < 0.05). Jerk was significantly reduced during the concentric (ascending) phase than eccentric (lowering) phase for bilateral and unilateral right and left arm elevations in all planes (all p < 0.05). Jerk during bilateral arm elevation was significantly reduced in the sagittal and scapular planes versus the frontal plane (both p < 0.01) and in the sagittal versus scapular plane (p < 0.05). Jerk during unilateral left arm elevation was significantly reduced in the sagittal versus scapular plane (p < 0.05). Jerk metrics did not differ between sagittal and scapular unilateral right arm elevation. Using inertial measurement units, jerk metrics can well describe differences between the dominant and non-dominant arm, concentric and eccentric modes and planes in arm elevation. Jerk metrics were reduced during arm movements performed with the dominant right arm during the concentric phase and in the sagittal plane. Using IMUs, jerk metrics are a promising method to assess the quality of basic shoulder movement.

Feasibility and significance of stimulating interscapular muscles using transcutaneous functional electrical stimulation in able-bodied individuals

OBJECTIVE

The study objective was to assess the feasibility of stimulating the lower trapezius (LT), the upper trapezius (UT) and serratus anterior (SA) muscles along with anterior or middle deltoid, using surface functional electrical stimulation (FES). The secondary aim was to understand the effects of LT, UT, and SA stimulation on maximum arm reach achieved in shoulder flexion and abduction.

DESIGN

Single arm interventional study.

SETTING

Inpatient Rehabilitation Hospital.

PARTICIPANTS

Ten healthy volunteers.

INTERVENTION

Participants completed 10 trials for each of the 3 conditions in flexion and abduction, i.e. (1) Active voluntary flexion or abduction, (2) FES for anterior deltoid for flexion or middle deltoid for abduction, and (3) FES for LT, UT, and SA along with anterior deltoid for flexion or middle deltoid for abduction.

OUTCOME MEASURES

Maximum arm reach and percent angle relative to the voluntary movement were computed from motion capture data for each condition. Wilcoxon signed-rank test was used to compare the maximum reach between two FES conditions.

RESULTS

The study results showed that all three interscapular muscles can be stimulated using surface FES. Maximum reach in abduction was greater for FES of middle deltoid along with the interscapular muscles (51.77° ± 17.54°) compared to FES for middle deltoid alone (43.76° ± 15.32°; Z = -2.701, P = 0.007). Maximum reach in flexion for FES of anterior deltoid, along with interscapular muscles, was similar to that during FES of anterior deltoid alone.

CONCLUSION

Interscapular muscles can be stimulated using surface FES devices and should be engaged during rehabilitation as appropriate.

Hemiarthroplasty as a salvage treatment for failed reverse total shoulder arthroplasty

Background

The implantation rates of reverse total shoulder arthroplasties (RTSAs) are increasing worldwide, resulting in higher absolute numbers of the associated complications and revision surgeries. This requires the discussion of salvage therapies for failed RTSAs without revision to a new RTSA. Revision to hemiarthroplasty may offer a valid fallback option in certain cases. This study aimed to analyze the incidence, indications, and clinical outcomes, especially the reduction in pain levels compared to a matched control group.

Methods

Our prospectively enrolled patient cohort of RTSA implantations at a tertiary referral center between January 2005 and December 2018 was retrospectively queried for revision to a hemiarthroplasty. For clinical outcome evaluation, a minimum follow-up duration of 2 years after revision to hemiarthroplasty was required. Clinical outcome measures were compared to two matching groups, one with RTSA preserving revision and one without any reintervention. The outcome measures were the absolute and relative Constant-Murley score (aCS and rCS), Subjective Shoulder Value (SSV), range of motion, and pain.

