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Jafarian Tangrood Z, Sole G, Cury Ribeiro D. Association between changes in pain or function scores and changes in scapular rotations in patients with subacromial shoulder pain: a prospective cohort study. Arch Physiother 2022; 12:18. [PMID: 35965342 PMCID: PMC9377126 DOI: 10.1186/s40945-022-00143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Scapular dyskinesis is reported as one of the potential factors contributing to the presentation of pain in subacromial shoulder pain. In clinical practice, the evaluation and control of scapular dyskinesis is considered important for managing the subacromial shoulder pain. The aim is to determine the association between changes in pain or function and changes in scapular rotations in participants with subacromial shoulder pain. Method Pain, function and scapular rotations were measured in 25 participants with subacromial shoulder pain at baseline and after 8 weeks. Pain was measured with Numeric Pain Rating Scale (NPRS) and function was measured with Patient Specific Functional Scale (PSFS). Scapular rotations were measured with a scapular locator at 60°, 90° and 120° of scapular arm elevation. Spearman rank correlations (rs) were used to assess the association between variables. Findings No association was observed between changes in pain or function scores with changes in scapular upward/downward rotations (rs = 0.03 to 0.27 for pain and − 0.13 to 0.23 for function) and scapular anterior/posterior tilt (rs = − 0.01 to 0.23 for pain and − 0.13 to 0.08 for function) of arm at 60°, 90° and 120° elevation. Data associated with scapular internal/external rotation was not reported due to low reliability. Conclusion These findings reject associations between changes in pain or function scores and scapular rotations. Future observational study is warranted using a multifactorial approach to understand potential factors that contribute to the presentation of subacromial shoulder pain.
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Rapp EA, Richardson RT, Russo SA, Rose WC, Richards JG. A comparison of two non-invasive methods for measuring scapular orientation in functional positions. J Biomech 2017; 61:269-274. [DOI: 10.1016/j.jbiomech.2017.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
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Crowe MM, Elhassan BT. Scapular and Shoulder Girdle Muscular Anatomy: Its Role in Periscapular Tendon Transfers. J Hand Surg Am 2016; 41:306-14; quiz 315. [PMID: 26754193 DOI: 10.1016/j.jhsa.2015.06.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
The importance of coordinated, normal scapulothoracic motion in facilitating full, pain-free motion of the shoulder complex has been increasingly studied over the past decade, leading to renewed interest in scapular-based reconstructions to improve shoulder girdle motion through the use of muscle advancements and tendon transfers. This article will review recent advances regarding scapulothoracic motion and the muscular stabilizers of the scapula, focusing on clinical diagnosis and anatomy as it pertains to scapular dyskinesis and common periscapular tendon transfers. Although many of these treatment techniques remain in their infancy and further follow-up is necessary before universal adoption, they provide a novel means of addressing difficult-to-treat and complex shoulder girdle pathologies.
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Affiliation(s)
- Matthew M Crowe
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Bourne DA, Choo AM, Regan WD, MacIntyre DL, Oxland TR. A New Subject-Specific Skin Correction Factor for Three-Dimensional Kinematic Analysis of the Scapula. J Biomech Eng 2009; 131:121009. [DOI: 10.1115/1.4000284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Noninvasive measurement of scapular kinematics using skin surface markers presents technical challenges due to the relative movement between the scapula and the overlying skin. The objectives of this study were to develop a noninvasive subject-specific skin correction factor that would enable a more accurate measurement of scapular kinematics and evaluate this new technique via comparison with a gold standard for scapular movement. Scapular kinematics were directly measured using bone pins instrumented with optoelectronic marker carriers in eight healthy volunteers while skin motion was measured simultaneously with optoelectronic markers attached to the skin surface overlying the scapula. The relative motion between the skin markers and the underlying scapula was estimated over a range of humeral orientations by palpating and digitizing bony landmarks on the scapula and then used to calculate correction factors that were weighted by humeral orientation. The scapular kinematics using these correction factors were compared with the kinematics measured via the bone pins during four arm movements in the volunteers: abduction, forward reaching, hand behind back, and horizontal adduction. The root-mean-square (rms) errors for the kinematics determined from skin markers without the skin correction factors ranged from 5.1 deg to 9.5 deg while the rms errors with the skin correction factors ranged from 1.4 deg to 3.0 deg. This technique appeared to perform well for different movements and could possibly be extended to other applications.