Results

A total of 21 out of 1237 RTSAs (1.7%) underwent salvage revision to hemiarthroplasty at a mean time of 20 ± 21 months (range, 1-75 months). Of those, 12 were available for a minimum follow-up of 2 years after revision to a hemiarthroplasty. The main indications were glenoid loosening (8/12), scapular spine fracture (2/12), and instability (2/21). Clinical outcome was analyzed at a mean follow-up period of 46 ± 26 months (24 months to 123 months) after revision to a hemiarthroplasty. The revision significantly reduced CS pain from 6 ± 4 points to 12 ± 3 points (scale 0 to 15 with 15 as optimum, P < .01). The aCS, rCS, SSV, and range of motion did not improve. Comparison with the RTSA preserving revision group and the RTSA group without reintervention showed significantly worse outcome scores for aCS (33 ± 10 vs. 55 ± 19 vs. 69 ± 12 points), rCS (41 ± 14% vs. 67 ± 20% vs. 84 ± 13%), SSV (35 ± 19% vs. 64 ± 20% vs. 81 ± 15%), flexion (53 ± 27° vs. 64 ± 20° vs. 128 ± 24°), and abduction (50 ± 23° vs. 109 ± 42° vs. 142 ± 24°). Pain was similar in all groups at the last follow-up visit.

Conclusion

In a few cases, RTSA retention or revision to another RTSA is impossible. For those patients, conversion to hemiarthroplasty is a valid fallback option to reduce the patient's pain levels and provide low-level function.

Effect of Rotation Sequence on Thoracohumeral Joint Kinematics during Various Shoulder Postures. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:4912-4915. [PMID: 34892309 PMCID: PMC9817035 DOI: 10.1109/embc46164.2021.9629667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Current methods for selecting a rotation sequence to biomechanically model shoulder joint angles during motion assessment are challenging and controversial due to insufficient knowledge of their effect on the clinical interpretation of movement. Seven rotation sequences were examined by factors including incidences of gimbal lock and joint angle error in two healthy adults during 12 postures using right and left arms. This work was the first to explore the effects of each of the six Cardan angle sequences and the International Society of Biomechanics recommended YXY Euler sequence on the thoracohumeral joint in an array of postures. Results of this work show that there is not a "one size fits all" approach via rotation sequence selection for reliable and coherent expression of shoulder joint postures, particularly of the thoracohumeral joint. For best biomechanical modeling practice, it is recommended that researchers carefully consider the implications of a particular rotation sequence based on the posture or task of interest and resulting incidences of gimbal lock and joint angle error.Clinical Relevance- This work examines the effect of seven different mathematical computations for assessing shoulder joint angles in different postures for application of clinical movement analysis.

Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review

Background

The important functional role the rotator cuff (RC) and biceps play in the shoulder, the close anatomical relationship between them and the high incidence of injuries require an appropriate multidisciplinary therapeutic approach after a rigorous assessment. The objective is to identify and analyze surgical interventions, whether or not followed by a postsurgical one, of associated dysfunctions on the RC and long head of the biceps (LHB) and their effectiveness in improving shoulder functionality.

Methods

A systematic review based on PRISMA protocol was conducted using PubMed, Web of Science, PEDro, Scopus, CINAHL, and Dialnet until 22 April 2021. The main inclusion criteria were as follows: randomized clinical trials including subjects diagnosed with RC and LHB lesions who had surgical and/not post-surgical treatments. The methodological quality of trials was evaluated by the PEDro scale. Data were shown in 3 pre-established tables: (1)sample data, diagnostic methods, dysfunctions and injury frequency, interventions, outcome measures and results; (2)significance and effectiveness of interventions; and (3)comparison of the effectiveness of interventions.

Results

Eleven studies were selected. The methodological quality of ten of them was assessed as good and one excellent (PEDro scale). All articles had surgical treatments and ten had postoperative management. All trials used arthroscopy and two open surgery too. Single-row, double-row and transosseous repair were used for RC lesions, while SLAP repair, tenotomy, and tenodesis were applied to LHB injuries. Measured parameters were functionality, pain, Popeye’s sign, strength, range of motion, satisfaction degree, biceps cramping, and quality of life. All approaches in general, surgical plus postsurgical, were always effective to the parameters measured in each study. Seven trials compared tenotomy and tenodesis: four of them obtained statistically significant differences in favor of tenodesis in Popeye’s sign, cramping, satisfaction degree, and/or forearm supination strength; and one, in favor of tenotomy in cramping. All studies measured functionality using functional assessment scales. The most widely used was the Constant Score.

Conclusions

Surgical plus post-surgical interventions in associated dysfunctions on RC and LHB were effective. Tenodesis obtained better results than tenotomy in Popeye’s sign, satisfaction, and forearm supination strength. However, there was no difference regarding biceps cramping.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02621-0.

Three-Dimensional (3D) Animation and Calculation for the Assessment of Engaging Hill-Sachs Lesions With Computed Tomography 3D Reconstruction

Purpose

To dynamically assess for Hill-Sachs engagement with animated 3-dimensional (3D) shoulder models.

Methods

We created 3D shoulder models from reconstructed computed tomography (CT) images from a consecutive series of patients with recurrent anterior dislocation. They were divided into 2 groups based on the perceived Hill-Sachs severity. For our cohort of 14 patients with recurrent anterior dislocation, 4 patients had undergone osteoarticular allografting of Hill-Sachs lesions and 10 control patients had undergone CT scanning to quantify bone loss but no treatment for bony pathology. A biomechanical analysis was performed to rotate each 3D model using local coordinate systems to the classical vulnerable position of the shoulder (abduction = 90°, external rotation = 0-135°) and through a functional range. A Hill-Sachs lesion was considered "dynamically" engaging if the angle between the lesion's long axis and anterior glenoid was parallel. Results: In the vulnerable position of the shoulder, none of the Hill-Sachs lesions aligned with the anterior glenoid in any of our patients. However, in our simulated physiological shoulder range, all allograft patients and 70% of controls had positions producing alignment.

Conclusions

The technique offers a visual representation of an engaging Hill-Sachs using 3D-animated reconstructions with open-source software and CT images. In our series of patients, we found multiple shoulder positions that align the Hill-Sachs and glenoid axes that do not necessarily meet the traditional definition of engagement. Identifying all shoulder positions at risk of "engaging," in a broader physiological range, may have critical implications toward selecting the appropriate surgical management of bony defects.

Level of Evidence

level III, case-control study.

Influence of humeral abduction angle on axial rotation and contact area at the glenohumeral joint

BACKGROUND

Although the elevation angle of the arm affects the range of rotation, it has not been evaluated up to the maximal abduction angle. In this study we conducted an evaluation up to maximal abduction and determined the contact patterns at the glenohumeral (GH) joint.

METHODS

Fourteen healthy volunteers (12 men and 2 women; mean age, 26.9 years) with normal shoulders (14 right and 8 left) were instructed to rotate their shoulders at 0°, 90°, 135°, and maximal abduction for each shoulder at a time. Using 2-dimensional and 3-dimensional single-plane image registration, the internal rotation (IR), external rotation (ER), and range of motion (ROM; ie, axial rotations) at the thoracohumeral (TH) and GH joints, and the contribution ratio (%ROM = GH-ROM/TH-ROM) were calculated for each abduction. The glenoid position with respect to the humeral head was also analyzed.

RESULTS

The TH-IR and TH-ER shifted toward an ER with increasing abduction angle, whereas the TH-ROM significantly decreased except at abduction between 0° and 90° (P < .001). The GH-IR and GH-ROM significantly decreased except at abduction between 0° and 90° (P < .001), but the GH-ER remained constant regardless of the abduction. The contribution ratio exceeded 80% for every abduction angle. The glenoid moved on the central and posterior areas of the humeral head at 0° and 90° abduction, respectively, and on the posterosuperior and anterosuperior areas at 135° and maximal abduction, respectively.

CONCLUSION

Our results provide new knowledge about wide axial rotation up to maximal abduction and constant GH-ER at any abduction.