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Affiliation(s)
- Douglas A. Bourne
- Department of Orthopaedics, Division of Orthopaedic Engineering Research, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Anthony M. Choo
- Department of Orthopaedics, Division of Orthopaedic Engineering Research, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
| | - William D. Regan
- Department of Orthopaedics, Division of Upper Extremity Reconstruction, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
| | - Donna L. MacIntyre
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Thomas R. Oxland
- Department of Orthopaedics, Division of Orthopaedic Engineering Research, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC V5Z 4E3, Canada
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Toledo JMD, Ribeiro DC, Loss JF. Análise por dinâmica inversa, um complemento da avaliação fisioterapêutica do ombro. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000300011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo do estudo é caracterizar as forças em atuação na articulação do ombro durante o movimento de elevação do membro superior no plano escapular por meio do método de dinâmica inversa, aqui sugerido como um meio complementar da avaliação fisioterapêutica. Esse método permite determinar os picos de momento proximal resultante (MPR) e da força proximal resultante (FPR) do ombro durante o movimento, possibilitando assim a avaliação objetiva das cargas impostas à articulação. Participaram do estudo 21 indivíduos do sexo masculino, cuja movimentação do ombro foi analisada por videogrametria em três diferentes situações de carga: sem carga, com peso livre e com resistência elástica. Um modelo matemático tridimensional foi utilizado para o cálculo do MPR e da FPR, permitindo caracterizar a evolução dessas variáveis ao longo da elevação do membro superior nas três situações de carga nos eixos póstero-anterior, caudal-cranial e médio-lateral, determinando seus respectivos picos. O método da dinâmica inversa revelou-se capaz de fornecer informações objetivas sobre as cargas impostas à articulação do ombro nas diversas amplitudes e situações de carga do movimento estudado, podendo tais informações servir como uma base concreta no planejamento de um programa de reabilitação do ombro.
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Bourne D, Choo A, Regan W, MacIntyre D, Oxland T. Accuracy of digitization of bony landmarks for measuring change in scapular attitude. Proc Inst Mech Eng H 2009; 223:349-61. [DOI: 10.1243/09544119jeim480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Digitizing bony landmarks is a common technique used to measure scapular position, but it has not been validated against a gold standard. The aim of this study was to determine the accuracy of this technique for four physiological arm movements using optoelectronic markers mounted on scapular bone pins as a gold standard. Eight subjects had bone pins inserted into their lateral scapular spine. Three points were digitized on the scapula with an optoelectronic probe: the medial root of the scapular spine, the posterolateral corner of the acromion, and the inferior angle of the scapula. The four active movements tested in this study were glenohumeral abduction, glenohumeral horizontal adduction, hand behind back, and forward reaching. The three bony landmarks were digitized six times in three different positions for each movement. Data from one subject were rejected secondary to pin loosening. The overall position-specific r.m.s. errors ranged from 2.0° to 12.5°. The full abduction position had considerably higher r.m.s. errors than the other positions (posterior tipping, 12.5°; upward rotation, 7.3°; internal rotation, 12.0°). It appears that the digitization of bony landmarks may be a valid method for measuring changes in scapular attitude with the following caveats: the full abduction position has a high r.m.s. error, and small scapular motions have high percentage errors.
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Affiliation(s)
- D Bourne
- Division of Orthopaedic Engineering Research, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - A Choo
- Division of Orthopaedic Engineering Research, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - W Regan
- Division of Upper Extremity Reconstruction, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - D MacIntyre
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Oxland
- Division of Orthopaedic Engineering Research, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF. Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am 2009; 91:378-89. [PMID: 19181982 PMCID: PMC2657311 DOI: 10.2106/jbjs.g.01483] [Citation(s) in RCA: 399] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many prior studies have evaluated shoulder motion, yet no three-dimensional analysis comparing the combined clavicular, scapular, and humeral motion during arm elevation has been done. We aimed to describe and compare dynamic three-dimensional motion of the shoulder complex during raising and lowering the arm across three distinct elevation planes (flexion, scapular plane abduction, and coronal plane abduction). METHODS Twelve subjects without a shoulder abnormality were enrolled. Transcortical pin placement into the clavicle, scapula, and humerus allowed electromagnetic motion sensors to be rigidly fixed. The subjects completed two repetitions of raising and lowering the arm in flexion, scapular, and abduction planes. Three-dimensional angles were calculated for sternoclavicular, acromioclavicular, scapulothoracic, and glenohumeral joint motions. Joint angles between humeral elevation planes and between raising and lowering of the arm were compared. RESULTS General patterns of shoulder motion observed during humeral elevation were clavicular elevation, retraction, and posterior axial rotation; scapular internal rotation, upward rotation, and posterior tilting relative to the clavicle; and glenohumeral elevation and external rotation. Clavicular posterior rotation predominated at the sternoclavicular joint (average, 31 degrees). Scapular posterior tilting predominated at the acromioclavicular joint (average, 19 degrees). Differences between flexion and abduction planes of humerothoracic elevation were largest for the glenohumeral joint plane of elevation (average, 46 degrees). CONCLUSIONS Overall shoulder motion consists of substantial angular rotations at each of the four shoulder joints, enabling the multiple-joint interaction required to elevate the arm overhead.