Joint angular excursions during cyclical behaviors differ between tetrapod feeding and locomotor systems

Tetrapod musculoskeletal diversity is usually studied separately in feeding and locomotor systems. However, comparisons between these systems promise important insight into how natural selection deploys the same basic musculoskeletal toolkit—connective tissues, bones, nerves and skeletal muscle—to meet the differing performance criteria of feeding and locomotion. In this study, we compare average joint angular excursions during cyclic behaviors– chewing, walking and running–in a phylogenetic context to explore differences in the optimality criteria of these two systems. Across 111 tetrapod species, average limb-joint angular excursions during cyclic locomotion are greater and more evolutionarily labile than those of the jaw joint during cyclic chewing. We argue that these findings reflect fundamental functional dichotomies between tetrapod locomotor and feeding systems. Tetrapod chewing systems are optimized for precise application of force over a narrower, more controlled and predictable range of displacements, the principal aim being to fracture the substrate, the size and mechanical properties of which are controlled at ingestion and further reduced and homogenized (respectively) by the chewing process. In contrast, tetrapod limbed locomotor systems are optimized for fast and energetically efficient application of force over a wider and less predictable range of displacements, the principal aim being to move the organism at varying speeds relative to a substrate whose geometry and mechanical properties need not become more homogenous as locomotion proceeds. Hence, the evolution of tetrapod locomotor systems has been accompanied by an increasing diversity of limb-joint excursions, as tetrapods have expanded across a range of locomotor substrates and environments.

A survey of human shoulder functional kinematic representations

In this survey, we review the field of human shoulder functional kinematic representations. The central question of this review is to evaluate whether the current approaches in shoulder kinematics can meet the high-reliability computational challenge. This challenge is posed by applications such as robot-assisted rehabilitation. Currently, the role of kinematic representations in such applications has been mostly overlooked. Therefore, we have systematically searched and summarised the existing literature on shoulder kinematics. The shoulder is an important functional joint, and its large range of motion (ROM) poses several mathematical and practical challenges. Frequently, in kinematic analysis, the role of the shoulder articulation is approximated to a ball-and-socket joint. Following the high-reliability computational challenge, our review challenges this inappropriate use of reductionism. Therefore, we propose that this challenge could be met by kinematic representations, that are redundant, that use an active interpretation and that emphasise on functional understanding.

Structural muscular adaptations in upper limb after stroke: a systematic review

BACKGROUND

Stroke is a leading cause of disability in the adult population, impairing upper limb (UL) movements affecting activities of daily living. Muscle weakness has been associated to disabilities in this population, but much attention is given to central nervous system alterations and less to skeletal muscles.

OBJECTIVE

The objective of this review is to carry out a systematic literature review to identify structural muscle alterations in the UL of poststroke individuals.

METHOD

The search was performed in December, 2017. MEDLINE, PubMed, SCOPUS, CINAHL, and Science Direct were used as electronic databases. There was no restriction regarding language and publication dates. Studies conducted on poststroke subjects and results on UL skeletal muscle alterations identified by imaging tests were included.

RESULTS

Seven studies were included. The sample size and the variables varied among the studies. All the studies compared the paretic UL with the nonparetic UL and one of the studies also compared healthy subjects. Ultrasonography was the most used measurement tool to assess muscle adaptation.

CONCLUSIONS

This review demonstrated little evidence with poor to fair quality on the structural muscle adaptations in the poststroke subjects, showing muscle atrophy, a higher stiffness, and amount of fibrous and fat tissue without alterations in lean tissue of distal muscles of the paretic UL compared to the nonparetic limb. However, the nonparetic side also presented alterations, which makes it an inappropriate comparison. Thus, well-designed studies addressing this issue are required.

Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions: Systematic Review and Meta-Analysis

Background: Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. Aim: To identify potential; targets for therapy by synthesizing findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks. Methods: A systematic review with identification of studies, data extraction, and potential risk of bias was completed independently by two reviewers. Online databases were searched from their inception to November 2017 to find studies of reach-to-target in people-with-stroke and healthy adults. Potential risk-of-bias was assessed using the Down's and Black Tool. Synthesis was undertaken via: (a) meta-analysis of kinematic characteristics utilizing the standardized mean difference (SMD) [95% confidence intervals]; and (b), narrative synthesis of muscle activation. Results: Forty-six studies met the review criteria but 14 had insufficient data for extraction. Consequently, 32 studies were included in the meta-analysis. Potential risk-of-bias was low for one study, unclear for 30, and high for one. Reach-to-target was investigated with 618 people-with-stroke and 429 healthy adults. The meta-analysis found, in all areas of workspace, that people-with-stroke had: greater movement times (seconds) e.g., SMD 2.57 [0.89, 4.25]; lower peak velocity (millimeters/second) e.g., SMD -1.76 [-2.29, -1.24]; greater trunk displacement (millimeters) e.g. SMD 1.42 [0.90, 1.93]; a more curved reach-path-ratio e.g., SMD 0.77 [0.32, 1.22] and reduced movement smoothness e.g., SMD 0.92 [0.32, 1.52]. In the ipsilateral and contralateral workspace, people-with-stroke exhibited: larger errors in target accuracy e.g., SMD 0.70 [0.39, 1.01]. In contralateral workspace, stroke survivors had: reduced elbow extension and shoulder flexion (degrees) e.g., elbow extension SMD -1.10 [-1.62, -0.58] and reduced shoulder flexion SMD -1.91 [-1.96, -0.42]. Narrative synthesis of muscle activation found that people-with-stroke, compared with healthy adults, exhibited: delayed muscle activation; reduced coherence between muscle pairs; and use of a greater percentage of muscle power. Conclusions: This first-ever meta-analysis of the kinematic differences between people with stroke and healthy adults performing reach-to-target found statistically significant differences for 21 of the 26 comparisons. The differences identified and values provided are potential foci for tailored rehabilitation interventions to improve upper limb recovery after stroke.

Kinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain, and clinical implications

BACKGROUND

The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints.

METHODS

This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience.

RESULTS

For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation.

CONCLUSION

The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities.

Getting a kinematic handle on reach-to-grasp: a meta-analysis

BACKGROUND AND OBJECTIVES

Reach-to-grasp is an essential everyday activity that is often impaired after stroke. The objectives of this review are: (1) identify differences in the kinematic characteristics of reach-to-grasp between individuals with and without stroke, and (2) determine the influence of object location on kinematics.

DATA SOURCES

MEDLINE, AMED, and Embase databases.

ELIGIBILITY CRITERIA

Studies investigating individuals with stroke and neurologically intact control participants completing reach-to-grasp (paretic upper limb) of an object assessed via kinematic assessment (motion analysis).

REVIEW METHODS

Following Cochrane Collaboration guidelines a meta-analysis comparing kinematic characteristics of reach-to-grasp between individuals with and without stroke. Potential risk of bias was assessed using the Down's and Black Tool. Data were synthesised by calculating the standardised mean difference (SMD) in kinematic characteristics between adults with and without stroke.

RESULTS

Twenty-nine studies met the review criteria, mainly of observational design; 460 individuals with stroke and 324 control participants. Kinematic differences in reach-to-grasp were identified in the central and ipsilateral workspace for example, individuals with stroke exhibited significantly lower peak velocity SMD -1.48 (95% CI -1.94, -1.02), and greater trunk displacement SMD 1.55 (95% CI 0.85, 2.25) than control participants. Included studies were assessed as demonstrating unclear or high potential risk-of-bias.

CONCLUSIONS

Differences in kinematic characteristics between individuals with and without stroke were identified which may be different reaching in the ipsilateral and central workspace. Suggesting, that object location may influence some kinematic characteristics and not others which may be pertinent when re-training reach-to-grasp.