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Affiliation(s)
- Paula M Ludewig
- Orthopaedic Biomechanics Laboratory, University of Minnesota, Minneapolis, Minnesota, USA.
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Braman JP, Engel SC, LaPrade RF, Ludewig PM. In vivo assessment of scapulohumeral rhythm during unconstrained overhead reaching in asymptomatic subjects. J Shoulder Elbow Surg 2009; 18:960-7. [PMID: 19395283 PMCID: PMC2841046 DOI: 10.1016/j.jse.2009.02.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 01/13/2009] [Accepted: 02/04/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND The contribution of scapulothoracic and glenohumeral motion to overall shoulder motion remains difficult to determine. We sought to determine the exact ratio between these two motion components in order to better understand overall shoulder kinematics in asymptomatic individuals in unconstrained reaching. MATERIALS AND METHODS This study assessed shoulder motion using bone-fixed sensors to quantify scapulohumeral motion during unconstrained raising and lowering of the arm. Electromagnetic tracking devices rigidly fixed to bone pins recorded active scapular and humeral motion. RESULTS We found a significant difference in the ratio of glenohumeral elevation to scapular upward rotation during arm raising (2.3) and lowering (2.7). Each degree of glenohumeral elevation yielded scapular upward rotation of 0.43 degrees (raising) compared with downward rotation of 0.37 degrees (lowering), across the motion arc. Until 125 degrees of glenohumeral elevation, the scapula internally rotated and then externally rotated with further elevation. Scapular upward rotation and posterior tilting progressively increased until maximal elevation. Scapulohumeral rhythm was greatest in the first increment of raising the arm and higher overall when lowering the arm. DISCUSSION Understanding these data allows improved evaluation of potential motion abnormalities in patients with shoulder pathology and may improve treatment for restoration of normal shoulder motion.
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Affiliation(s)
- Jonathan P. Braman
- Department of Orthopaedic Surgery University of Minnesota 2450 Riverside Avenue, R200 Minneapolis, MN 55454
| | - Sean C. Engel
- Department of Orthopaedic Surgery University of Minnesota 2450 Riverside Avenue, R200 Minneapolis, MN 55454
| | - Robert F. LaPrade
- Department of Orthopaedic Surgery University of Minnesota 2450 Riverside Avenue, R200 Minneapolis, MN 55454
| | - Paula M. Ludewig
- Department of Physical Medicine and Rehabilitation University of Minnesota 420 Delaware St SE MMC 388 Minneapolis, MN 55455
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Hill AM, Bull AMJ, Wallace AL, Johnson GR. Qualitative and quantitative descriptions of glenohumeral motion. Gait Posture 2008; 27:177-88. [PMID: 17509885 DOI: 10.1016/j.gaitpost.2007.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 02/12/2007] [Accepted: 04/15/2007] [Indexed: 02/02/2023]
Abstract
Joint modelling plays an important role in qualitative and quantitative descriptions of both normal and abnormal joints, as well as predicting outcomes of alterations to joints in orthopaedic practice and research. Contemporary efforts in modelling have focussed upon the major articulations of the lower limb. Well-constrained arthrokinematics can form the basis of manageable kinetic and dynamic mathematical predictions. In order to contain computation of shoulder complex modelling, glenohumeral joint representations in both limited and complete shoulder girdle models have undergone a generic simplification. As such, glenohumeral joint models are often based upon kinematic descriptions of inadequate degrees of freedom (DOF) for clinical purposes and applications. Qualitative descriptions of glenohumeral motion range from the parody of a hinge joint to the complex realism of a spatial joint. In developing a model, a clear idea of intention is required in order to achieve a required application. Clinical applicability of a model requires both descriptive and predictive output potentials, and as such, a high level of validation is required. Without sufficient appreciation of the clinical intention of the arthrokinematic foundation to a model, error is all too easily introduced. Mathematical description of joint motion serves to quantify all relevant clinical parameters. Commonly, both the Euler angle and helical (screw) axis methods have been applied to the glenohumeral joint, although concordance between these methods and classical anatomical appreciation of joint motion is limited, resulting in miscommunication between clinician and engineer. Compounding these inconsistencies in motion quantification is gimbal lock and sequence dependency.
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Affiliation(s)
- A M Hill
- Shoulder Bioengineering Group, Department of Bioengineering, Imperial College London, Sir Leon Bagrit Centre, Mechanical Engineering Building, South Kensington Campus, London SW7 2AZ, UK
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Kedgley AE, Mackenzie GA, Ferreira LM, Drosdowech DS, King GJW, Faber KJ, Johnson JA. The effect of muscle loading on the kinematics of in vitro glenohumeral abduction. J Biomech 2007; 40:2953-60. [PMID: 17433334 DOI: 10.1016/j.jbiomech.2007.02.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
This in vitro study evaluated the effects of four different muscle-loading ratios on active glenohumeral joint abduction. Eight cadaveric shoulders were tested using a shoulder simulator designed to reproduce unconstrained abduction of the humerus via computer-controlled pneumatic actuation. Forces were applied to cables that were sutured to tendons or fixed to bone, to simulate loading of the supraspinatus, subscapularis, infraspinatus/teres minor, and anterior, middle, and posterior deltoid muscles. Four sets of muscle-loading ratios were employed, based on: (1) equal loads, (2) average physiological cross-sectional areas (pCSAs), (3) constant values of the product of electromyographic (EMG) data and pCSAs, and (4) variable ratios of the EMG and pCSA data which changed as a function of abduction angle. The investigator generated passive motions with no muscle loads simulated. Repeatability was quantified by five successive trials of the passive and simulated active motions. There was improved repeatability in the simulated active motions versus passive motions, significant for abduction angles less than 40 degrees (p=0.02). No difference was found in the repeatability of the four different muscle-loading ratios for simulated active motions (p0.067 for all angles). The improved repeatability of active over passive motion suggests simulated active motion should be employed for in vitro simulations of shoulder motion.
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Affiliation(s)
- Angela E Kedgley
- Bioengineering Research Laboratory, Hand and Upper Limb Centre, St. Joseph's Health Care London, 268 Grosvenor Street, London, Ontario, Canada
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Bourne DA, Choo AMT, Regan WD, MacIntyre DL, Oxland TR. Three-dimensional rotation of the scapula during functional movements: an in vivo study in healthy volunteers. J Shoulder Elbow Surg 2006; 16:150-62. [PMID: 17113324 DOI: 10.1016/j.jse.2006.06.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 06/05/2006] [Indexed: 02/01/2023]
Abstract
The goal of this study was to measure 3-dimensional shoulder motion by use of a direct invasive technique during 4 different arm movements in healthy volunteers. Eight subjects with healthy shoulders were recruited. Optoelectronic marker carriers (ie, infrared light-emitting diodes) were mounted on bone pins, which were inserted into the lateral scapular spine. Subjects performed 4 different arm movements while the motion was being recorded by a precision optoelectronic camera. Joint angles were calculated in 3 dimensions. Intraclass correlation coefficients and root-mean-square differences were calculated as measures of reliability. During abduction, the scapula tipped posteriorly (44 degrees +/- 11 degrees), rotated upward (49 degrees +/- 7 degrees), and rotated externally (27 degrees +/- 11 degrees). For reaching, the scapula consistently rotated upward (17 degrees +/- 3 degrees) and rotated internally (18 degrees +/- 6 degrees) whereas tipping was generally less than 10 degrees (5 degrees +/- 2 degrees). Overall, the range of scapular movement for the hand behind the back was small and variable, with most rotations not exceeding 15 degrees. For horizontal adduction, the scapula tipped anteriorly (8 degrees +/- 3 degrees), rotated upward (5 degrees +/- 2 degrees), and rotated internally (27 degrees +/- 6 degrees). These scapular rotations provide normative data that will be useful for diagnosing scapular dysfunction.