PROSPERO

CRD42014009479.

Bilateral changes in 3-D scapular kinematics in individuals with chronic stroke

BACKGROUND

Stroke can lead to altered scapular motion that may limit the ability to perform activities of daily living. The aims were to evaluate scapular kinematics of individuals with chronic stroke and the correlation with paretic arm function.

METHODS

Scapular kinematics was assessed in thirty-four individuals (Chronic stroke=17; controls=17) during arm elevation and lowering in scapular and self-selected planes, and during hair combing. The use of the paretic arm to perform activities of daily living was assessed by the Motor Activity Log (MAL-30). Scapular kinematics was compared among paretic and non-paretic arms, and controls. Correlation between scapular kinematics and MAL-30 was also verified.

FINDINGS

Paretic and non-paretic arms showed increased scapular internal rotation (p<0.05) during arm lowering in the scapular plane, and during arm elevation and lowering in the self-selected plane compared to controls. Increased internal rotation (p<0.05) was also found in the paretic arm during hair combing compared to controls. Increased scapular anterior tilt (p<0.05) was observed in the paretic arm during arm elevation while performing the activity of hair combing and during arm elevation and lowering in the scapular and self-selected planes compared to controls. The non-paretic arm showed increased anterior tilt (p<0.05) during arm elevation and lowering in self-selected plane compared to controls. No difference in scapular upward rotation among neither arms, nor correlation between scapular kinematics and MAL-30 were found (p>0.05).

INTERPRETATION

Individuals with chronic stroke showed bilateral scapular kinematics alterations. However, these alterations are not correlated with paretic arm function.

Assessment of Kinematics and Electromyography Following Arthroscopic Single-Tendon Rotator Cuff Repair

BACKGROUND

The increasing demand for rotator cuff (RC) repair patients to return to work as soon as they are physically able has led to exploration of when this is feasible. Current guidelines from our orthopedic surgery clinic recommend a return to work at 9 weeks postoperation. To more fully define capacity to return to work, the current study was conducted using a unique series of quantitative tools. To date, no study has combined 3-dimensional (3D) motion analysis with electromyography (EMG) assessment during activities of daily living (ADLs), including desk tasks, and commonly prescribed rehabilitation exercise.

OBJECTIVE

To apply a quantitative, validated upper extremity model to assess the kinematics and muscle activity of the shoulder following repair of the supraspinatus RC tendon compared to that in healthy shoulders.

DESIGN

A prospective, cross-sectional comparison study.

SETTING

All participants were evaluated during a single session at the Medical College of Wisconsin Department of Orthopaedic Surgery's Motion Analysis Laboratory.

PARTICIPANTS

Ten participants who were 9-12 weeks post-operative repair of a supraspinatus RC tendon tear and 10 participants with healthy shoulders (HS) were evaluated.

METHODS

All participants were evaluated with 3D motion analysis using a validated upper extremity model and synchronized EMG. Data from the 2 groups were compared using multivariate Hotelling T² tests with post hoc analyses based on Welch t-tests.

MAIN OUTCOME MEASUREMENTS

Participants' thoracic and thoracohumeral joint kinematics, temporal-spatial parameters, and RC muscle activity were measured by applying a quantitative upper extremity model during 10 ADLs and 3 rehabilitation exercises. These included tasks of hair combing, drinking, writing, computer mouse use, typing, calling, reaching to back pocket, pushing a door open, pulling a door closed, external rotation, internal rotation, and rowing.

RESULTS

There were significant differences of the thoracohumeral joint motion in only a few of the tested tasks: comb maximal flexion angle (P = .004), pull door internal/external rotation range of motion (P = .020), reach abduction/adduction range of motion (P = .001), reach flexion/extension range of motion (P = .001), reach extension minimal angle (P = .025), active external rotation maximal angle (P = .012), and active external rotation minimal angle (P = .004). The thorax showed significantly different kinematics of maximal flexion angle during the call (P = .011), mouse (P = .007), and drink tasks (P = .005) between the 2 groups. The EMG data analysis showed significantly increased subscapularis activity in the RC repair group during active external rotation.