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Affiliation(s)
- Douglas A Bourne
- Division of Orthopaedic Engineering Research, The University of British Columbia, Vancouver, British Columbia, Canada.
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Thigpen CA, Padua DA, Morgan N, Kreps C, Karas SG. Scapular kinematics during supraspinatus rehabilitation exercise: a comparison of full-can versus empty-can techniques. Am J Sports Med 2006; 34:644-52. [PMID: 16282575 DOI: 10.1177/0363546505281797] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Supraspinatus strengthening is an important component of shoulder rehabilitation. Previous work has determined that the full-can and empty-can exercises elicit the greatest amount of supraspinatus activity. However, scapular kinematics has not been considered when prescribing supraspinatus exercises. HYPOTHESIS Scapular downward rotation, internal rotation, and anterior tipping during the empty-can exercise are increased when compared with the full-can exercise. STUDY DESIGN Descriptive laboratory study. METHODS Twenty participants performed full-can and empty-can exercises while an electromagnetic tracking system was used to collect three-dimensional scapular kinematic data. Scapular angles at 30 degrees, 60 degrees, and 90 degrees of the ascending and descending phases of humeral elevation were compared using 2-way repeated measures analysis of variance. RESULTS There was more scapular anterior tipping and internal rotation during the empty-can exercise at all sampled humeral elevation angles except at 30 degrees of the descending phase for anterior/posterior tipping (P < .05). CONCLUSION Scapular anterior tipping and internal rotation are increased during the empty-can exercise, whereas scapular upward rotation was not different between exercises. CLINICAL RELEVANCE Increased scapular internal rotation and anterior tipping decrease the volume of the supraspinatus outlet during the empty-can exercise. When maintenance of the subacromial space is important, use of the full-can exercise seems most appropriate for selective strengthening of the supraspinatus muscle.
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Affiliation(s)
- Charles A Thigpen
- Interdisciplinary Program in Human Movement Science, Sports Medicine Research Lab, University of North Carolina at Chapel Hill, CB# 8700, 06F Fetzer Gym, University of North Carolina, Chapel Hill, NC 27599, USA.
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García-Alsina J, García Almazan C, Moranta Mesquida J, Pleguezuelos Cobo E. Angular position, range of motion and velocity of arm elevation: a study of consistency of performance. Clin Biomech (Bristol, Avon) 2005; 20:932-8. [PMID: 16098645 DOI: 10.1016/j.clinbiomech.2005.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Revised: 05/09/2005] [Accepted: 05/11/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND To define the normal range, velocity and consistency of the movement of active arm elevation with humerus in neutral or in external rotation using a simplified kinematic model. METHODS Nine normal volunteers and the non-involved side of twenty five patients with unilateral shoulder lesion participated. A 3D optoelectronic tracking system was used to register the movement of raising the arm from the normal upright position to maximal elevation in a repetitive way. Peak humeral position, range of movement, velocity of motion and consistency of cycles were analyzed. Descriptive statistics, correlation between variables and with sex, age and side are presented, including differences between performances of movement done in neutral or external rotation. FINDINGS Data of the six variables were: maximal abduction 142 degrees [137.4-147.0], range of motion 118.1 degrees [112-124], maximal velocity 238 degrees/s [209-265]; mean velocity 113 degrees/s [96-130]; coefficient of variation of maximal angular abduction was 2.2% [1.7-2.7]; coefficient of variation of maximal velocity 8.6% [7.3-9.9]. No significant differences were observed either on side, sex or between the shoulder of normal volunteers or that of the patients with opposite shoulder lesions. Participants older than 45 years old showed only a significant slightly lower average velocity. The study confirms the weak association between dependent (biomechanical) and independent variables. INTERPRETATION As it is described here, analysis of arm elevation has not been previously studied and shows that has a good consistency in angular position, velocity and repeatability of motion in normal conditions which permits a picture of the overall performance of the shoulder.
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Affiliation(s)
- Joan García-Alsina
- Instituto de Valoración Corporal, Roger de Llùria, 33, 08009 Barcelona, Spain.
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Price CI, Rodgers H, Franklin P, Curless RH, Johnson GR. Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: a noninvasive evaluation. Arch Phys Med Rehabil 2001; 82:955-60. [PMID: 11441385 DOI: 10.1053/apmr.2001.23826] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine whether scapular downward tilt (ScDT) and dynamic scapular lateral rotation (ScLR) in subjects with and without stroke is associated with subluxation, and to prove the reliability of a Scapula Locator System in an elderly population. DESIGN Repeated measures of ScLR by 2 observers. SETTING Outpatient rehabilitation department of a district general hospital. PARTICIPANTS To test device reliability, 5 healthy men (mean age +/- standard deviation, 72 +/- 5 yr). To test scapula position, 30 stroke patients (19 men, 11 women; mean age, 73 +/- 6 yr) and 15 healthy controls (12 men, 3 women; mean age, 62 +/- 6 yr). INTERVENTIONS The control subjects' ScDT was compared with stroke subjects' ScDT after stratification according to 3 patterns of ScLR symmetry and the presence of palpable glenohumeral subluxation. MAIN OUTCOME MEASURES For device reliability, 3-way analysis of variance. For scapula position, triangulated location by Scapula Locator System of acromion, inferior angle, and root of the scapular spine; then measurement of scapula motion to determine symmetry, lag, or lead. RESULTS The inter- and intraobserver reliability of the Scapula Locator System device was high (1% of variance each). Normal ScDT was positive (left side: 10.94 degrees +/- 2.62 degrees; right side: 9.69 degrees +/- 4.36 degrees ), indicating a downward-facing glenoid fossa. This finding was unchanged by stroke (10.46 degrees +/- 2.42 degrees ). All controls and 16 stroke subjects had symmetry between shoulders for ScLR rate and ScDT. Two other patterns (p <.01) of ScLR were found after stroke: 8 subjects had a slower rate of affected arm ScLR (lag) with a correspondingly greater ScDT on the affected side (2.61 degrees +/- 6.7 degrees ); 6 subjects had a faster rate of affected arm ScLR (lead) but with an upward-facing glenoid fossa on the affected side (ScDT: -11.84 degrees +/- 8.48 degrees ). No significant inter- or intrasubject difference in ScDT existed in the 6 cases of glenohumeral subluxation. CONCLUSIONS The scapula normally tilts downward with or without stroke. The effect of stroke is similar on tonic (ScDT) and phasic (ScLR) control of scapula position. Subluxation is not linked with a particular scapular resting position after stroke.
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Affiliation(s)
- C I Price
- North Tyneside General Hospital, North Shields, UK.
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McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg 2001; 10:269-77. [PMID: 11408911 DOI: 10.1067/mse.2001.112954] [Citation(s) in RCA: 406] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to describe 3-dimensional scapular motion patterns during dynamic shoulder movements with the use of a direct technique. Direct measurement of active scapular motion was accomplished by insertion of 2 1.6-mm bone pins into the spine of the scapula in 8 healthy volunteers (5 men, 3 women). A small, 3-dimensional motion sensor was rigidly fixed to the scapular pins. Sensors were also attached to the thoracic spine (T3) with tape and to the humerus with a specially designed cuff. During active scapular plane elevation, the scapula upwardly rotated (mean [SD] = 50 degrees [4.8 degrees ]), tilted posteriorly around a medial-lateral axis (30 degrees [13.0 degrees ]), and externally rotated around a vertical axis (24 degrees [12.8 degrees ]). Lowering of the arm resulted in a reversal of these motions in a slightly different pattern. The mean ratio of glenohumeral to scapulothoracic motion was 1.7:1. Normal scapular motion consists of substantial rotations around 3 axes, not simply upward rotation. Understanding normal scapular motion may assist in the identification of abnormal motion associated with various shoulder disorders.
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Affiliation(s)
- P W McClure
- Department of Physical Therapy, Arcadia University, Glenside, Pa 19038, USA.
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Karduna AR, McClure PW, Michener LA, Sennett B. Dynamic measurements of three-dimensional scapular kinematics: a validation study. J Biomech Eng 2001; 123:184-90. [PMID: 11340880 DOI: 10.1115/1.1351892] [Citation(s) in RCA: 411] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The validation of two noninvasive methods for measuring the dynamic three-dimensional kinematics of the human scapula with a magnetic tracking device is presented. One method consists of simply fixing a sensor directly to the acromion and the other consists of mounting a sensor to an adjustable plastic jig that fits over the scapular spine and acromion. The concurrent validity of both methods was assessed separately by comparison with data collected simultaneously from an invasive approach in which pins were drilled directly into the scapula. The differences between bone and skin based measurements represents an estimation of skin motion artifact. The average motion pattern of each surface method was similar to that measured by the invasive technique, especially below 120 degrees of elevation. These results indicate that with careful consideration, both methods may offer reasonably accurate representations of scapular motion that may be used to study shoulder pathologies and help develop computational models.