CONCLUSIONS

Although limited abduction was expected due to repair of the supraspinatus tendon, only a single ADL (reaching to back pocket) had a significantly reduced abduction range of motion. Thoracic motion was shown to be used as a compensatory strategy during seated ADLs. Less flexion of the thorax may create passive shoulder flexion at the thoracohumeral joint in efforts to avoid active flexion. The RC repair group participants were able to accomplish the ADLs within the same time frame and through thoracohumeral joint kinematics similar to those in the healthy shoulder group participants. In summary, this study presents a quantification of the effects of RC repair and rehabilitation on the ability to perform ADLs. It may also point to a need for increased rehabilitation focus on either regaining external rotation strength or range of motion following RC repair to enhance recovery and return to the workforce.

LEVEL OF EVIDENCE

III.

Assessment of the glenohumeral joint's active and passive axial rotational range

BACKGROUND

Assessment of the range of axial rotation of the glenohumeral joint will improve understanding of shoulder function, with applications in shoulder rehabilitation and sports medicine. However, there is currently no complete description of motion of the joint. The study aimed to develop a reliable protocol to quantify the internal and external axial rotations of the glenohumeral joint during active and passive motion at multiple humeral positions.

METHODS

Optical motion tracking was used to collect kinematic data from 20 healthy subjects. The humerus was positioned at 60°, 90°, and 120° of humerothoracic elevation in the coronal, scapular, and sagittal planes. Internal and external rotations were measured at each position for active and passive motion, where intrasubject standard deviations were used to assess variations in internal-external rotations.

RESULTS

The protocol showed intrasubject variability in the axial rotational range of <5° for active and passive rotations at all humeral positions. Maximum internal rotation was shown to be dependent on humeral position, where a reduced range was measured in the sagittal plane (P < .001) and at 120° elevations (P < .001). Conversely, maximum external rotations were not affected by humeral position.

CONCLUSION

The results describe normal ranges of internal-external rotation of the glenohumeral joint at multiple humeral positions. The protocol's low variability means that it could be used to test whether shoulder pathologic conditions lead to changes in axial rotational range at specific humeral positions.

A new description of scapulothoracic motion during arm movements in healthy subjects

The participation of scapula motion in arm movement is clinically well known and recent three dimensional (3D) analyses using kinematic techniques have confirmed its importance. Scapular motion relative to the thorax has a theoretical maximum of 6 degrees of freedom (DoF), resulting from rotations at both clavicular joints (3 rotational DoF each). However, most recent kinematic studies have only analysed the 3D rotations of the scapula relative to the thorax. In the present study, the 3D translations of the barycentre of the scapula were considered in order to complete the description of movement at the shoulder complex. Eight healthy subjects performed arm elevation in the sagittal and frontal planes, simulated activities of daily living (hair combing and back washing) and maximum voluntary scapula movement (forward and backward rolling). Measurements were recorded using a 6 DoF electromagnetic device and the acromial method of analysis was used. The results showed that 3D scapular rotations and translation of its barycentre were functionally consistent for all tasks. A principal component analysis (PCA) yielded three factors, explaining 97.6% of the variance. The first two factors (protraction and shrug, according to clinical descriptions) combined rotations and translations, consistent with the hypothesis that the scapula rolls over the curved thoracic surface. The third factor related to lateral-medial rotation, thus representing rotation in the plane tangential to the thorax. The PCA suggested that scapular motion can be described using these 3 DoF. This should be studied in a larger group of individuals, including patients with pathological conditions.

Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke

OBJECTIVES

To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter.

METHOD

Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference.

RESULTS

The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10).

CONCLUSIONS

The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion.

An analysis of functional shoulder movements during task performance using Dartfish movement analysis software

Purpose:

Video-based movement analysis software (Dartfish) has potential for clinical applications for understanding shoulder motion if functional measures can be reliably obtained. The primary purpose of this study was to describe the functional range of motion (ROM) of the shoulder used to perform a subset of functional tasks. A second purpose was to assess the reliability of functional ROM measurements obtained by different raters using Dartfish software.

Materials and Methods:

Ten healthy participants, mean age 29 ± 5 years, were videotaped while performing five tasks selected from the Disabilities of the Arm, Shoulder and Hand (DASH). Video cameras and markers were used to obtain video images suitable for analysis in Dartfish software. Three repetitions of each task were performed. Shoulder movements from all three repetitions were analyzed using Dartfish software. The tracking tool of the Dartfish software was used to obtain shoulder joint angles and arcs of motion. Test-retest and inter-rater reliability of the measurements were evaluated using intraclass correlation coefficients (ICC).

Results:

Maximum (coronal plane) abduction (118° ± 16°) and (sagittal plane) flexion (111° ± 15°) was observed during ‘washing one's hair;’ maximum extension (−68° ± 9°) was identified during ‘washing one's own back.’ Minimum shoulder ROM was observed during ‘opening a tight jar’ (33° ± 13° abduction and 13° ± 19° flexion). Test-retest reliability (ICC = 0.45 to 0.94) suggests high inter-individual task variability, and inter-rater reliability (ICC = 0.68 to 1.00) showed moderate to excellent agreement.

Conclusion:

Key findings include: 1) functional shoulder ROM identified in this study compared to similar studies; 2) healthy individuals require less than full ROM when performing five common ADL tasks 3) high participant variability was observed during performance of the five ADL tasks; and 4) Dartfish software provides a clinically relevant tool to analyze shoulder function.

Defining functional shoulder range of motion for activities of daily living

INTRODUCTION

The range of motion (ROM) in the wrist and elbow required for daily activities has been reported to be less than the normal anatomic ROM. This functional ROM has not been defined for the shoulder. Many shoulder outcome assessment tools use specific functional tasks of daily living to score functional results of treatment. This study quantified the total shoulder ROM required to perform the functional tasks of the American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), and University of Pennsylvania (U-Penn) Shoulder Score (PSS).

MATERIALS AND METHODS

The FASTRAK electromagnetic tracking system (Colchester, VT, USA) was used to test 40 shoulders in 20 volunteers with no shoulder pathology found on physical examination. Three sensors were used: 1 each on the T3 spinous process, the scapular spine, and the arm over the distal humerus. Subjects performed each functional task of the ASES, SST, and PSS while flexion, extension, abduction, adduction, external rotation, and internal rotation were recorded.

RESULTS

Average shoulder motions required to perform the 10 functional tasks were flexion, 121° ± 6.7°; extension, 46° ± 5.3°; abduction, 128° ± 7.9°; cross-body adduction, 116° ± 9.1°; external rotation with the arm 90° abducted, 59° ± 10°; and internal rotation with the arm at the side, 102° ± 7.7°.

CONCLUSION

Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools.

Direct Kinematic Modeling of the Upper Limb During Trunk-Assisted Reaching

The study proposes a rigid-body biomechanical model of the trunk and whole upper limb including scapula and the test of this model with a kinematic method using a six-dimensional (6-D) electromagnetic motion capture (mocap) device. Large unconstrained natural trunk-assisted reaching movements were recorded in 7 healthy subjects. The 3-D positions of anatomical landmarks were measured and then compared to their estimation given by the biomechanical chain fed with joint angles (the direct kinematics). Thus, the prediction errors was attributed to the different joints and to the different simplifications introduced in the model. Large (approx. 4 cm) end-point prediction errors at the level of the hand were reduced (to approx. 2 cm) if translations of the scapula were taken into account. As a whole, the 6-D mocap seems to give accurate results, except for pronosupination. The direct kinematic model could be used as a virtual mannequin for other applications, such as computer animation or clinical and ergonomical evaluations.