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Affiliation(s)
- A R Karduna
- Department of Rehabilitation Sciences, MCP Hahnemann University, Philadelphia, PA 19102, USA.
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17
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Abstract
Interest in arm movements has increased tremendously in recent years. This interest has been motivated by different goals: the desire for a more scientific approach to replacement or support of the joints of the upper limb, the need for input to biomechanical computer models, and the clinical interest in comparing normal movements with pathological movements. The availability of commercial marker-tracking systems has facilitated achieving these goals. However, the complex nature of arm movements and the lack of standardized movements raises many challenges. In comparison with gait analysis, few arm motion analyses have been conducted. The purpose of this review is to aid researchers and clinicians interested in conducting an arm motion study in choosing the appropriate methodology. This is accomplished both by describing the methods used in past investigations and by highlighting important findings. Due to the variety of research goals, there is sometimes more than one appropriate method and the choice is left to the reader. Nevertheless, since it is extremely desirable to record and express the data in a standardized way, standardization proposals are described. This review, which focuses on methodology rather than results, addresses the following topics: motivations and tasks studied, tracking methods, the shoulder complex, joint centres and rotation axes, marker positions, coordinate system definitions, terminology and rotations, accuracy, and presentation methods.
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Affiliation(s)
- C Anglin
- Sulzer Orthopedics Limited, Winterthur, Switzerland
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18
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Van Roy P, Clarys JP. Intra-articular kinematics of the normal glenohumeral joint in the late preparatory phase of throwing: Kaltenborn's rule revisited. ERGONOMICS 2000; 43:1726-1737. [PMID: 11083151 DOI: 10.1080/001401300750004131] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A new method to quantify intra-articular relationships between articular surfaces of the glenohumeral joint during discrete poses representing the late preparatory phase of throwing is presented. This method is based on 3D bone reconstructions from medical imaging data processed into finite helical axis parameters. With the shoulder moving in the anatomical planes from 90 degrees abduction and 90 degrees external rotation into the apprehension test pose, the centre of the humeral head posteriorly translated on the glenoid and rotated about a finite helical axis, which was positioned at the joint contact. The data are contrasted with Kaltenborn's convex-concave rule explaining intra-articular kinematics of the glenohumeral joint as a ball-and-socket joint. The data show at all conditions that the glenohumeral joint does not act as a ball-and-socket joint. Consequently, the mobilization techniques used in manual therapy, which are based on this convex concave rule, should be adapted.
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Price CI, Franklin P, Rodgers H, Curless RH, Johnson GR. Active and passive scapulohumeral movement in healthy persons: a comparison. Arch Phys Med Rehabil 2000; 81:28-31. [PMID: 10638872 DOI: 10.1016/s0003-9993(00)90217-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Clinical studies investigating shoulder complaints have found that active exercises and passive manipulation are not equally effective treatments, perhaps because active and passive movements align the individual shoulder girdle components differently. This study sought to investigate whether a significant difference exists in scapulohumeral rhythm of the healthy shoulder when the humerus is elevated actively or passively. STUDY DESIGN Both shoulders of 10 healthy volunteers (9 men; mean age 50 yrs) were studied using an electromagnetic coordinate system to locate the position of the scapula relative to the humerus and trunk. Scapula position in three dimensions was recorded at 10 degrees intervals during active and passive humeral elevation in the coronal plane between 10 degrees and 50 degrees. Each shoulder was measured three times. RESULTS Analysis of variance showed that in all three planes of scapula movement (lateral rotation, backward tip, and retraction) the components of variance attributable to the differences in active and passive movement were less than 5%. CONCLUSIONS During humeral elevation between 10 degrees and 50 degrees no significant difference exists between active and passive shoulder complex motion in healthy individuals. These findings may help to explain why passive manipulation is an effective treatment for shoulder complaints.
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Affiliation(s)
- C I Price
- North Tyneside General Hospital, North Shields, UK
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